Osteomyelitis Part 1 – A Case Study of Patient 90/1951.

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Patient 90/1951 was initially transferred from the Newcastle Royal Victoria Infirmary (RVI), having been treated for a lesion on the left os-calcis (heel bone). The pus taken from the lesion was tested and returned positive for tubercle bacilli, tuberculosis infection. The patient was admitted to Stannington in June 1951. Later, in July 1951, a cold abscess formed in the right cuboid. According to the patient’s medical notes both sinus lesions were healed by January 1952, following a course of dihydrostreptomycin which, as a result of the healing, was discontinued.

In March 1952, radiographic imaging revealed the patient had developed tuberculosis osteomyelitis.

Osteomyelitis is an infection of the bone marrow, whereby the bone undergoes inflammatory destruction to create lesions. These lesions, or sinuses, can allow pus formation and ultimately new bone begins to form in repair. Osteomyelitis is caused by non-specific bacterial infection and as such is not a specific indicator of tuberculosis. In cases of tuberculosis, osteomyelitis is likely to be caused by haematogenous spread, also known as miliary tuberculosis.

Patient 90/1951, shown below, developed tuberculosis osteomyelitis affecting the tibiae. The radiograph shows the left leg, both laterally (left) and anteroposteriorly (right). Extensive bone destruction can be seen, as well as swelling with some new bone growth to the proximal tibia. The patient notes indicate that the patient was admitted to the RVI for an operation to incise the abscesses on their left leg in August 1952.

HOSP-STAN-07-01-02-2011-33
HOSP-STAN-07-01-02-2011-33

 

This is but one example of osteomyelitis in connection with tuberculosis. Further examples are evident within the patient files and will be discussed as the project continues.

For those of you who find the radiographic images of interest, more can be seen on our Flickr stream at https://www.flickr.com/photos/99322319@N07/sets/72157648833066476/

Sources:

C. Roberts & K. Manchester, The Archaeology of Disease Third Edition (New York: Cornell University Press, 2005)

This Week in World War One, 5th February 1915

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Berwick Advertiser title 1915

5th FEBRUARY 1915

MINDRUM

Louvain town hall in ruins
Rubble in front of the ruined town hall in Louvain after its sacking by the German army in 1914.
© IWM (Q 53271)

On Thursday, January 28th, a lecture was given in the school in aid of the Belgian Relief Fund.  The lecturer was M. Wouters of Antwerp, whose account of his personal experiences of the war was listened to by a deeply interested audience.  M. Wouters went through the whole of the earlier part of the war, including the sieges of Liege and Antwerp, and the sacking of Louvain and Namur.  Thereafter he was invalided to England.

His account of these terrible times was thrilling and showed what a heroic part gallant little Belgium had played for the saving of Liberty and Civilization. The lecture was illustrated by lantern views of some of the horrors wrought by the ruthless Germans, and concluded with a passionate appeal to Englishmen for more help in men and money.  The proceeds amounted to £5, and this will be sent to assist in a small way in relieving the distress prevailing among the unfortunate people the story of whose self-sacrificing bravery will forever “re-echo down the long corridors of Time.”

Belgain refugees
Belgian refugees in 1914. Image from Wikimedia Commons.

 GIFTS FOR SICK SOLDIERS AT BELL TOWER HOSPITAL

Mr Robertson, books; Miss Pearson, eggs; Mrs Young, St Leonard’s Cakes;Miss Weatherhead, 31 Castlegate, eggs; Miss Herriot, scones; Miss Tait, Bridge Street, currant loaf; Miss B Fair, illustrated papers; Mrs Wilsden, The Elms, apples and oranges; Miss Alder, Halidon, soup; Miss Wood, Horncliffe, beef jelly; “A Friend”, morning papers; “A Friend”, bananas; Mrs A. Darling, Bondington, scones; Mrs Herriot, Sanson Seal, cakes; Miss Herriot, do, loan of gramophone and records; Mrs Gemmel, 25 Low Greens, daily papers and vegetables; “A Friend”, Two puddings.

 

Advert for Fairnington & Sons drapers
Advert from the Berwick Advertiser 5th February 1915

 

Mr Henry Mulrea Johnston

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Henry Mulrea Johnston was born in County Down, Ireland in 1877 and studied medicine at Queen’s College, Belfast graduating in 1903.  He went on to study and work at Trinity College, Dublin before moving to London in 1910 where he worked at St Bartholomew’s and Great Ormond Street Hospitals and became a fellow of The Royal College of Surgeons in 1911.  In 1912 he was appointed Resident Medical Officer at The Royal Victoria Infirmary in Newcastle.

 

During WWI he joined the RAMC and was posted to a hospital in Sidcup where he concentrated his efforts on deformities of the face.  Prior to joining the army he had been committed to research using the latest radiological techniques for diagnostic purposes, something that was evident in his research for many years.  An image in an article from the British Dental Journal demonstrates some of the pioneering work that Johnston was involved in whilst at Sidcup and it is also possible that it is Johnston who is pictured on the right of the picture. http://www.nature.com/bdj/journal/v217/n6/full/sj.bdj.2014.820.html

14 year old male with cyst of the humerus treated with with intra-medullary and osteo-periosteal grafts. 6 weeks after operations HOSP/STAN/10/1/30/3
14 year old male with cyst of the humerus treated with with intra-medullary and osteo-periosteal grafts. 6 weeks after operation
HOSP/STAN/10/1/30/3

 

Following the war he was also appointed Visiting Surgeon to Stannington Children’s Sanatorium, a role which he carried on until 1945.  In his obituary from the British Medical Journal it is remarked that “In general surgery he loved to demonstrate bone tumours and cysts and to illustrate his cases with beautiful radiographs of his own taking.”  Amongst the records of Stannington Sanatorium we have a selection of photographic copes of some of Mr Johnston’s x-rays reflecting some of his interests outside of the Sanatorium.  The collection of images shows patients of varying ages with different skeletal deformities, most of which appear to be unrelated to tuberculosis.

Male, age 8. Perthe's disease affecting femoral head. HOSP/STAN/10/1/24/1
Male, age 8. Perthes’ disease affecting femoral head.
HOSP/STAN/10/1/24/1
Female, age 22. Right hand. HOSP/STAN/10/1/21/1
Female, age 22. Right hand.
HOSP/STAN/10/1/21/1

Click on images to enlarge

 

Sources:                                                                                                                                                                           ‘Henry M. Johnston, F.R.C.S’, British Medical Journal, Vol. 2, No. 4724, 21 Jul 1951, pp. 181-182

British Dental Journal http://www.nature.com/bdj/journal/v217/n6/full/sj.bdj.2014.820.html  [24 Nov 2014]

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