Report on Neurology

1910 Boston Medical and Surgical Journal  
The patient is a girl of thirteen years whose left arm was amputated in its upper fourth by Dr. L. A. La Garde, of the United States Army, for congenital cavernous telangiectasis eighteen months ago. The condition for which the amputation was done extended from the fingers to the upper and midelle; thirds of the arm. Dr. La Garde kindly asked mi' to see the case; in consultation with bim; he exhibited the little patient at meetings of this society both before and after operation. The ampul at
more » ... n stump was in all ways excellent, the flaps we're ample, the bone' well covered. Those' of you who we're' here when the' patient was shown directly after the amputation may remember that the' view was expressed thai the bone would " grow down," that the stump woulel become conical anel require bone resection. At this time you sec that the prediction has been fulfilled; the stump is markedly conical, the bone' presses against the skin, the skin is beginning to lie' adherent through this pressure. The stump is painful anel a suitable amount of bone will be resected tomorrow. ' In previous papers2 I have' called attention to the practical certainly that when a little child suffers amputation through the upper part of the arm or the upper part of the leg a conical condition of the stump will result. I have never known this to fail. It occurs because the humérus and the bones of the; leg develop in large' part from their upper epiphyses. The' growth takes place at the upper epiphysis anel pushes the bone down into anel through the soft parts. When the surgeon does his original operation it is best for him to tell the parents that this will probably take place. The; younger the child, the' more' frequently will the bone have to be cut off. The Soeie'té de Neurologic and the Société de Psychiatrie devoted four sessions to the discussion of this problem 21 at the first annual reunion of the two societies last winter, dealing with the psychological, physiological, neurological and psychiatrical problems. Janet discussed the question on the psychological side. The reaction of the individual to any special circumstance may often be determined in advance by his constitution and education; in other cases, although the -'< lîev. Noiirol., xvii, 1S51, Deo. 30, HIUO. > reaction is not organized in advance, there is a partial adaptation to the circumstance; in neither case does he consider that there is place for emotiem. There are, however, circumstances for which the individual is not adapted by his previous organization, and to which he cannot adapt himself, although he perceives the circumstances and feels the necessity of reacting to them. In these cases, instead of the useful reaction, there are various disturbances of all the; functions of the organism. To these disturbances, coming on under these conditions, he gives the name of " emotion." The disturbances are very complex. There arc modifications of feeling, giving rise to fear, anger, shame, indignation, discouragement, despair, pain, or feelings of inadequacy, weakness, incapacity, indecision, etc. There are intellectual modifications, systematized agitations in the form of fears, obsessions and the like, or loss of memory anel confusion. There are various disturbances of the visceral functions,
doi:10.1056/nejm191011101631907 fatcat:zbxjvrjyfrcrhgc3vbaupz4hee