Malformation

“ Internal diseases ensue, such as disorganization of the liver, or rot, polypi in the trachea, clyers, malformation of the bones of the neck and legs, and general deformity." This position, however, will be strengthened by drawing attention to insulated portions of our race, where the effects of such a system are exhibited on a considerable scale. ”

“ Medical inspectors reported the rapid spread of malformation of the bones, curvature of the spine, heart diseases, rupture, stunted growth, asthma, and premature old age among children and young persons: the said children and young persons being worked by manufacturers without any kind of restraint. ”

“ Those malformations, however, which are due to qualities in the germinal material itself are inherited, and certain of them with remarkable persistence. There are instances in which the slight malformation consisting in an excess of fingers or toes has persisted through many generations. ”

“ Clyde.
“Of course, you’d have it repaired at whatever cost of suffering. You’d submit her to a long and serious operation; and probably to the constant pain of a rigid iron frame upon her leg for months, perhaps years. To obviate the deformity you’d consider that not too high a price to pay, and rightly. Well, here is the case of a more far-reaching malformation, curable by a minor operation, without danger, mercifully quick, with only the briefest after-effects of pain, and you draw back from it. Why?” ”

“ There has always been a great deal of popular interest attached to the malformations owing to the part which maternal impressions are supposed to play in their production. In this, some striking impression made on the pregnant woman is supposed to affect in a definite way the structure of the child. The cases, for instance, in which a woman sees an accident involving a wound or a loss of an arm and the child at birth shows a malformation involving the same part. ”

“ Protracted work frequently causes deformities of the pelvis, partly in the shape of abnormal position and development of the hip bones, partly of malformation of the lower portion of the spinal column. ”

“ These represent wide departures from the type of the species as represented in the form. There is no hard and fast line separating the slight departures from the normal type known as variations and mutations, from the malformations. Certain of the malformations known as monstrosities hardly represent the human type. These are the cases in which the foetus is represented in a formless mass of tissue, or there is absence of development of important parts such as the nervous system or there is more or less extensive duplication of the body. ”

“ 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. ”

“ Malformations and anomalies of any region should be thoroughly examined and carefully described. The most common ones found in adults are hare-lip, cleft palate, branchial cysts, bifid sternum, accessory ribs, malformations of fingers and toes, hypertrophy of great toe, hypospadias, cryptorchidism, pseudohermaphrodism, congenital dislocations, particularly of hip, lumbosacral meningoceles and dermoid cysts, microcephalus, club-foot and hernia, its variety, location, size and condition. ”

“ The lesions or injuries of the body which form so prominent a part of disease vary in kind, degree and situation, depending upon the character of the injurious agent, the duration of its action and the character of the tissue affected. The most obvious injuries are those produced by violence. By a cut, blood vessels are severed, the relations of tissues disturbed, and at the gaping edges of the wound the tissue usually protected by the skin is exposed to the air, resulting in destruction of the cells contained in a thin layer of the surface. ”

“ The chests of-lived persons, and of hale, hearty families, will always be found to be deep, ample and expansive; their shoulders broad, waists large, and persons stocky; but those who die young, unless of accident or some acute inflammatory disease, as well as sickly, delicate, feeble children and invalids, will be found to be slim-built, narrow and shallow chested, small round the waist, and poorly developed in the abdomen: as are most who are afflicted with dispepsia, liver-complaint, scrofula, weakness, palpitation of the heart, consumption, and this whole class of diseases. ”

“ Similar results are produced by convulsions, dentition, nervous irritation, contusions, sprains, fractures, partial luxations, and preternatural laxity of the ligaments. In some instances the defect is occasioned by the presence of a corn, an ulcer, or some other disease which induces the person to walk on one side of the foot, the tip, or the heel, to ward off pressure from the tender parts. A vicious habit is thus established, which, if it be kept up, as it often is, for any length of time, leads to irregular action in the muscles, and to distortion of the bones into which they are inserted. ”

“ Although the tissue elements in this disease resemble those of a new growth arising in the marrow, they differ in their arrangement and in their method of growth; there is no tendency to erupt through the cortex of the bone, to invade the soft parts, or to give rise to secondary growths.
_Clinical Features._--The onset of the disease is insidious, and attention is usually first directed to it by the occurrence of fracture of the shaft of one of the long bones--usually the femur--from violence that would be insufficient to break a healthy bone. ”

“ The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. ”

“ Morbid variations of structure and function present three leading phases of action, the acute, chronic, and diathetic. The primary causes of each are the same, a faulty personal hygiene and an unfavorable environment, but a derivative cause very generally predominates in the heritage of a defect or taint in the blood. In acute variations the struggle between the tendency to death and the tendency to reversion is usually short and severe, but decisive. The contending forces are often so nearly equal that a very little will turn the scale one way or the other. ”

“ 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. ”

“ They call that a disease where the whole body is corrupted; they call that sickness where a disease is attended with a weakness, and that a defect where the parts of the body are not well compacted together; from whence it follows that the members are misshapen, crooked, and deformed. So that these two, a disease and sickness, proceed from a violent concussion and perturbation of the health of the whole body; but a defect discovers itself even when the body is in perfect health. But a disease of the mind is distinguishable only in thought from a sickness. ”

“ The very notion of Diagnosis in our modern sense of the word depends upon Morbid Anatomy. The older physicians seldom attempted to determine the seat of an ailment. [8] Disease was looked upon not as a condition depending upon disordered physiological functions, but as something external, attacking a previously healthy person, disturbing, and, if not expelled by art, finally destroying him; while any structural changes which were found after death were regarded rather as the effects than the causes of the symptoms during life. ”

“ 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. ”

“ Such disease, when the patient does not soon succumb to its virulence, advances to a frightful extent, affecting a large surface, destroying the whole thickness of the bone, and even exposing the internal parts. In a case of this description, which occurred in the Royal Infirmary under my care, the anterior half of the cranium was totally destroyed, the left orbit contained a putrid mass, consisting of the disorganised eye mixed with pus and bloody fluid; the dura mater was exposed, and sloughed at several points, and the unhealthy discharge from the parts lodged on the surface of the brain. ”

“ It is indeed rather a pathological curiosity than an important item in surgical disease, and many surgeons of long experience have never met with a single example. Of the mechanism of its causation we know almost nothing, of its ultimate tendencies we know little more, and its morbid anatomy is almost entirely speculative. ”

“ In a family residing in this neighbourhood, where, out of fourteen children, eight have died; it appears that, of these eight deaths, three were cases of hydrocephalus, two of disease of the mesenteric glands, and two of phthisis pulmonalis. In other families we find the osseous fabric the seat of strumous disorganization, and one child will have a rickety affection, or a deformity of the chest, such as in after life may evoke some phthisical tendency, another a caries of the bones, and a third spinal distortion. ”

“ There are in my private collection a few specimens of necrosis, in which matter found its way into the neighbouring joint, leading to disease of the tissues composing it, and rendering amputation necessary for the preservation of the patient’s existence. External injury may produce this disease by causing a violent increase of action, or it may be so severe as at once to deprive part of the bone of its vitality. Destruction of the periosteum, and of the vessels which enter the surface of the bone, frequently gives rise to superficial necrosis or exfoliation. ”

“ Most common forms are Pott’s disease, spondylitis, ankylosis, spinal curvature, contractions and retractions of parts, bow-leg, knock-knee, changes in the pelvis, dwarfism, shortening of extremities, exostosis, drumstick or clubbed fingers, flat foot, loss of bones, amputations, occupation deformities, swelling of joints, tophi, Charcot’s joint, hygroma, ganglion, etc. ”

“ Most students of the condition believe that they arise from the field of operation, and may be caused by infection of the tissues, by injury to the tissues, or by the motion of the part of the body operated upon. ”

“ In addition to the hideous deformity, the patient suffers from blocking of the nose, loss of smell, and protrusion of the eyes, sometimes followed by loss of sight. The condition is liable to spread to the zygomatic and frontal bones, the vault of the skull, and to the mandible. The base of the skull is not affected. The disease is of slow progress and may become arrested; life may be prolonged for many years, or may be terminated by brain complications or by intercurrent affections. ”

“ Most fatal diseases, moreover, have their original seat in the viscera of one of the three great cavities of the body, and no disease originating elsewhere can become fatal, until, by sympathy or metastasis, some of those parts are deeply affected. To enlightened physiologists this statement presents but a series of familiar truths. To the groups of organs exclusively, then, I repeat, contained in the abdomen, the thorax, and the cranium, must we look as the main source of human character. ”

“ Disease of the bones, whether hereditary or acquired, is an essential descriptive element in reconstituting individuality. Caries and necrosis, rickets, spinal disease, ankylosis, and other external manifestations of bone lesion may furnish pointers of such value as often to be incontestible. They are so evident as not to require detailed mention; but much care in such cases is necessary to distinguish between disease, decay, and violence, and artefacta. ”

“ Different parts of the cut surface of the same organ should be compared as to color, moisture and dryness. (Areas of suppuration, congestion, œdema, inflammation, recent hemorrhage, hydropic degeneration, liquefaction necrosis, etc., are more moist than normal; old thrombi, fibrinous exudates, old hemorrhages, simple, coagulation, caseous and Zenker’s necrosis, dry gangrene, anæmic and hemorrhagic infarctions, amyloid, concretions of cholesterin, bile-pigment, lime-salts, urates, etc., contents of dermoid cysts and cholesteatomata, etc., are dry.) ”

“ The general health is often impaired in consequence; frequently the disease occurs in those of broken-up constitution, along with sores and eruptions on other parts of the surface, ulcerations of the mucous membranes, and other indications of cachexia. ”