Fractures, dislocations, diseases and deformities of the bones of the trunk and upper extremities / by Hugh Owen Thomas.

  • Thomas, Hugh Owen, 1834-1891.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Fractures, dislocations, diseases and deformities of the bones of the trunk and upper extremities / by Hugh Owen Thomas. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    The Diagnosis of the Commencement of Disease during the Middle and Adult Period of Life.—During the early period of life, we are debarred from much assistance in diagnosing by the lesser intelligence of our patient to describe his feelings, so it would much assist our practice if a diagnosis of commen- cing spinal disease could be made by mere physical signs. As age increases, the patients are more and more able and willing to express their feelings, so that we can rely upon the result of cross-questioning them. The surgeon is asked to examine a boy of about seven to twelve years of age. The parents report that they have noticed that lie is disinclined to indulge in his usual muscular exertions; that he expresses himself as feel- ing tired early in the day and that, when sitting, he rests his hands upon his thighs. The parents further report that, when coughing or sneezing, he complains of a slight pain sometimes in the abdomen, other times in his hack. The boy is now undressed, and the surgeon does not notice any special deformity of the spine, but when he requests the boy to stoop, some irregularity of the spinous processes is seen. After this observation, the surgeon places a hand upon each shoulder of the patient, which he firmly grasps and, unexpected by the boy, gives his body a shove forward, and before he recovers from his surprise, the surgeon, retaining his grasp of the shoulders, gives the body a sharp, but moderate, rotation, and the boy's face indicates pain. On questioning the boy, the surgeon elicits from him that sudden contact with other youths during play also gives him pain. The surgeon now, though he has observed no physical de- formity indicative of disease, expresses to the parents his strong suspicion that spinal disease is commencing and that suitable treatment should be tried at once. The next patient the surgeon is requested to examine is an adult, of about thirty years of age. He informs the surgeon that for many months he has felt obscure pains in his thighs and his lower extremities weak, that the act of stooping is difficult to perform, and that he believes that his trouble arose after a severe sprain while at work. After the patient has divested himself of his clothing, the sutgeon fails to detect any