CLINICAL LECTURE OxV A CASE OF EXCISION OF 

 THE KNEE-JOINT, AND HORSEHAIR AS A 

 DRAIN FOR WOUNDS, WITH REMARKS ON 

 THE TEACHING OF CLINICAL SURGERY 



Delivered at King's College Hospital, December lo, 1877. 

 [Lancet, ICS78, vol. i, p. 5.] 



Gentlemen. — I bring this little girl before you to-day because it is important 

 that you should not only see the patients when they first come under our care 

 in the hospital, not merely have the diagnostic features of their diseases pointed 

 out to 3'ou, hear the appropriate treatment discussed, and witness any operations 

 that ma}^ be performed, but also follow the after-progress of the cases, and 

 further, because b}^ bringing her into the theatre I can show ^-ou what I wish 

 you to notice regarding her very much better than by taking you to her bed 

 in the ward. 



Let me remind 3^ou of the essential features of the case. As she was brought 

 before you ten days ago, the left knee was bent considerably be^'ond a right angle, 

 the leg being in fact at an angle of about 45° with the thigh, and we were given 

 to understand that this condition of things had existed from the age of three 

 years, when she was affected with a disease of the knee-joint up till the time 

 of her admission to the hospital at the age of ten. The scar of a sinus was 

 present at one side, but it had long since healed. The limb in that position 

 was of course worse than useless. I also pointed out that it was atrophied ; 

 or, to speak more correctly, had lagged behind the other in growth ; so that 

 the fibula was i^ inches shorter than the other, and there was a difterence of 

 eleven-sixteenths of an inch between the two feet as measured from the point 

 of the calcaneum to the end of the great toe. 



I may remark that this atrophy, or lagging behind in development, seems 

 to be interesting as explaining, in part at least, the corresponding fact after 

 excision of the knee. If that operation is performed in early childhood, it is 

 often observed that as the patient grows to adult life the affected limb is more 

 or less considerably smaller than the sound one. This has been supposed to be 

 due to taking away too much of the ends of the bones so as to tleprive them 

 of their epiph^'ses, but a case like the i^resent points to anotlier ex}'>lanation. 



I.ISTEK II G LI' 



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