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BOOK XXIV.

ON DISEASES OF THE FINGERS.

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1st. On Adhesion Of The Fingers.

The congenital adhesion of one or several of the fingers or Uses is

sometimes observed in the newly-born. A serious deformity of the

hand results, which we must attempt to remedy. In the foot it is

not of so much importance, and it may be let alone.

/ r The adhesions of the fingers are either bony or fleshy. The fleshy

adhesions are the most frequent; they involve one or several fingers, a

portion or the whole of the interdigital space. The fleshy adhesions

should be divided with a bistoury or with scissor?. In the case of

* osseous adhesions, the skin is to be first divided with a bistoury, and

. i Jl i'f- , then the separation finished with a small saw.

But the most important step is the consecutive dressing. It should

be carefully attended to in order to avoid the reproduction of the

adhesion. The fingers should be isolated by means of lint spread

»T with Goulard's ointment; and then small compresses, applied at the

^. W<< angle of the separation of the fingers, extending on the back and palm

i r UU. of the hand, fixed to the wrist by a bandage, prevent cicatrization

. z' - taking place in an unfavourable manner.

2nd. On Supernumerary Fingers.

'» Incomplete, malformed fingers, often exist regularly or irregularly - . superadded to the other fingers of the hand. It is especially on the ulnar edge of the hand that this deformity is met with. It is less ;' • ■•'. frequently observed on the side of the thumb.

These fingers are sometimes placed on the same row as the others, attached to an isolated metacarpal bone; or, on the contrary, they are out of line and adhere to the phalanges or to the neighbouring metacarpal bones.

Well-formed supernumerary fingers, placed on the same line as the others, should be respected. Irregularly placed, incomplete fingers, require an immediate extirpation very soon after birth. This operation may be practised with a bistoury. »«»8 of a semicircular incision

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of the skin, at the base of the finger to be removed, the articulation -;

is opened, and after having dislocated the appendix, the operation ia'*1] *iuk

finished by forming a small flap sufficient to cover the wound. The

parts are to be brought into apposition by adhesive plaster, and the

whole covered with lint and a bandage. At the end of three days

the wound is cicatrized, and no bad symptom ever complicates this

operation.

3rd. On Digital Nodes.

I apply the term of digital nodes to chronic swellings so frequent on the fingers and toes of young children.

The nudes exist, either around the articulations or around the phalanges. The fingers are swollen, spindle-shaped; the skin is red, I * livid, and cold. The cellular tissue and the fibrous tissue are indurated.-** M\AL* An indolent grey ulceration often exists on the swelling, and continues *~ i an indefinite time without enlarging or deepening. The bones and the' ■'-*" *'''' articulations remain in a state of perfect integrity. ^ . , i'

These swellings result from chilblains, or from contusions or wounds of the fingers; but there is a general cause, the existence of which must Jm « |"i <' '«• not be overlooked, and which presides over their development. This cause is scrofula. Digital nodes are only, in my opinion, a form of (/Six. H~*-) cutaneous scrofulous affection. _ .

Digital nodes have often been mistaken for white swellings of the / /'

fingers and caries of the phalanges. This is an error. In most of the cases neither the bone nor the articulations are diseased, and the amputated fingers only present simple swelling of the periosteum and of the surrounding cellular tissue.

The nodes remain a very long time, but are easily cured if the bones or the articulations do not become inflamed.

Antiscorbutics and antiscrofulous medicines internally, iodurated ointments externally, local and general saline baths, counter-irritation with a heated button of iron, generous living, exercise, and country air, suffice to cure this disease.

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BOOK XXV.

ON GROWTH IN ITS RELATIONS WITH THE DISEASES OF CHILDREN.

The growth of man ia the result of the same impulse as that which has given him existence. It is a phenomenon which is necessarily accomplished, and which an unknown force sustains and directs towards a determinate end.

Engendered by sexual intercourse, this force suddenly takes possession of the cell which constitutes the human germ, and will only quit it on the day of its entire development in humanity. It exists before its effect like all the forces of nature, and it varies according to race, seasons, air, and locality. Matter servilely obeys it, as long as no other force happens to disturb it. Then, lessened or neutralized in its action, the development of man suffers from it, that which should be on the right side is observed on the left, white becomes changed to black, that which should be straight is transverse, separated parts coalesce, and those which should be united, on the contrary, remain separate. From the least apparent deformity, to the most complete disturbances of development and of growth, all is possible when the force which directs them happens to be obstructed in its impulse.

After nine months intra-uterine operation, this force is outwardly transmitted with the infant; it continues its work, in tho air and light, in the midst of new and varied agents, having from this time forward for an auxiliary, the power of a new .alimentation, until then unknown.

At this period, tho body is finished as regards its outline and its totality, vices of conformation are no longer to be dreaded, growth should henceforth be effected in length and in breadth, and that according to laws as yet little known, but which it would be an important matter to discover.

M. de Buffon is the first who has prepared the way, and he has left a magnificent testimony of it in his account of the growth of a well proportioned young man. Quetelet has followed the example of

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our great naturalist, and by numerous calculations, judiciously made, in his work of pure statistic, has nearly elucidated the law of physiologic growth from birth to puberty. Physicians might have seized upon these facts in order to investigate them, or to elucidate pathology, but with the exception of some rare works, amongst which I may cite those of Duchamp and Richard (of Nancy), science has remained silent on this point.

The growth of man, although very variable and impeded by numerous influences, such as temperature, locality, regimen, mode of life, disease, fever, <fec, is, notwithstanding, accomplished in a tolerably regular manner, as I am about to demonstrate from tables borrowed from Quetelet.* I shall afterwards investigate the influence of diseases on the growth, and, vice vend, the influence of growth on the development of diseases.

Thus—1st. On growth in the physiological state.

2nd. On the influence of diseases on growth.

3rd. On the influence of growth on the development of diseases.

1st. On Growth In The Physiological State.

Quetelet made his observations and published his statistical tables in Belgium. It is useless to say, however, that we should not rigorously conclude from the results at Brussels, the existence of similar results at Paris, or in every other place. Haec icripri tub tole romano, exclaimed Baglivi, in addressing his readers; he was right, and here, in less decided terms, we say the same thing, in order that we should not draw too absolute conclusions from researches which may only be approximative, if they are verified amongst us.

Fifty male children were measured at the time of birth; they may be arranged in the following manner:+

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* Annala d' hygient pubtupte; Paris, 1831; t. vi, p. 89. | Tlif French pouce or inch equals H incli Knglish.

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The same difference exists in the in the following table, made by and Van Essch : *

1 day

1 year

2 years

3 „

* ,.

5 „

6 »

7 „
S
9

lit
11
12
13
11
15
16
17
18
1!)
20
Growth finished

At the sixteenth or seventeenth year, the growth of the girls is then relatively nearly as much advanced as that of young men at eighteen or nineteen years; and it is also observed that from five to fifteen years the growth is fifty-two millimeters for them, whilst it is fifty-six millimeters for the boys.

M. Quetelet has founded the law of growth of the inhabitants of Brussels from his calculations.

1st. The most rapid growth takes place immediately after birth; the child in the space of a year increases about 7-8 inches.

2nd. The growth of the child diminishes in proportion as his age increases nearly towards the age of four or five years, a period at which he attains the maximum of probable existence; thus, during the second year following birth, the growth is only half what it was the first, and during the third year, about one third only.

3rd. After the fourth or fifth year, the growth in height becomes nearly regular until towards the sixteenth year, that is to say, towards the age of puberty, and the annual growth is about 2.18 inches.

4th. After the age of puberty, the height still continues to increase, but very slightly; thus, from the sixteenth to the seventeenth year it

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* I have abstained from reducing those fractional parts of the French meter into English measures: the French meter is equal to 3.28 feet English.

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