Patient 262/1946 was transferred to Stannington from the RVI with extensive bone lesions in the left tibia, first metatarsal and subastragaloid joint. The tibial lesion had multiple soft tissue sinuses with continuous discharge, for which she was prescribed penicillin.

Medical notes for this patient note that improvement was seen relatively quickly, despite the formation of new abscesses. Her x-ray report from April 1947 reads: "Sinus persists along mid 1/3 tibia and inner border foot - appearance better. There has been lesion in subastragaloid joint - healed. Tibia shows fusiform thickening mid 1/3 to lowest 1/3 with some cavitation but no sequestrum. Requires complete plaster with windows for dressing (every 5 days)"

The first 18 months of this patient's stay in Stannington involved much time spent bedridden in plaster cast. A stern comment made in her notes in October 1947 stated:

"Must stay in bed and not get dressed. Reason for this is that she has worn the plaster by walking on it when allowed to get dressed."

Despite further improvements throughout 1947 and into 1948, sinuses in the tibia and first metatarsus persisted, and when the plaster casts were renewed they were described as being "very smelly and discoloured " from the soft tissue abscesses overlying the bone lesions. As a result this patient was put forward for curettage. She was transferred to the RVI in April 1948, returning to Stannington in May, however, on her return it was noted that the process had not had any noticeable benefit to the patient, in fact she had developed three new soft tissue sinuses. Patient 262/1946 was again immobilised in plaster with her ankle at a right angle and told to "dress as infrequently as possible."

Notes from an examination of the affected area in August 1948 revealed:

"The cavity in the tibia appears reduced in size. There is better calcification of the shaft. Periosteal reaction appears to be greater...Appearances are on the whole improved."

This patient was put forward for Streptomycin treatment in September 1948. She was still immobilised in plaster which was periodically refreshed due to the continuation of discharging sinuses, although some signs of healing of the skin was evident. X-Ray reports in December 1948 comment on the lack of alteration in appearance of x-rays.

Continued...

SEX: FEMALE

ADMISSION : 7th June 1946

DISCHARGE : 22nd Sep 1949

DIAGNOSIS: TB Osteitis L. Tibia and 1st Metatarsal L. Old lesion in the subastragaloid joint

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