A treatise on orthopaedic surgery / by Royal Whitman.

  • Royal Whitman
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on orthopaedic surgery / by Royal Whitman. Source: Wellcome Collection.

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    standing and walking, and of the contour of the spine, which is the result of the erect posture, does not apply to the infant in arms, nor need the spine be divided into contrasting sections for the purpose of differential diagnosis. In Pott’s disease of infancy the muscular spasm is usually more intense and its extent is greater ; the child screams when it is moved or when the diapers are changed. Slight irregularity of the spinous processes indicating the position of the destructive process is often evident and abscess is not unusual. There is usually no difficulty in determining the presence of disease even in very early cases, but, as has been men- tioned, it is sometimes difficult to decide whether the lumbar spine or one of the hip-joints is involved. Pott’s disease of infancy may be mistaken for acute rhachitis, or scurvy. The symptoms of such affections are, however, not limited to the spine, but involve to a greater or less degree the limbs and joints, indicating that the discomfort and pain are due to a general, not to a local disease. The Rhachitic Spine. The deformity of the spine, caused by rhachitis, is not infrequently mistaken for the kyphcsis of Pott’s disease. It has been stated that when in early infancy the child is placed in the sitting posture the spine bends in a long, posterior curve, indicative of the weakness normal at this age. Such a curvature is characteristic also of acquired weakness and_ particularly that caused by rhachitis in early childhood. During the subacute stage of general rhachitis the child that has never walked or that has ‘‘ lost its walk ”’ sits much of the time in its chair, or is car- ried about on the mother’s arm. In this posture the spine is bent backward and a curvature of the lower thoracic and lumbar region is habitual. Soon a slight projection persists, even when the child is lying down; it usually increases in size and becomes more resistant if its exciting cause remains; thus, a somewhat rounded and rigid posterior curvature of the dorsolumbar portion of the spine is formed. The diagnosis from Pott’s disease should be made without diffi- culty, because the evidences of general rhachitis are always present, and because the deformity is almost as much to be expected as would be distortions of the legs were the child walking. If the patient is placed in its habitual sitting posture it will be seen that the deformity is simply an exaggeration of a normal attitude. In this attitude the patient remains contentedly for an indefinite time, whereas if Pott’s disease were present the child would lhe on its
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