Dr. Underwood's treatise on the diseases of children : with directions for the management of infants.

Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: Dr. Underwood's treatise on the diseases of children : with directions for the management of infants. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    -J course depressed, the ulcer very much resembling the form of the human mouth, when the angles of the lips are drawn to- gether, and the middle part is pushed forward. When the skin is entire, the disease appears in the form of a tumour, varying in size from that of a pea, or even smaller, ' to that of half an orange ; being also more or less elevated. \ The highest point is usually very thin, and sometimes trans- j parent, from having no true skin ; other parts of the tumour | are red or livid, having very much the appearance of some ^ cancerous tumours upon the point of ulceration. The surface is generally very soft to the touch, especially in the centre, from which a fluid retires upon pressure, and round the margin of the swelling the bony edges of the spine may be distinctly felt; a circumstance that ought always to be attended to, as leading to a certain diagnostic. In other cases, no fluctuation is perceptible, but a carneous substance, hard and thick ; and such infants cannot endure being laid on the back, but presently become convulsed. Muys mentions an instance of the disease being situated between the scapulm, in which the skin was not at all discoloured ; the deficiency of bone was, therefore, very small, as likewise seems to have been the case from the event, as will be mentioned in its place. The internal appearances are various; sufiice it to say, that as the disease takes place during the process of ossification, the internal arrangement seems to depend very much upon the period at which the complaint may commence. In general, there is a confusion of nerves, blood-vessels, membranes, and ] ligaments, together either with a hard flesh-like substance, or j a certain portion of discoloured lymph. This is, probably, 1 small at first; but the necessary support of bone being want- | ing, the lymphatics of the membrane investing the spinal ) marrow, it has been supposed, continually deposit their con- .■ tents, enlarging the tumour, and increasing the disease. I saw one instance in a foetus of about five months growth, where the bone (the os sacrum, as yet indeed in a cartilaginous state) was complete on the outside, but deficient within ; the spinal marrow was also wanting, and there was a considerable quan- tity of water.