34. I have already said that but little is to be apprehended on the
score of accidents subsequent to the operation (26). Out of the
numerous operations of the kind performed lately in Europe, but few
cases have proved troublesome in their consequences, and even these
were influenced by some foreign circumstances. Thus, for example, one
of the patients of Simson rode out on horseback a few hours after the
operation, on a cold and stormy day, and thus produced a troublesome
affection of the part. A similar remark may be made respecting the case
formerly mentioned (27).
35. The apparatus or dressing remains untouched for the two or three
first days, during which time it is necessary to wet it frequently
with vegeto-mineral water. It is a certain truth, that the use of this
liquid retards the suppuration of wounds, and that, when continued a
due length of time, it keeps inflammation at that degree most proper
for the process of healing.
36. On the removal of the dressing, the wound is sometimes so perfectly
healed up, as not to exhibit the least discharge. At other times a
slight suppuration takes place; but, at the end of a few days, the cure
is complete. Under the care of Desault, it was always effected in eight
or ten days.
37. Let us bring the doctrine just laid down to the test of experience.
Five cases have been published on this point. I have selected two of
them, both which occurred in the same subject, where we find the same
operation twice performed with equal success.
CASE I. M. Vielle, aged nineteen, was attacked about the beginning of
the year 1790, by a spontaneous swelling in the joint of the knee.
Inconsiderable at first, but increased afterwards by a laborious
journey, it disappeared at the end of two months, discovering to the
touch, near the internal edge of the rotula, a foreign body, which was
hard and moveable, and which somewhat impeded the motions of the joint.
About a month afterwards, the swelling returned, and, having continued
for three months, disappeared again, when the body was found at the
external side of the rotula, increased in size. Sundry external
applications were tried for six months without success.
Weary of this unavailing practice, the patient came, in March, 1791, to
consult Desault, who discovered a cartilaginous substance of a flat and
circular figure. Its usual situation was at the external side of the
joint, but it could be easily moved to the internal side, and could be
turned on its own axis within the joint, nor did it occasion any pain,
when suffered to remain at rest by the side of the rotula. But, when
it passed behind the tendon of the extensor muscles, the patient was
unable to stand, and he experienced severe pains when it made its way
under the condyls or behind the rotula.
The indication was evident. Before the operation Desault prepared the
patient by a proper regimen, and then, in the method already described
(28), extracted a foreign body, whitish, and oval, fourteen lines in
length, ten in breadth, and two and a half in thickness at its middle.
It consisted of three pieces, united by a ligamentous substance,
and was smooth on the side next the joint, but rough with irregular
tubercles on the opposite side, and on its circumference. There was no
loss of blood during the operation: the usual dressing was applied,
after the most attentive examination, as to the existence of a second
body.
Neither pain nor swelling supervened, and by the fourth day, the
reunion was complete. In a short time motion was performed with as much
ease as before the occurrence of the complaint. In the mean while, a
degree of uneasiness remained in the joint; but barely perceptible at
first, this uneasiness continued to increase; in about four months,
symptoms of the existence of another foreign body made their appearance.
M. Vielle being now a distance from Desault, put himself under the care
of his brother, who extracted a second body, in the manner already
described, except that the incision was made at two strokes.
Dressing the same as in the preceding case, with this additional
precaution, that the thigh and leg were covered by a roller, for the
purpose of moderating the action of the muscles.
No fever, no pain; the reunion completed on the eighth day, except a
small point in the centre of the wound, which suppurated slightly till
the fourteenth. There was now neither difficulty in walking, nor the
least sensation of pain. Since that time, M. Vielle has enjoyed the
entire use of his limb.