Surgical Procedures – Tenotomy

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This week we’re going to take a look at one of the surgical procedures that was used to treat TB and to counter some of it’s side-effects.   A register of operations held within the collection lists a number of different procedures that were carried out on the patients, the majority having been performed by the visiting surgeon Mr Johnston.  These procedures were employed predominantly before the advent of effective antibiotics but many of them still continued to be used effectively after the introduction of drug therapies.  Over the coming months we will explore a range of different treatments that were employed at Stannington, beginning this week with tenotomy.

 

The records of Stannington Sanatorium show tenotomy to have been performed on several patients suffering from tuberculosis of the bones and joints.  The procedure involved the division of the tendon to lengthen it and would be performed in order to counter deformity caused by the tuberculous disease and increase flexion in a particular joint.  The tendon would be divided, with the two sections allowed to pull apart and then allowed to re-heal at the overlap of the two parts thus resulting in a lengthening of the tendon.  This is not a procedure exclusive to the treatment of tuberculosis but rather in tackling any disease or deformity that has adversely affected the joint.  Patients could find themselves unable to fully flex a particular joint and may be left holding it at an unusual angle owing to muscle contracture and possible subluxation, whereby one muscle pulls more strongly than its counterpart causing partial or complete dislocation of the joint.  Following the procedure the affected joint may be put in plaster or splinted to ensure that the tendon heals at the new length and the joint is in the correct position.

 

Patient 83/39 was one patient that underwent the procedure, in this particular case division of the hamstrings to tackle poor flexion in the right knee.  Female and aged 3, patient 83/39 was admitted to the sanatorium on 22 October 1937 with a positive mantoux test and the affected knee described as hot, swollen and having limited flexion.  Her pre-admission report reads:

“Fell and after 14 days R knee began to swell and began to limp.  Went to Durham County Hosp. & leg was immobilised in plaster 4 times.  Typical tub. R knee joint probably synovial type.”

 

Figure 1 - HOSP/STAN/7/1/2/206_01
Figure 1 – HOSP/STAN/7/1/2/206_01

 

The above radiograph was taken in November 1937, two weeks after admission, with the x-ray report as follows ‘Thickening of capsule.  Eburnation and erosion of femoral condyles, especially outer.’

 

Her progress is noted in her file throughout her stay and in May 1938 it is reported that the flexion in her knee is at 45 degrees and in August 1938 it is decided that she should have her hamstrings divided with the procedure carried out by Mr Johnston on 17 August 1938.  There appears to be some initial progress as in September 1938 flexion in the right knee is now reported to be 50 degrees and by October she was wearing a Thomas splint (a traction splint commonly used to immobilise the leg).

 

During 1939 progress appeared to be limited with flexion remaining at around 45 degrees throughout, but by January 1940 we see reports that the knee has improved and is almost straight.  In April 1940 she was walking well and she was eventually discharged on 9th August 1940 able to walk in a splint.  It is debateable as to how much impact the division of the hamstrings had on the eventual straightening of the knee and how much was down to the long term splinting and immobilisation of the joint but she was nonetheless eventually discharged as quiescent.  The two radiographs below were taken later on in her stay and date from c.1939/40,

 

HOSP-STAN-07-01-02-206_04
Figure 2 – HOSP/STAN/7/1/2/206_04
HOSP-STAN-07-01-02-206_02
Figure 3 – HOSP/STAN/7/1/2/206_02

 

 

 

 

 

 

 

 

 

 

 

Sources:

J. Krol, Surgery for Deformities Due to Poliomyelitis, (Geneva: World Health Organisation, 1993)

This Week in World War One, 26th February 1915

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Berwick Advertiser title 1915

26th FEBRUARY 1915

BOY SCOUT NOTES BY “REVEILLE”

 

The new headquarters of the Boy Scouts in Palace Green have proved to be just what were required to ensure the successful working of the movement during the winter months.

Palace Green Pavilion
The Palace Green Pavilion is still the home of Berwick Scouts.
© Copyright Barbara Carr and licensed for reuse under this Creative Commons Licence

The building has been well used, a different troop having met each evening in the week, and the attendances have been exceptionally good. There is a pleasing keenness displayed by the boys which goes far to lighten the task of those who have their training in hand, and the number of badges that have been earned, proves that they are entering into the work in the proper spirit.

Large numbers of recruits have signed on during the past six months. Owing to the dearth of scoutmasters-a difficulty by the way, which has always had to be faced-those who were already in charge of troops have had an extremely busy time of it lately. The load has been lightened in no small way by the active assistance of Lieut. Graham, of Mossknow, Ecclefechan, who is at present attached to the K.O.S.B. depot. He is Scout Commissioner for Mid-Dumfries District, and also manages a troop. Lieut. Graham takes a very keen interest in boys and their work, and is much respected by the Scouts who readily take advantage of the instruction he so capably gives. The Scout Association is much indebted to Commissioner Graham for his kindly help.

Scout leaders at Wooler
R. Clements (front row, 2nd from right) and other scout group leaders on a summer camp at Wooler in 1910. REF: BRO/1828/4

There is still room for further assistance, however, and any interested friends of the movement will be welcomed at Headquarters any evening excepting Saturdays, to see for themselves the nature of the instruction.

The weather has been propitious enough on one or two occasions of late to permit of outdoor work being undertaken. Many of the tests for badges were done indoors, but those that necessitated an outside area were gone through when the patrols had their outings. Since Mr Thompson Seton’s lecture at Berwick, patrol calls have been sounded with greater courage and efficiency, especially when the bricks and mortar have been left behind and the fields and sea banks gained.

The north-country temperament prevents the boy from doing what he thinks may cause people to laugh at him; he certainly laughed at Mr Seton’s admirable imitation of the cries of the wolf and the elk. However, when this natural shyness is overcome and animals have been studied the scout may be pleased to display his abilities, and not, let us hope, to the regret of his older neighbours.

Jimmy Strength
Statue of Jimmy Strength in the garden of the Scout Headquarters in 1908. REF: BRO/1636/6/9

The various troops have been equipped with neckerchiefs and shoulder knots, so that, in future, there will be greater uniformity among the members of the various units.

In order to raise funds for the local association, a whist drive is to be held in the Good Templar Hall next Tuesday.

The outside of the Headquarters has been painted and the place has quite a fresh appearance. “Jimmie Strength” has also received a new “coat”.

Horncliffe Troop is going on well under Mr Robson, the Council Schoolmaster.

The latest local scout to receive his King’s Scout badge is Patrol leader J. M. Dodds of the Grammar School troop, who has something like eighteen proficiency badges.

A number of excellent models of bridges and several useful stools and other household furniture have been made by

the scouts. If sufficient are produced before the winter season finishes it may be possible to have an exhibition of these things.

Advert for Browns Opticians
Advert from the Berwick Advertiser 26th February 1915

 

The Stannington Radiographs

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The radiographs make up a significant part of the Stannington collection with a total of 14,674 separate images relating to 2220 different patients covering roughly a 20 year period from 1936 to c.1955. When the records were recovered in the 1980s the vast majority of the radiographs were copied on to microfiche and the originals destroyed as they were unstable. However, we still have 326 original radiographs within the collection. Over the course of the project all the microfiche images and the originals will be digitised and made publicly accessible. We also hope to preserve the remaining original radiographs as examples of how x-ray images at the time were produced. The problem here lies with the unstable nature of the film and its natural degradation.

 

All the radiographs were produced on cellulose acetate film, known as safety film as it replaced the earlier nitrate film that was highly flammable and potentially self-combustible, a problem for many film archives today. Over time the cellulose acetate film naturally breaks down, the early stages of this are recognisable by the strong smell of vinegar coming off the film as the process gives off acetic acid and because of this is known as vinegar syndrome. Eventually as the base of the film and the top layer pull away from one another the film will begin to buckle and crack and bubbles can form under the surface.

IMG_0904
Figure 1
IMG_0905
Figure 2

This process is already evident in several of the radiographs we hold (figures 1 & 2) and unfortunately there isn’t anything that can be done to reverse or halt the process. By storing the films in a closely monitored temperature and humidity controlled environment we hope to delay the process in most of the radiographs for as long as possible.

 

IMG_0903
Figure 4
IMG_0902
Figure 3

 

 

 

 

 

 

 

 

The x-rays were originally stored in ordinary brown envelopes and there could be as many as 15 in each envelope. (Figure 3)  To help preserve them we have instead transferred each x-ray into an individual acid free sleeve. (Figure 4)  By storing them individually we are able to minimise any accumulation of acetic acid that is produced in the degradation process.  Thanks to advice from conservators at Durham County Record Office and their assistance in sourcing the new x-ray envelopes, all the original films are now safely stored in their own envelopes in our photogrpahic strong room.

 

This degradation is evident in some of the microfiche as well as the original films had obviously started to buckle already at the time they were transferred to microfiche in the 1980s. Consequently some of the images are obscured by a crackling effect. Nevertheless the vast majority of the 14,674 images remain easily readable and the digitisation process will mean that they remain clearly accessible for future use.

 

[See our Flickr stream for examples of some of the radiographs https://www.flickr.com/photos/99322319@N07/sets/72157648833066476/]

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