Excerpt from Medico-Chirurgical Transactions, Vol. 72

July, 1885, in which he concludes his remarks upon an interesting series of cases with the expression of his belief that in suitable cases erasion is, in disease of the knee, better surgery than excision. In this estimate I heartily concur. Indeed, so satisfactory is the operation, and so comparatively devoid of risk, that there may be a danger of its ultimately being resorted to in cases of chronic disease of the knee which should more properly have been dealt with by rest and general measures, or in which disease was so far advanced that no measure short of amputation would be likely to ensure a successful result.

Looking back to the pre-bacillary days and watching a surgeon resect a joint, one sees him perhaps cutting away masses of pulpy synovial membrane and granulation tissue after he has removed the articular surfaces of bone, but he gives little thought to the sodden fringes of the membrane which he leaves in the crevices between the bones and the articular capsule. He certainly did not consider it to be part of his business to scrape the flabby tissue from every nook and corner of the joint, nor did he pay much attention to the cloacw and sinuses which, in the case of an old joint abscess, riddled and undermined the surrounding skin. A reference to the text-books of ten or twenty years ago shows how little importance was paid to the thorough removal of all infiltrated tissues. And standing as we do on what we are almost tempted to consider as the topmost pinnacle of the temple of surgical science, we ask how any of these cases could recover? Our thoughts instinctively fly to the crowds of bacilli tuberculosis which were in all probability colonising the swollen membranes, and to the septic germs which were lurking in the open approaches to the joint. At the present day we should consider the surgeon to be courting failure who dealt with the diseased tissues in so half-hearted a manner. But although history tells us that resection cases did not prosper as a rule, still the fact remains that many of them did eventually get soundly well.

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