The prevention of deformity after infantile paralysis by recumbency during the stage of recession / by Adoniram B. Judson.

  • Judson, Adoniram Brown, 1837-1916.
Date:
1907
Catalogue details

Licence: In copyright

Credit: The prevention of deformity after infantile paralysis by recumbency during the stage of recession / by Adoniram B. Judson. 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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    faces of the hip, knee and ankle. And when it is noted that the arms are free while the legs bear the weight of the body, it is reasonably inferred that the joints of the lower extremities when affected, or even suspected, should be protected by either recumbency or appropriate apparatus. The conclusion is a plain proposition and needs no discussion or verification. It shares the simplicity of Jenner’s argument when he traced the relation of cause and effect and prescribed vaccination. In another field Finlay, walking with his eyes open, apprehended the relation of cause and effect and prescribed the sequestra- tion of the mosquito. The necessity of reforming the environment of the lower extremities having been derived from clinical observations of joint disease, can practical conclusions be drawn in a similar manner from observing the course of infantile paralysis? Disability from this disease is seen eight times as often in the lower as in the upper extremities, and yet in the early stage the paratysis is found in all parts of the motor nervous sys- tem. The muscles of the recumbent patient are in very mod- erate use and in a position entirely favorable to spontaneous recession of the paralysis. The arms and hands retain this advantage when the patient is erect, but the impaired muscles in the legs and feet give way at once when they meet the re- sistance of the weight of the body. They rapidly become elon- gated and attenuated, and could not well be placed in an atti- tude more destructive of the possibility of restoration. The result is seen in club foot, talipes valgus and cavus, short tendo Achillis, paralysis of the anterior muscles of the thigh, and flail joints. When prescribed recumbency shall give to all parts the same environment, recession of paralysis will be equally en- couraged in the lower and upper limbs, the disproportion of 8 to 1 will be lessened, and the sum of deformity from this dis- ease will be materially reduced. The value of the method is thus proved, but it is not read- ily demonstrated. When comparing methods it is not easy to show that one is better than another. It may always be said that a case cited in behalf of a certain method may have been one that would have done well under any treatment. Tables of carefully recorded cases might lead to correct estimates, but studies of this kind are difficult and have not escaped criti- cism. Dr. Gaillard Thomas said with wit and wisdom that if there is anything more misleading than facts it is figures. Medicine and surgery are still outside of the realm of exact