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JCR: Journal of Clinical Rheumatology:
Rheumatology Retrospective

Septic Joint Successfully Treated With Arthrotomy: 1861

Dorwart, Bonnie Brice MD, FACP

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From Lankenau Hospital, Wynnewood, Pennsylvania.

Reprints: Bonnie Brice Dorwart, MD, FACP, 124 Maple Avenue, Bala Cynwyd, PA 19004-3031. E-mail: dorwart@verizon.net.

Mr. A.J., …[age] 29, received a penknife wound in the knee joint, immediately on the outer edge of the patella, which being small and causing little inconvenience, gave him no concern whatever.

“The wound healed by first intention on the surface, and he continued his work as drayman as usual for 2 weeks, having not the least suspicion that mischief was brewing.

“At the end of that time, however, the joint began to inflame, and shortly after attended with the most excruciating pain. The inflammatory action rapidly extending, the tissues of the whole joint were soon involved, and in a week more, when I was called, extensive fluctuation could be distinctly felt not only about the articulation, but in the lower part of the thigh. Chloroform and morphine had been used extensively, affording only temporary relief from the intense pain.

“The case being a common one, I at once opened the joint freely by 2 incisions, 8 inches long each, just back of the patella, on the internal and external side of the leg, which gave exit to nearly a quart of purulent matter, which was burrowing in the joint and lower part of the thigh. The smarting of the incisions had hardly subsided before the patient pronounced himself relieved, and the following night slept as well as if nothing had been the matter. The incisions were filled with lint, wet in an evaporating lotion composed of one part of alcohol and 10 of water; a roller [bandage] wet in the same was applied all over the leg as tightly as the patient could conveniently bear, commencing at the foot. About twenty-five ounces of spr. mindereri [spirit of Mindererus, ammonium acetate solution] were given every twenty-four hours for the first 3 days, and an opiate administered occasionally.

“On the fifth day, the wound being in a state of suppuration, the cold lotion was discontinued and poultices applied instead.

“The roller was still continued upon the limb from the foot to the upper third of the thigh, a small opening simply being left at the most dependent portion of each incision. The poultices were applied outside of the roller.

“The lint was permitted to remain in the wound for about 2 weeks, when it was removed. Tincture of iodine was applied every day all over the joint after suspending use of the evaporating lotion.

“A gentle motion was instituted about the tenth day, and kept up through the major part of convalescence, which lasted about 9 weeks, when the patient was ale to walk comparatively well. He improved rapidly after that until recovery was complete, though the wound was not entirely cicatrized for over 5months. Not the least immobility followed in this case, and the patient recovered completely in every respect.

Remarks—In this case a single incision would doubtless have answered the purpose, though not so well as two. The true plan of operation in these cases is not only to discharge every drop of purulent matter that may be collected, but likewise prevent any more collecting; and free incisions kept well open until the parts inside become healthy, together with a roller tightly applied to the limb, are the means of securing this object. The operation is not a severe one when well performed, as it may be done safely with great rapidity.”

Cooper ES. On opening the joints. Cincinnati Medical and Surgical News. February 1861:44–46.

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E.S. Cooper, AM, MD, was Professor of Anatomy and Surgery in the Medical Department of the University of the Pacific, San Francisco, when he wrote this article. Such a report gives us renewed appreciation of the healing abilities of a joint, of the ancient dictum, “Where there is pus I must drain,” of the aggressive removal of every drop of pus, and of the early institution of physical therapy.

From the Historical Medical Library, College of Physicians of Philadelphia, Philadelphia, PA.

Web site: www.collphyphil.org. Click on Library & Wood Institute, and then on Historical Library.

Keywords:

septic arthritis; arthrotomy

© 2005 Lippincott Williams & Wilkins, Inc.

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