Congenital Defect of the Fibula

F. J. COTTON, A. L. CHUTE
1898 Boston Medical and Surgical Journal  
wonderful and they brought stores of new knowledge and material to our profession, especially botanical ; they were not as startling in their effect upon philosophy as popular history has generally led readers to suppose. All that Columbus found supported philosophical deductions common among the learned for centuries ; he himself mentioned Averroes as one of the philosophers who led his thought toward the attempt to discover " new worlds." Finally, as to the Reformation : Cusa's life again
more » ... sa's life again shows that the movement was in full swing within the Church for more than a century before the stupidity .of some of the popes causing the misfortunes of Italy, .abusing all decent Christian sentiment of Europe, and allying themselves with narrow Spanish fanaticism brought the movement to a crisis. There is no satisfaction in attempting to account for Paracelsus by any of these movements; the influences were too general to give us any conception of his special thought. The hero worshipper loves to create a man of power who causes all that follows him, or who is a child of the gods for whom all great movements were especially ordered. Artistic use of great generalities is the powder for their rhetorical pyrotechnics. They resent the analysis which proves that the sulphur, the nitre, the charcoal were slow productions of nature and art which man was long in learning to combine. Closer study generally brings the hero into the human ranks, and, if he is real, respect and veneration is only made warmer and deeper ; debate on uncertain points is rendered less extreme ; an atmosphere better fitted for existence of truth and justice is created. Partisan spirit, fanaticism, sectarianism, dogmatism are the only sufferers and in their present flourishing condition we may spare our compassion. Paracelsus is often blamed for his contempt of the ancients ; we must endeavor to realize the spirit of the reformer of his time. Savonarola felt and spoke in much the same manner when he said, " The philosophers are in hell, and an old woman knows more of saving faith than Plato." In spite of all the singularity and originality which characterize Paracelsus, in spite of his boasted independence, he, like the other sixteenthcentury physiologists, was confined in a system of cosmology which probably he adopted from Cusa. He was more original and independent in his relations to chemistry than to medicine, but on every side were the bars of his prison ; all his attempts at original observation, all his inductions were rigidly shaped and adjusted according to the metaphysical ideas in which he had enveloped himself. His struggles for freedom were more energetic, his flights bolder than those of most of the sixteenth-century physiologists, even judging him by the standard of the most advanced school of Padua. In this respect all were in a common plight, -the rule of the systems had existed from the beginning and nothing of the strength of the rule was abated at the Renascence. The birds might exhibit more restlessness, they might sing louder and sweeter, but they were as safely caged as in the ancient days. We may pity them as we see them suffer their self-inflicted injuries, in beating against the bars ; we may admire them as we perceive the energy of their attempts for freedom, but we cannot find among them, not even in Paracelsus, the " founder of modern physiology." Browning was right in his immortal poem : Paracelsus was ever aspiring ; true to his German nature, he honestly and obstinately clung to his ideal, but he lacked in power for realizing and organizing it. How modern medicine was made possible, how physiology was established, will be the chief topic in our next talk. -*-Temesvary, six years later, reiterated these views, and the theory now usually accepted, that of amniotic pressure and adhesions, though suggested by Dareste in 1882, seems to have been overlooked by most authors until 1892, when Sperling, in a masterly paper, reviewed the whole subject and challenged all evidence supposed to prove that these so-called intrauterino fractures were fractures at all, and pointing out the possible explanation of their causation by abnormalities of the amnion. His arguments in brief were: A fracture in utero by indirect or direct violence would be hard to produce, the fetus being suspended in amniotic fluid and protected by the uterine and abdominal walls. Violence sufficient to produce such a fracture would usually at least produce miscarriage. If uterine pressure were the cause of fracture we should have fractures occurring with some frequency intra partum, when the intrauterine pressure is greatest ; in fact, however, such fractures occur only at or near full term, and as a result, not of intrauterine pressure alone, but of the counterpressure of the bony pelvis as well. Callus is practically never found in the cases seeming to belong to the class under discussion. The presence of the so-called scar is not valuable evidence of compound fractureit is not even proved that it is a scar. The defects of fibula and toes, so frequently associated with the tibial bend, point to an origin as early as the second month of fetal life, for at this time the parts are laid down, and defects in the true sense cannot arise later. These defects cannot be so far as we can see either cause or result of the so-called fracture. Hence the association points to a common cause for both. It seems likely that both are due to pressure and pull of the abnormal amnion and its adhesionsthe more likely inasmuch as this seems to be the cause of other similar deformities. Haudek, in an extensive article in 1896, accepting Sperling's conclusions, adds to the evidence the report of the microscopic examination of one of these so-called scars which he had excised. It showed no interruption of the skin layers, and only such fibrous and atrophie changes as could best be explained as the result of pressure, in short, could not be called true scar. He also called attention to the fact that defects of the radius, which in early fetal life lies exposed in supination, are, with the associated defect of thumb and fingers, the not infrequent counterpart of defect of the similarly exposed fibula. Kirmisson notes in this connection the scar-like mark over the bowed ulna which occurs in some of these cases of radial defect.
doi:10.1056/nejm189809011390902 fatcat:oelouczys5g2pbrvrkuuzdlmqm