Peripheral neuritis in acute rheumatism and the relation of muscular atrophy to affections of the joints / by Judson S. Bury.

  • Bury, Judson Sykes.
Date:
1888
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Licence: Public Domain Mark

Credit: Peripheral neuritis in acute rheumatism and the relation of muscular atrophy to affections of the joints / by Judson S. Bury. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    lift fifteen weeks, and was followed by general muscular wasting. Dr. Reynolds, who was then doing duty at the Pendleton Dispensary, took notes of her case. I remember seeing her much wasted, with consider- able articular deformity, and the right hand presented a marked *' claw like position. Cast 10.—A man, aged 44, recently under the care of Dr. Morgan, who had had several attacks of rheumatism during the last 20 years. Last October he was feverish, sweated much, and many joints were painful and swollen, and the doctor in attendance said he had rheumatic fever. He began to get thin afterwards, and has wasted ever since. There is now (January, 1888,) general and great muscular atrophy and fibrillation of many muscles. There is also some irregularly distributed anaesthesia on the right forearm, and the front of the right leg. All the tendon reactions are slightly increased. A mitral systolic murmur is heard, and is conducted round to the angle of the scapula. There is very evident enlargement of the ends of some of the long bones; thus, at the elbow, the bones feel much thickened, and this is especially noticeable with the head of the radius. Down each side of the front of the chest, and corresponding in appearance and position to the rickety beads met with in a young child, there is a remarkable row of bony nodules, apparently due to thickening of the ribs. These little knobs are certainly not the relics of rickety beads; the latter are due mainly to overgrowth of cartilage, and never persist into adult life. In three or four other cases I have noticed hypertrophy of the ends of the long bones in acute rheumatism; sometimes the coronoid process of the ulna is felt thickened; sometimes its lower end near the styloid process, as in Case 1, and in the case just related, many bones were afiiected. There is sometimes great tenderness over the thickened portion of the bone, suggesting periostitis, and sometimes a little fibrous nodule maj' be felt adherent to the presumably-inflamed periosteum. [Such features as muscular atrophy, hypertrophy of bone, together with a similar deformity of hand botli in rheumatic fever, and in the most chronic form of rheumatoid arthritis, point surely to an almost identical pathology.] With regard to tlie cases of general muscular atrophy, are we to regard them as examples of a general trophic change set up reflexly by much joint irritation, or have we, as the ansestliesia in one case would seem to indicate, a degeneration of the extremities of a large number of peripheral nerves'! The last group to which I would invite your attention, is that embracing local palsies and atrophies of muscle in cases of chorea. Case 11.—There is a patient now in the Infirmary, under Dr. Simpson, a girl aged 20 years, who had articular rheumatism, affecting Riainly the joii^ts of tbe low^r Umbs, just before Cliristm^. In February