Deformity

“ It has been frequently asserted that deformity of the spine is usually the result of disease, but this is contradicted by experience; and we do not feel disposed to concur with any fallacy simply out of deference to the authorities by whom it is promulgated or supported; for, so far from deformity being occasioned by disease, disease is ordinarily the result of deformity. ”

“ When one bone is broken, there is little displacement. The power of motion is lost to a considerable degree, and there is some deformity, but little or no shortening. The existence of fracture is ascertained by tracing the bones with the fingers, and by gently rotating the limb; the broken portions moving on each other produce distinct crepitation. ”

“ CONGENITAL AND PATHOLOGICAL DEFORMITIES OF THE PREPUCE AND URETHRA.—STRICTURE AND MECHANICAL OBSTRUCTIONS OF THE URETHRA.
When any of the central organs of the body presents in a form differing from that which we term natural, or structurally perfect and efficient, if the deformity be one which results as a malformation, ascribable to an error in the law of development, it is always characterized as an excess or defect of the substance of the organ at, and in reference to, the median line. ”

“ Of course, as the child stoops forward, the arms hang beyond the centre of gravity, the shoulders are consequently more rounded, the strain on the muscles of the back con­siderably increased, and, if this influence were suffered to continue, a permanent deformity would be the necessary result. ”

“ If, for any reason, bone is put under constant pressure, a certain amount of readjustment of the bony constituents takes place in order to adapt the bone to its altered condition. The most striking example of this sort of atrophy is perhaps the Chinese ladies’ feet, where the bones, being bent into an abnormal position, beginning early in childhood, ultimately show enormous deformity and an entire rearrangement of the trabeculae of the bone. ”

“ There are certain fallacies to be guarded against. For example, a fracture may exist and yet unnatural mobility may not be present, because the bones are impacted into one another, or because the fracture is an incomplete one. Again, the extreme tension of the swollen tissues overlying the fracture may prevent the recognition of movement between the fragments. Deformity also may be absent—as, for instance, when there is no displacement of the fragments, or when only one of two parallel bones is broken, as in the leg or forearm. ”

“ The first impression, I think, made upon a visitor is the almost invariable physical deformity that attends imbecility—ill-proportioned, distorted bodies, dwarfed, misshapen gelatinoids, with bones that have no stiffness. ”

“ In cases in which the curvature is not affected by suspension, the deformity is usually permanent, but by suitable exercises it may be prevented from becoming worse, and the patient may be educated to disguise it to a considerable extent. Training is also directed towards regaining the muscular sense ”

“ Swelling, with spasmodic of these symptoms may be wanting; there is little deformity, and no shortening, when one of two or more action of the muscles, soon takes place. One or several parallel bones is fractured. In fracture of the extremities, extrication of air into the cellular tissue, about the ends of the bone, is not unfrequent, though difficult to account for—giving rise to crepitation, superficial, and quite a distinct sensation from that imparted by the broken bone. ”

“ In view of the fact that light men exhibit a larger range, of chest-expansion, this excess in the defective size of the chest is unlooked for. The other chest-defect is deformity, in which the difference in ratio in the two groups is only about .18. The fact that two classes are made in the chest-deformities leads me to suppose that the deformities are congenital, or the result of defective development in childhood; while the deficiency in size is the result of disease or injury later in life. ”

“ It is very doubtful if the deformity is intentional; its moderate extent and the total lack of signs of counter-compression would indicate with more probability that the deformity might have been produced by the individual lying, when an infant, by compulsion or habit, on something hard, probably a board. ”

“ No deformity of a child's body gives rise to so much alarm to parents, or is the subject of greater diversity of treatment among medical men, as lateral curvature of the spine, and this is due, I believe, to an imperfect acquaintance with its origin. Specialists are accustomed to treat lateral curvature, knock-knee, and flat-foot as distinct deformities, while in truth they are all links in the chain of one deformity. ”

“ It generally affects both feet, but it may be confined to one and if only one is affected, the right is oftener affected than the left. The deformity varies. At the time of birth and for some months afterwards the deformity can usually be corrected by proper manipulation, but later, if left to itself, it becomes in greater or less measure fixed, because of the muscular contraction, and developed changes in the shape of the bones. ”

“ They will inevitably twist and squirm themselves down into one position or another which throws the internal organs out of position, and which by iteration and reiteration results in a continuously accentuating deformity. ”

“ In the course of time the delayed bone-formation takes place, and the bones themselves become as hard as ivory, but the limbs do not straighten, and the deformity produced in infancy is but confirmed in after-life. ”

“ J. Brown, M. D. and J. P., Sunderland:—"They labour more frequently than other classes of the community under deformity of the lower limbs, especially that variety of it described as being 'in-kneed.' This I should ascribe to yielding of the ligaments, owing to long standing in the [Pg 84] mines in a constrained and awkward position." ”

“ It is believed to be the fact that the deformity is more common among people of this type, [Pg 65] and it will be well for those so constituted to guard against anything that tends to its development. ”

“ There is little difficulty in remedying the slight displacement which takes place when but one bone is broken, and in retaining the parts in a favourable position. In children, occasionally, one of the bones of the forearm is broken, the other being bent very considerably, so as to cause great deformity.62 When both have given way, slight extension is required, and the forearm is placed in the middle state between pronation and supination. ”

“ In the majority of cases the bones of the lower extremities are much earlier and more severely affected than those of the upper extremity, but the capacity of walking is usually maintained even in the presence of great deformity. ”

“ The deformity is produced by applying tight bandages round the feet of the girls when about five years old. The process is an extremely painful one, and its results are not only an alteration in the relative position of the growing bones and other structures, but an arrest of their development, so that they remain permanently in a stunted or atrophied condition. The alterations of form consist in two distinct processes: 1. Bending the four outer toes under the sole of the foot, so that the first or great toe alone retains its normal position, and a narrow point is produced in front: 2. ”

“ The tendency ceases at adult life, because the ligamentous and bony structures of the articulation have then assumed their permanent condition, and any later deformity simulating it can only occur as a result of a totally different set of conditions. ”

“ This deformity, for we can call it nothing less, causes them to walk as though they were crippled. Many of them are obliged to use the cane to assist them, and they always appear as if it caused them pain to walk. The small feet, we were credibly informed, are confined to the aristocracy. ”

“ Mechanical means would only, by weakening and wasting the muscles, increase the mischief, and thus the deformity. In this world of ours there is too much reliance placed on artificial, and too little on natural means of cure. ”

“ Pains in the extremities, particularly joints, if not clearly showing signs of improvement in two or three days, should also be the object of a physician's visit, as a fracture near a joint, if not correctly treated early, may result in permanent deformity. ”

“ If we examine a number of hands, it will be found that there is a remarkable wide physiological variation in the range of movement at the phalangeal articulations in different individuals, and it requires but a small departure outside the physiological limits of variation to constitute the pathological deformity under consideration. ”

“ When the distortion is not great, this in general cures the disease, and leaves the vital functions unim­paired.
"The second and third curvatures are those which begin in the simplest way, and if neglected assume the most formidable character. It is generally manifested on the right side, and may frequently be traced to the habit of lying upon and using the right members exclu­sively. When the deformity increases, the capacity of the chest must be diminished and its functions impaired, and the heart, lungs, and other vital organs injured ”

“ The simple Fracture is that whereby the Bone is broken, without any other Accident; and the complicated Fracture is that which is follow'd by some Accident; as that in which there is a splitting of the Bone in pieces, or {189}where the Bone is broken in two several places, or else when the Fracture is accompany'd with a Luxation, a Wound, an Inflammation, or other Circumstances of the like Nature.
Are old Men or Children most subject to these Fractures of the Bones? ”

“ Mechanism of Deformities.—From what has been said on the cases in which deformities are absent it is evident that one at least of three conditions are required for their production: the paralysis must be unequally distributed in the muscles surrounding a joint; pressure must be exerted by the weight of the body or traction by the weight of the limb; effort must be made to utilize the maimed part of the limb by means of other parts, or even by the muscles of the trunk. ”

“ In this variety the degree of force which produced the fracture would not be sufficient to cause a fracture in a healthy bone.
The causes of traumatic fractures may be either predisposing or exciting.
Predisposing Causes. The bones of the human body attain their greatest strength toward middle age. From infancy up to that time the bones are very elastic and yielding. Toward old age an interstitial atrophy occurs. It causes a thinning of the cortex of the shafts and of the trabeculae of the spongy portions of the long and short bones. ”

“ A dislocation or luxation is a persistent displacement of the opposing ends of the bones forming a joint. We are here concerned only with such dislocations as immediately follow upon injury. Those that are congenital or that result from disease will be studied later.
Causes.—The majority of dislocations are the result of indirect violence, the more movable bone acting as a lever, on a fulcrum furnished by the natural check to movement in the form of ligament, bone, or muscle. It is in this way that most dislocations of the shoulder, hip, and elbow are produced. ”

“ A Dislocation is the forcible displacement of a bone from its socket. It is, generally, the result of a fall or a violent blow. The tissues of the joint are often ruptured, while the contraction of the muscles prevents the easy return of the bone to its place. A dislocation should be reduced as soon as possible after the injury, before inflammation supervenes.
PRACTICAL QUESTIONS. 1. Why does not a fall hurt a child as much as it does a grown person? ”

“ If a fracture, then, occur in the head, it is discovered by the sharpness, weight, hardness, or violent force of the body which struck it, and by the symptoms which supervene upon the person who has been struck, such as vertigo, loss of speech, and sudden prostration, more particularly if it be a fracture with depression, or contusion, or expression, or the internally-arched fracture, owing to the compression of the brain. ”

“ And a bone sustains fractures, either so fine as to escape the sight, or such as are apparent, and contusions which are not apparent, and depression from its natural position, especially when one person is intentionally wounded by another, or when, whether intentionally or not, a blow or stroke is received from an elevated place, and if the instrument in the hand, whether used in throwing or striking, be of a powerful nature, and if a stronger person wound a weaker. ”

“ In this connexion I will notice another class of cases not so numerous, in which the bone-setter either imagines or pretends there is fracture, when there is nothing but a sprain, or an injury of the nerves of the limb, producing inability of motion. Such cases, at least in old persons, recover slowly. If the bone-setter puts on his splints, he commits a great error, but it is an error that may not be detected. ”

“ This whole group of above-mentioned stigmata, which seem to have a congenital origin, or, rather, to be connected in a general way with growth itself, are called malformations, to distinguish them from deformations, which evidently have an acquired origin, especially from pathological causes, such, for instance, as rachitis and forms of paralysis which arrest the development of a limb, etc., resulting in functional and morphological asymmetry. ”

“ The touch will always discover in what part of the bone the fracture is situated, which, if it be oblique, will partake more or less of the characters of the longitudinal or the transverse, accordingly as it approaches to the one or the other. ”

“ In dislocations backwards, the man is not to be stretched so as to raise him up, but he is to lie upon a hard body as in dislocations outwards; and, as we mentioned with regard to dislocations of the vertebra backwards, the man is to be laid on his face upon a board or bench, and the ligatures are to be applied, not to the loins, but to the leg as mentioned a little above. ”