A system of practical medicine. By American authors. Vol. 2 : $b General diseases (continued) and diseases of the digestive system
Science
A system of practical medicine. By American authors. Vol. 2 : $b General diseases (continued) and diseases of the digestive system
Medicine -- Practice
[Footnote 15: Z. Oppenheimer prefers the name rachitic asthma in place
of laryngismus, and suggests an explanation of the symptoms from a
strictly anatomical point of view. If not correct, it is at all events
interesting, as everything this ingenious writer proposes. He points to
the ligament situated between the spinæ intrajugulares of the temporal
and occipital bones, which, as long as it is of normal consistency,
separates the jugular vein from the pneumogastric nerve. As it is
covered with periosteum and dura, it is apt to ossify, and forms an
osseous partition in the foramen jugulare, which participates in all
the changes taking place in the periosteum. As this becomes softened
and succulent, so will the ligament, either on both sides or on either.
Its influence on the neighborhood depends on its size or succulence (as
also on the difference in width of the foramen jugulare or lacerum,
which corresponds with the difference in size of the transverse
sinuses). The irritation of the pneumogastric is perhaps easily
explained thereby, but in very exceptional cases only the accessory
nerve would be affected. As, however, the latter controls the
sterno-cleido mastoid and trapezius, and also the laryngeal muscles,
and is apt to provoke cardiac paralysis during diastole, the occurrence
of sudden death would be best accounted for.]
While the size of the cranium is normal, or sometimes more than normal,
the face undergoes some changes which result in absolute or relative
diminution of size. These depend mostly on a reduction in the volume of
the jaws. Glisson knew of it, and therefore looked for the cause of
rachitis in the process of dentition. Now, both maxillæ are liable to
become rachitical at an early date, as early indeed as the bones of the
cranium. Rachitical deposits and softening take place in them very
generally. The lower maxilla is flat anteriorly, it loses its rounded
outline, is shorter in longitudinal direction, while the rami are thick
and clumsy; the whole bone is shorter than normal, and sometimes
asymmetric. Its changed appearance is greatly due to the effect the
muscles, with their powerful insertions, produce on the softened bone;
mainly the masseter, also the mylohyoid, which draws the lateral
portions inward, and the geniohyoid, which pulls at the central
portion. Of the latter, the lower portion is drawn out, the inner and
the alveolar part inward. Thus, the teeth, mainly the incisors, of the
lower jaw are turned inward to such an extent that, as those of the
upper look outward, the two rows of teeth do not touch but cover each
other. Besides, the periosteal proliferation around the alveoli is
excessive, sometimes so much so as not only to crowd the teeth into
irregular positions, but even to absorb and annihilate alveolar
processes in the course of the morbid changes. The cases in which the
number of teeth are actually diminished by rachitis are not at all
rare. In the superior maxilla the last-described anomaly is also
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