Common disorders and diseases of childhood / by George Frederic Still.

  • Still, George Frederic, 1868-1941.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Common disorders and diseases of childhood / by George Frederic Still. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    after this treatment was begun, there was already shght movement of fingers and wrists, and a week later there was good movement of the upper limbs. This syphilitic epiphysitis might be mistaken for infantile scurvy, but the latter disease rarely occurs under the age of six months and practically never under four months. Infantile paralysis also hardly occurs under the age of six months, and rheumatism can be excluded for it is almost unknown in infancy. The tenderness and pain on movement will usually suffice to eliminate a paralysis of cerebral origin which, moreover, is seldom hmited to one hmb as tliis syphihtic pseudo-paralysis usually is. The history of onset some weeks after birth serves to distinguish it from the palsy which results from damage to the brachial plexus during birth. The diagnosis is important, for ■with mercurial treatment the pseudo-paralysis disappears com- pletely in a week or two; local treatment is seldom necessary, beyond protection of the flaccid limb from mechanical injury. But if the syphihtic origin of the condition is overlooked, apart from the suffering entailed to the infant, there is a risk of separa- tion of the epiphysis and also of suppuration, wliich I have seen occur about the affected epiphysis with undoubted syphihs, per- haps from superadded pyogenic infection of the damaged tissue. Dactylitis is less frequent than epiphysitis, if indeed it is to be distinguished therefrom ; some observers have thought it was an epiphysitis, others have rather described it as a periostitis or an osteomyehtis. It was present only in 2 per cent, of my cases. Out of nine which I collected seven were under one year, including five which occurred at four weeks ; none were over two years of age. The fingers are more often affected than the toes and usually more than one finger is affected. There is a fusiform swelhng usually of the proximal phalanx. Dr. Carpenter in his mono- graph on congenital sypliihs mentions affection of the meta- carpal bones in one case, and I have seen one similar case. The condition can hardly escape observation, the difficulty is to distinguish between syphihtic and tuberculous dactyhtis. It has been said that the syphihtic tends to be symmetrical in the two hands, but this was not apparent from the nine cases I have mentioned nor do I know of any rehable point of distinc- tion ; the age-incidence will sometimes assist, for tubercle is excessively rare under the age of three months and by no means common under the age of six months, whereas most of the syphihtic lesions of infancy including dactyhtis are almost as likely to occur under three months of age as later ; the diagnosis