The diseases of infants and children / by Edmund Cautley.

  • Cautley, Edmund, 1864-1944.
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of infants and children / by Edmund Cautley. Source: Wellcome Collection.

    128/1070 (page 108)
    degrees of webbing of the toes were present, and three children had extra toes. Webbing of the fingers, generally between the third and fourth, is the most common malformation of the hand, and is due to an arrest of development. In early foetal life the fingers are bound together by webs of varying extent. The thumb becomes detached in the eleventh week, and the fingers separate later. Hence it is common for the thumbs to remain free, though all the fingers are united. In three recorded instances the thumbs were affected. Syndactylism of the toes is similar in character. The treatment is purely surgical. The Thumb and First Metacarpal may be absent. This rare deformity is usually associated with defect or absence of the radius. Occasionally the radius is normal. The trapezium and scaphoid may be absent. An absent radius may be associated with club-hand. Bifurcation of the terminal phalanx of the thumb assumes two varieties. The bone may be bifid, and the nail single, though grooved. Or both may be bifid and united by a web. It may affect one or both thumbs, and both big toes. Other ungual phalanges may show similar conditions. Malcolm (1908) records a curious case in which the nails were absent on the thumb, first and second fingers, and radial half of the third. The feet were affected in the same way. It had occurred in four generations. Absence of the proximal phalanges, the fingers ending in rounded stumps, has been transmitted through five generations (Lewis Marshall, 1903). Of the various deformities of the leg we find absence of the tibia, alone or associated with other defects, such as supernumerary digits and absent radii. In a case of Openshaw’s the upper fifth of the tibia in the left leg was alone present, and the right external malleolus was absent. Both the fibulae and certain toes may be absent; or one alone, in conjunction with the outer half of the foot and two outer toes. The patellae may be absent causing genu recurvatum, or congenitally dislocated, producing genu valgum. Possibly this is due to weakness of the vastus internus muscle. Ante-partum Injuries are comparatively infrequent for the foetus is well protected. Nevertheless both slight and serious damage may occur, even though there is no external evidence of violence. In rare cases the child is born with a wound in process of healing, due to an accidental or intentional blow on the pregnant womb. Sometimes multiple fractures are found, but these are more likely to be the result of osteogenesis imperfecta. Injuries at Birth are much more frequent, and due to the relative size of the head of the child, and the bony outlet of the pelvis; deformity of the pelvis ; tumours ; injury by the examining finger ; and to the amount of violence, necessary or unnecessary, used in delivering the child, or to the local pressure of the forceps. The cranial bones may be fractured ; the parietal being the most liable in unassisted labour, and the frontal if forceps are used. Fracture of the vertebral column ; of one or more bones of the