Le Progres Medical contains an interesting account of a curious contest held between dismembered athletes at Nogent-Sur-Marne, a small town in the Department of the Seine, in France. Responding to a general invitation, no less than seven individuals who had lost either leg or thigh, competed in running races for prizes. The enterprising cripples were divided into two classes: the cuissards, or those who had lost a thigh, and jambards, or those who had lost a leg; and, contrary to what might have been expected, the grand champion came from the former class. The distance in each race was 200 meters. M. Roullin, whose thigh, in consequence of an accident, was amputated in 1887, succeeded in traversing the course in the remarkable time of thirty seconds (about 219 yards); whereas M. Florrant, the speediest jambard, required thirty-six seconds to run the same distance; and was, moreover, defeated by two other cuissards besides the champion. The junior race was won in thirty-five seconds, and this curious day's sport was ended by a course de consolation, which was carried off in thirty-three seconds by M. Mausire, but whether he was a cuissard or a jambard was not stated.
On several occasions in England, cricket matches have been organized between armless and legless men. In Charles Dickens' paper, "All the Year Round," October 5, 1861, there is a reference to a cricket match between a one-armed eleven and a one-legged eleven. There is a recent report from De Kalb, Illinois, of a boy of thirteen who had lost both legs and one arm, but who was nevertheless enabled to ride a bicycle specially constructed for him by a neighboring manufacturer. With one hand he guided the handle bar, and bars of steel attached to his stumps served as legs. He experienced no trouble in balancing the wheel; it is said that he has learned to dismount, and soon expects to be able to mount alone; although riding only three weeks, he has been able to traverse one-half a mile in two minutes and ten seconds. While the foregoing instance is an exception, it is not extraordinary in the present day to see persons with artificial limbs riding bicycles, and even in Philadelphia, May 30, 1896, there was a special bicycle race for one-legged contestants.
The instances of interesting cases of foreign bodies in the extremities are not numerous. In some cases the foreign body is tolerated many years in this location. There are to-day many veterans who have bullets in their extremities. Girdwood speaks of the removal of a foreign body after twenty-five years' presence in the forearm. Pike mentions a man in India, who, at the age of twenty-two, after killing a wounded hare in the usual manner by striking it on the back of the neck with the side of the hand, noticed a slight cut on the hand which soon healed but left a lump under the skin. It gave him no trouble until two months before the time of report, when he asked to have the lump removed, thinking it was a stone. It was cut down upon and removed, and proved to be the spinous process of the vertebra of a hare. The bone was living and healthy and had formed a sort of arthrodial joint on the base of the phalanx of the little finger and had remained in this position for nearly twenty-two years.
White has described a case in which a nail broken off in the foot, separated into 26 splinters, which, after intense suffering, were successfully removed. There was a case recently reported of a man admitted to the Bellevue Hospital, New York, whose arm was supposed to have been fractured by an explosion, but instead of which 11 feet of lead wire were found in it by the surgeons. The man was a machinist in the employ of the East River Lead Co., and had charge of a machine which converted molten lead into wire. This machine consists of a steel box into which the lead is forced, being pressed through an aperture 1/8 inch in diameter by hydraulic pressure of 600 tons. Reaching the air, the lead becomes hard and is wound on a large wheel in the form of wire. Just before the accident this small aperture had become clogged, and the patient seized the projecting wire in his hand, intending to free the action of the machine, as he had previously done on many occasions, by a sharp, strong pull; but in so doing an explosion occurred, and he was hurled to the floor unconscious. While on the way to the hospital in the ambulance, he became conscious and complained of but little pain except soreness of the left arm about the elbow. The swelling, which had developed very rapidly, made it impossible for the surgeons to make an examination, but on the following day, when the inflammation had subsided sufficiently, a diagnosis of fracture of the bones of the arm was made. There was no external injury of the skin of any magnitude, and the surgeons decided to cut down on the trifling contusion, and remove what appeared to be a fragment of bone, lodged slightly above the wrist. An anesthetic was administered, and an incision made, but to the amazement of the operators, instead of bone, a piece of wire one inch in length and 1/8 inch in diameter was removed. On further exploration piece after piece of the wire was taken out until finally the total length thus removed aggregated 11 feet, the longest piece measuring two feet and the shortest 1/4 inch. The wire was found imbedded under the muscles of the arm, and some of it had become wedged between the bones of the forearm. Probably the most remarkable feature of this curious accident was the fact that there was no fracture or injury to the bone, and it was thought possible that the function of the arm would be but little impaired.
Tousey reports a case of foreign body in the axilla that was taken for a necrotic fragment of the clavicle. The patient was a boy of sixteen, who climbed up a lamp-post to get a light for his bicycle lamp; his feet slipped off the ornamental ledge which passed horizontally around the post about four feet from the ground, and he fell. In the fall a lead pencil in his waistcoat pocket caught on the ledge and was driven into the axilla, breaking off out of sight. This was supposed to be a piece of the clavicle, and was only discovered to be a pencil when it was removed six weeks after.
There are several diseases of the bone having direct bearing on the anomalies of the extremities which should have mention here. Osteomalacia is a disease of the bones in adult life, occurring most frequently in puerperal women, but also seen in women not in the puerperal state, and in men. It is characterized by a progressive softening of the bone-substance, from a gradual absorption of the lime salts, and gives rise to considerable deformity, and occasionally to spontaneous fracture.
Rachitis or rickets is not a disease of adult life, but of infancy and childhood, and never occurs after the age of puberty. It seldom begins before six months or after three years. There are several theories as to its causation, one being that it is due to an abnormal development of acids. There is little doubt that defective nutrition and bad hygienic surroundings are prominent factors in its production. The principal pathologic change is seen in the epiphyseal lines of long bones and beneath the periosteum. Figure 213 shows the appearance during life of a patient with the highest grade of rachitis, and it can be easily understood what a barrier to natural child-birth it would produce. In rachitis epiphyseal swellings are seen at the wrists and ankle-joints, and in superior cases at the ends of the phalanges of the fingers and toes. When the shaft of a long bone is affected, not only deformity, but even fracture may occur. Under these circumstances the humerus and femur appear to be the bones most likely to break; there is an associate deformity of the head, known as "craniotabes," together with pigeon-breast and various spinal curvature. The accompanying illustration is from a drawing of a skeleton in the Warren Museum in Boston. The subject was an Indian, twenty-one years of age, one of the Six Nations. His mode of locomotion was by a large wooden bowl, in which he sat and moved forward by advancing first one side of the bowl and then the other, by means of his hands. The nodules or "adventitious joints" were the result of imperfect ossification, or, in other words, of motion before ossification was completed.
Analogous to rachitis is achondroplasia, or the so called fetal rickets—a disease in which deformity results from an arrest, absence, or perversion of the normal process of enchondral ossification. It is decidedly an intrauterine affection, and the great majority of fetuses die in utero. Thomson reports three living cases of achondroplasia. The first was a child five months of age, of pale complexion, bright and intelligent, its head measuring 23 inches in length. There was a narrow thorax showing the distinct beads of rickets; the upper and lower limbs were very short, but improved under antirachitic treatment. The child died of pneumonia. The other two cases were in adults, one thirty-nine and the other thirty-six. The men were the same height, 49 inches, and resembled each other in all particulars. They both enjoyed good health, and, though somewhat dwarfed, were of considerable intelligence. Neither had married. Both the upper and; lower limbs showed exaggerations of the normal curves; the hands and feet were broad and short; the gait of both of these little men was waddling, the hunk swaying when they attempted to make any rapid progress.
Osteitis deformans is a hyperplasia of bone described by Paget in 1856. Paget's patient was a gentleman of forty-six who had always enjoyed good health; without assignable cause he began to be subject to aching pains in the thighs and legs. The bones of the left leg began to increase in size, and a year or two later the left femur; also enlarged considerably. During a period of twenty years these changes were followed by a growth of other bones. The spine became firm and; rigid, the head increased 5 1/4 inches in circumference. The bones of the face were not affected. When standing, the patient had a peculiar bowed condition of the legs, with marked flexure at the knees. He finally died of osteosarcoma, originating in the left radius, Paget collected eight cases, five of whom died of malignant disease. The postmortem of Paget's case showed extreme thickening in the bones affected, the femur and cranium particularly showing osteoclerosis. Several cases have been recorded in this country; according to Warren, Thieberge analyzed 43 cases; 21 were men, 22 women; the disease appeared usually after forty.
Acromegaly is distinguished from osteitis deformans in that it is limited to hypertrophy of the hands, feet, and face, and it usually begins earlier. In gigantism the so-called "giant growth of bones" is often congenital in character, and is unaccompanied by inflammatory symptoms.