Vol. 60, 1909 - University of North Carolina at Chapel Hill

128
THE CHARLOTTE MEDICAL JOURNAL.
No treatment availed. The parents were that the cause of the myxedematous sympapparently
anxious for the young lad to tomsas the atrophy or absence of the thyroid
take part in foot-ball and continued in Iheir gland in infants either congenital oracquired
efforts to find out the cause of the trouble, When beginning at a period after birth its
which objectively produced a decided swell- cause may be acongenital smallness and coning
at the lop of the shin bones. sequent insufficiency of the gland. When
Examination disclosed, a little above the there are too great demands for the typhoid
tubercle of each tibia, a rounded projection, secretion, which will occur sooner or later,
most marked when the knee was flexed, the symptoms of myxedema come on.
Radiographs accompanying the report show Either the thyroid elaborates a substance
the condition clearly.
useful to the organism, the absence of which
Tuberculosis ol the Hip-Joint.- Walder- causes the symptoms, or the office of the
Strom 1 Clrlbltt. fur Chirurgic ) treated 60 gland is to remove from the circulation subcases
of tuberculosis in and around the hip- stances that are deleterious, which are not
joint. In 18 of these cases the X-rav ex- removed when atrophy has occurred. At
amination showed the presence of an isola- whatever period of the child's life this luted
focus in the femoral neck, within the sufficiency occurs, the development of mmd
reo-ion of the capsule. Based upon careful and the growth of the skeleton immediately
X-rav examinations, the author believes cease. The patient becomes an idiotic
the coxitis in these 18 cases to have origi- dwarf—an entire idiot when the suppression
nated from these isolated foci in the femoral of function is early, an imbecile when it
neck. In three cases onlv did the patient occurs later. As the thyroid plays so imcome
under treatment before the focus had portant a role m the genital system of the
gone on to coxitis or destruction of the female, there are more myxedematous fefemoral
head. Two of the patients were males than males. The dwarf is afflicted
entirely cured bv operation, and one recov- with a solid edema of the skin and mucous
ered with a slight coxa vara and good fuiic- membranes, which gives him an expresstion.
Among the remaining cases 10 pa- ionless, swolen face, a thick tongue, and
tients could certainly have been freed from hoarse voice. The patient shows a great
the tuberculous disease in the same manner disinclination for all kinds of movements, is
if thev had come under treatment at an cold on account of the lowered temperature,
early stage. He points out the importance lias a feeble and comprsheiisible pulse, and
of evacuating every known focus in the an open fontanelle. Puberty never becomes
femoral neck without damaging the joint, established. The only successful remedy
for the following reasons: (l) There is no is the use of thyroid extract,
method to ascertain within a short time Treatment of Labor in Contracted Pelwhether
the tuberculosis is stationary or vis.—Schauta (Jour. Obst., Gyn. Brit,
progressive in character. (.2) The focus in Emp.) states that our aim should be to leave
the fermoral neck is situated so as to have labor in contracted pelvis as long as possi-
oiily a short distance to travel before reach- ble to the natural forces, and these failing,
ing the joint when progressing in any direc- to perform only those operations which will
tion but toward the trochanter major, (3 ) most likely save both mother and child.
After the focus has penetrated into the joint The management of labor in contracted
very extensive destruction follows. pelvis will shape itself in the following man-
It is essential to save as much bone ma- ner, provided it is carried out from the comterial
as possible at the time of the opera- mencement in a skillful manner and in an
tion. The author therefore makes use of institution under strict asepsis. In cases
Rydygier's incision, with temporary detach- with a conjugate above 8 cm. there is a
meiit of the trochanter major. The focus is possibility of spontaneous birth, and therethen
located and carefully removed, under fore expectant treatment is to be adopted,
very accurate aseptic precautions. The In cases under 8 cm. Cesarean section is to
operation is terminated by reattachment of be kept in view. In cases bordering on the
the trochanter after injection of iodoform above, that is with a conjugate of 8 '2 to 7/^
glycerin and primary suture. cm. hebosteotomy is to be considered. This
The same method is utilized by the author operation, in a conjugate of 8 to S'2 cm.;
for foci in the femoral neck, with otherwise would be an alternative operation to spoupurely
synovial tuberculosis of the hip-joint, taneous birth; in a conjugate of 7 '2 to 8 '2
Iodoform glycerin injections are made into cm., an alternative to Cesarean section,
the hip-foint during the operation. The The choice would be determined by the size
after treatment is carried out with the assist- and hardness of head, the strength of labor
ance of plaster bandages of extension dress- pains, the voluntary efforts and general
ings. condition of the patient. This method of
Spontaneous Infantile Myxedema.— treatment should be looked upon in the
Beudry (Jour, de Med. et de Chir.) believes future as typical. All other methods hith-
i,