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to give firmness to the joint. The reduction of the congenital dislocation of the fill thigh has been effected by Pravaz (Annales d'Hygiène Publique) in a girl and in a boy, both eight years of age. Guérin effected a cure in six cases. To effect this, gradual extension was made use of, followed by violent abduction, assisted by methodical pressure on the great trochanter; Guérin cuts through the muscles which do not lengthen, and even through the ligaments.-P.H.B.]

CHAPTER II.

ON ARTHRITIS AND RHEUMATISM.

Articular inflammations, of whatever nature they may be, are rare in infants and children at the breast. I do not pretend to trace the history of these diseases, in consequence of the insufficiency of cases up to the present time recorded in science. I shall confine myself to the relation of two recent cases which may be added to those which have been published in the Thesis of M. Treilhard de la Terrisse.

Case 1. Acute poly-articular rheumatism; recovery. A child, five months old, labouring under otorrhoea without febrile symptoms, became suddenly ill and was successively attacked with acute pains accompanied with swelling, at first in the feet, then in the knees. This pain was increased by pressure and the movements of the limb, as far as could be proved by the cries of the patient; there was no redness of the skin, and the heart remained free and did not present any functional disturbance.

There was no gastric or pulmonary symptom. The fever continued very moderate, the pulse did not rise higher than 130 pulsations.

At the end of eight days the swelling of the feet vanished, and the pain appeared to lessen; but these symptoms continued in the knees for a month. They finally disappeared under the influence of local narcotic and sedative applications, datura stramonium in poultices.

Case 2. Mono-articular rheumatism; death. A young child, fifteen days old, was attacked with mono-articular rheumatism of the shoulder.

This disease proved rapidly fatal; it became developed in the midst of very extraordinary circumstances. The mother, recently delivered, fell under the influence of a very serious puerperal epidemic raging at the time; she had puerperal fever with suppurative arthritis of the knee. The child suckled by her fell ill, refused the breast, had diarrhoea with jaundice and fever, its right shoulder appeared to be painful, but without appreciable swelling; movements were impossible, and even pressure with the fingers caused the most acute pain; death resulted at the end of some days. The scapulo-humeral articulation was observed filled with reddish serous pus, the synovial membrane much injected and the bones perfectly intact. With the exception of slight redness in the large intestine, the mucous membrane of which was slightly inflamed, the other organs did not present any change.

Case 3. Poly-articular rheumatism; suppuration; death. Child of the male sex, four days old; induration of the cellular tissue of the limbs and of the dorsal region. Diarrhoea soon came on, with alteration in the features of the face. The

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child admitted 28th of April, died early in May. The right coxo-femoral articulations, the two femoro-tibial, the left tibio-tarsal and the radio-carpal of the same side, are filled with pus. The cartilages are of a dull yellow without any appreciable alteration of their tissue. The skin of the dorsal surface of the

radio-carpal articulation presents a red patch.

No abscess in the muscles nor in the lungs, which were simply the seat of a little infiltration (congestion) at their posterior surface and at their base; all the other organs healthy.

Case 4. Metastatic arthritis. J. B. Fleury, three days old, was brought to the infirmary, August 20, 1832, having the tongue red at the edges and a diarrhoea of green matters. On the 27th, patches of thrush in the mouth, ulceration of the frænum of the tongue; died on the 29th. Miliary, subpleural, purulent collections, surrounded by a bluish areola, scattered here and there on the surface of the lungs; the right coxo-femoral, and femoro-tibial articulations contain a reddish purulent synovia; the synovial membrane is red, the cartilages of a dull yellow colour. The right scapulo-humeral articulation contains a sero-purulent liquid, and the left true pus. Purulent collection between the biceps, coracobrachialis, and deltoid muscles; the cephalic vein which traverses this collection is red and thickened. Encysted abscess near the left wrist; nothing remarkable in the brain and its appendages; bladder excessively distended by urine.

Case 5. Metastatic arthritis. A twin child, of the male sex, six days old, was brought, September 16th, 1832, to the infirmary, and presented the following symptoms: tongue red at the edges with projection of the papillæ, greenish diarrhoea, induration of the cellular tissue of the back. The improvement in the state of this child is such that on the 18th he is given to the charge of the sedentary nurses. On the 27th of the same month he was readmitted into the infirmary, with intense redness of the buccal mucous membrane, which was sprinkled with patches of thrush; the greenish diarrhoea had reappeared, and the marasmus had become decided. These symptoms became worse, and the child died October 17th. Extreme emaciation, eschar on the sacrum with denudation of the bones. Circular ulceration at the extreme part of the left elbow, the base of which communicates with the articulation; cartilages of a yellowish tint. The inferior epiphysis of the humerus is detached from the bone. Collection of pus under the scapular and the great dorsal muscle; the serratus magnus and the subscapular muscles are destroyed. The veins present no traces of inflammation; left femora-tibial articulation contains pus; the cartilages are healthy. The right coxo-femoral articulation communicates by means of a fistulous canal with a purulent collection, which existed in the iliac fossa of the same side; the psoas and iliac muscles are destroyed; the brain and its appendages healthy; lungs congested at their posterior part; thymus transformed into a pouch filled with pus. Thrush of the mouth and of the oesophagus, partial softening of the stomach; friability of the mucous membrane in the upper part of the small intestine; swelling of Peyer's glands; bladder distended by a large quantity of urine.

The above are cases which cannot be yet grouped together in a precise manner; and if it is necessary for me to state my opinion, I should refer the first three to acute articular rheumatism, and the others to metastatic arthritis which is so frequently observed in cases of purulent absorption. It is better to wait for fresh observations in order to clear up this point.

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BOOK XXIV.

ON DISEASES OF THE FINGERS.

1ST. ON ADHESION OF THE FINGERS.

The congenital adhesion of one or several of the fingers or toes 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.

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 scissors. In the case of osseous adhesions, the skin is to be first divided with a bistoury, and 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 with Goulard's ointment; and then small compresses, applied at the angle of the separation of the fingers, extending on the back and palm of the hand, fixed to the wrist by a bandage, prevent cicatrization 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

s of a semicircular incision

Bihus

Book XXIV.]

ON DISEASES OF THE FINGERS.

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

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is opened, and after having dislocated the appendix, the operation is tur 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 nodes exist, either around the articulations or around the phalanges. The fingers are swollen, spindle-shaped; the skin is red, livid, and cold. The cellular tissue and the fibrous tissue are indurated this An indolent grey ulceration often exists on the swelling, and continues an indefinite time without enlarging or deepening. The bones and the articulations remain in a state of perfect integrity. These swellings result from chilblains, or from contusions or wounds all

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of the fingers; but there is a general cause, the existence of which musta
not be overlooked, and which presides over their development. This
cause is scrofula. Digital nodes are only, in my opinion, a form of
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 ampu

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tated fingers only present simple swelling of the periosteum and of the the dise

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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fem de es erma kimay, u de ma empire étaien of some pment and of growth it be prettie via the fire with free them iscene as be thecrusted in is anke

Afer une made t-terme penatin, tis fere is outwarly tumed a me mim; i otias e wek i te i od 5 a the mist f new and varied gente, inring fra this time foward ir a atrary, the power of a new menude stil then unknown.

At this period, the body is fristed as regards its outline and its velty, vice of oniration are no kager to be dreaded, growth enon.1 betoxforth be effected in kngth and in breadth, and that wording 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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