Progress in the Theory and Practice of Medicine

HERMAN M. ADLER
1909 Boston Medical and Surgical Journal  
Out-Patient Department, with fairly good union, wearing a light plaster. The knee was kept in plaster for six months, at which time it was deemed safe to allow weight bearing, with an extension shoe. There was 2| inches shortening in the affected leg. Nov. 16, 1907, the patient reported at request. The knee is in excellent condition. She has very slight discomfort in walking, but still used a crutch for fear of falling. Dec. 17, 1908, the patient reported that the knee gave her no
more » ... er no inconvenience. CASE 3. MADELUNG'S DEFORMITY. W. DeM., age thirteen, came to the Out-Patient with the following history: He had been well up to November, 1906, when he had an attack of diphtheria. On recovering from this illness marked weakness was noticed in the muscles of the forearms, and there was unusual prominence of the styloid process of the right ulna. This had grown worse and the wrist and hand seemed to be displaced backward on the forearm. He had difficulty in writing and holding a pen, which was growing worse. The same condition was present in the left wrist to a lesser degree. The grasp of the right hand was decidedly weaker than the left. The radius and ulna were prominent anteriorly, and there was atrophy of the interossei in both hands. Fig. 4 is a Roentgen plate of the hands in a lateral view, and Fig. 5 an antero-posterior view showing the deformity. Vibration of the flexor muscles of the forearms has restored almost complete muscular power to the forearms and hands, although no change in the deformity has resulted. CASE 4. MADELUNG'S DEFORMITY. M. P., age twenty-one, came to the Out-Patient Department of the Rhode Island Hospital, Jan. 21, 1908. When five or six years old she had injured the left wrist in some way, just how she was unable to tell. Nothing was done for it at the time, and she sought advice for the deformity and pain. Pain had êbeen experienced for many years, but of late it had become so severe that she was unable to use the hand. The radius was bent sharply forward at its lower extremity, carrying the hand and wrist with it, while the ulna had continued in a perfectly straight line, making a sharp prominence at its styloid process on the posterior surface of the wrist. The patient did not return for treatment and passed from observation. These two cases are reported as additions to the literature of this interesting deformity. CASE 5. CONGENITAL DEFORMITY OF THE PHALANGES. Fig. 6 shows an interesting deformity of the phalanges which is bilateral. The hands and wrists are normal, except for the forefingers and the proximal phalanges of the middle fingers. In the forefingers, the proximal phalanx has not developed normally but is seen as a small triangular, wedge-shaped body placed between the metaearpal and second phalanx. The epiphysis is not situated in its normal position below the epiphysis of the metaearpal, but lies on the outer side of the finger facing the thumb. The second phalanx of this finger is characterized by the presence of two epiphyses, one placed normally at its proximal and the other, larger and thicker, at its distal end. The distal phalanx is apparently normal, though perhaps not fully developed at its distal extremity. The proximal phalanx of the middle finger shows a large thick epiphysis, somewhat different in the two hands, with the epiphyseal line broken and irregular in contour. The views of physiologists on the subject of respiration have been divided, some holding that respiration is carried out by a definite secretory action of the alveolar epithelium, others believing that the gas exchange in the lungs may be explained sufficiently by purely physicochemical means. The recent work of Bohr' seems to establish the possibility of a secretory action of the alveolar epithelium for C03. The experiments were arranged so that the lungs in dogs breathed separately, one lung receiving air, the other a mixture of air and C02. The C02 tension was determined in both lungs, in the right heart and in a large artery. It was found that the C02 tension in the lung breathing the mixture of C02 and air was higher than in the blood of the right heart; nevertheless, a passage of C02 took place from the blood to the lung. If this proves to be a general fact, and not dependant upon unusual circumstances, it will go far to establish the contention that the alveolar epithelium is a specific factor in the aid of respiration; consequently there seems to be no theoretical reason why the oxygen transfer to the blood should not eventually be proved to have a similar foundation. However this may be, the fact that the alveolar epithelium is involved in the process of respiration adds simply another factor and in no way interferes with the conception of the physicochemical basis for the gas exchange through the lung. Haldane and Poulton 2 have formulated the law that the respiration is normally so regulated that the C02 tension in the alveolar air remains constant in any individual though it varies somewhat among different persons. The slightest increase in C02 tension, even 1 mm. of mercury, results in an enormous increase (80%) in rate of respiration. As the Co2 tension falls, under diminished barometric pressure, as, for instance, on mountain tops, the alveolar oxygen tension is correspondingly increased and thus the organism compensates for the changes in the constitution and pressures of the atmosphere at high elevations.3 The decrease in the alveolar C02 tension is brought about by the hyperpnea caused by^the lack of oxygen, and no such decrease in tension occurs when it is compensated by the administration
doi:10.1056/nejm190904081601405 fatcat:a7556sgpcfaghffpa6oyzewgcu