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
Catalogue details

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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    duration of the atrophy suggest organic changes either central or peri- pheral. The presence also of increased tendon reactions, sometimes of contractures, and the fact that very rarely a lateral sclerosis may start from an arthritic attack* indicate that we may have changes not only in- the motor cells but also probably in the terminations of the pyramidal tract or in that network of nerve fibrillse by which they are supposed to be connected with the ganglionic cells, changes possibly not detectable- by the microscope, yet, in all probability, more than functional. (2) That one of the plainest and commonest phenomena of acute, subacute, or chronic rheumatism is wasting of the interosseous muscles of the hand ; and that while some cases may be explained in the same way as other arthritic atrophies, viz., reflexly from inflamed knuckles,, there is sufficient evidence that in a large number of cases the atrophy is due to an ulnar neuritis. Thus, in ulnar paralysis the index and Fio. 9. middle fingers are less affected than the two inner fingers, because, as yoir will remember, the outer two humbricales are supplied by the median. Now this is usually, though not invariably, the case in the rheumatic hand, as you see in Fig. 2, where the little and ring fingers show over-extension of the first phalanges and flexion of the others. In rheumatism too there appears to be a special incidence on the adductor pollicis and the abductor indicis. Confirmatory evidence- of neuritis is afforded by the frequency with which impaired cutaneous sensibility is met with in the ulnar nerve territory, along with thickening and tenderness over the trunk of the nerve itself. (3) That although the ulnar is by far the commonest nerve to be affected, there is substantial proof that other nerves of the brachial plexus and that branches of the lumbar and sacral plexuses are also- frequently attacked. • Gowor's Diseases of the NorvouB System. Vol. I., p. 330.