On the study of the hand for indications of local and general disease / by Edward Blake.

  • Blake, Edward T. (Edward Thomas), 1842-1905.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: On the study of the hand for indications of local and general disease / by Edward Blake. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    25/60 (page 29)
    It is an adult male disease, seldom seen in women, pos- sibly because they do not carry a cane; rare in the young, suggesting trauma as an exciting cause. It is not to be confounded with congenital contraction of the little finger, common to both sexes. The distinctive features may be tabulated thus : — Congenital form is often : (1) Hereditary ; it is (2) Stationary and nearly always (3) Symmetrical. Acquired form is usually (1) Unilateral; if bilateral, then (2) Asymmetrical, and it is essentially (3) Progressive. Many of the sufferers from gout, and most of the • subjects of rheumatoid arthritis, are prone to temporary attacks of chondritis with fibrous degeneration, followed by bulging of the cartilage, known as “ lipping,” due to muscular traction on the opposing articular surfaces. I will not go into the question of what is the distinc- tion between Heberden’s nodes and Haygarth’s nodosities, about which so many doughty pathological knights have broken a lance ! It is now the fashion to say that the former are gouty, the latter rheumatoid. We may note though that Heberden, in his original treatise, definitely • states that these manifestations observed by him did not occur in the subjects of gout. I will merely ask the reader to note the highly interesting point that Bouchard found so great a proportion of cases having enlarged proximal pha- langeal joints in his examples of dilated stomach (see p. 18). This has been confirmed by the writer. It may be added that it is the terminal phalangeal articulations which are usually found affected after oral and pelvic suppuration. It is of interest to remember that whilst gout shows a marked preference for the hallux, the corresponding pollex so frequently selected by cerqbro-spinal disease, as a com- mencing site, often entirely escapes the attacks of rheuma- tism and its allies. A. notable exception is Fortescue Fox’s ‘‘thumb-base arthritis,” usually traumatic. Here the palm becomes cupped and the freedom of thumb-play is gravely impaired.