Joint diseases, especially those of children / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Joint diseases, especially those of children / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of one half of the errors in diagnosis. If the spine IS the seat of the disease, this rigidity is marked not only in the peculiar postures and stooping move- ments of the child, but in every position of flexion, extension, lateral bendings, rotation, etc., all of yv'hich should be noted. This rigidity long ante- dates the deformity of kyphosis; in fact, the surgeon who waits for the presence of an angular kyphosis in the spine to demonstrate the giving way of the bodies of the vertebras is no wiser than many an ignorant mother. The mischief is already done, and the physician can only repair damages that should have been prevented long before. Pain, although ordinarly dwelt upon as one of the essential symptoms of tuberculous spine or hip or knee disease, may be entirely absent. Again, the absence of pain is often given by physicians as an excuse for failure in diagnosis. Local pain in my experience is the exception, not the rule. Reflected pains along the line of the irritated nerves which emerge from the diseased vertebrae are, however, common, and the child is treated for cough, for in- testinal disease, for leg pains, etc., until too late. Pain is recognized by the muscular sense of the patient long before it is definitely interpreted by the brain as a distinct sensation. This early recogni- tion is evidenced by rigidity and limp, but not by open complaint. Throughout the entire course of hip disease, although the head of the femur has been destroyed and the acetabulum perforated, not a single complaint of recognizable pain at hip or the knee may have been made by the patient. On the other hand, when there is an acute osteitis or epiphy- sitis, the pain may be intense and excruciating from the beginning. These extremely painful cases, which continue in spite of all forms of treatment, are the ones in my experience that go on to rapid destruction of the bone, and which require early ex- cision of the head of the femur. The night cries so