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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    In 1869, Olli-rier, in his thesis on muscular atrophies, alludes to a case under the care of Duchenne, in which a traumatic synovitis of the knee was followed by great wasting of the thigh muscles, and he suggests the reflex nature of the phenomenon, and adds that such muscular atrophy is also met with in chronic articular rheumatism. Vulpian also, in 1875, pointed out that the wasting begins almost as soon as the arthritis, and he ranges it amongst reflex atrophies.. Fort, in 1876, showed that a slight arthritis of the shoulder may be accompanied by such rapid atrophy of the deltoid, that in eight days the flattening of the shoulder may simulate the deformity due to dislocation. Sir James Paget, in his clinical lectures, also speaks of the extreme rapidity with which this muscular atrophy supervenes in all acute articular inflammations. But the most complete and suggestive account of the subject is to be found in a thesis by Valtat, published in 1877. He points out the importance of noticing that although it is difficult to separate paralysis from atrophy, yet sometimes the former is present without the latter; thus he mentions a severe sprain of the wrist where, after the pain and swelling had gone, there was found complete paralysis of the extensor muscles, while the atrophy was absent or doubtful. The muscular atrophy, he says, is always marked and distinct at the beginning of the second week; thus, between eight and eleven days after a knee arthritis, the thigh on the affected side will measiire about one inch less than the healthy thigh, '<' Pain is not essential as an antecedent, for an indolent hydrarthrosis may be followed by atrophy; and, conversely, Paget has observed similar wasting consecutive to a neuralgic joint pain without inflammation. The extensor muscles are the most profoundly and the first to be affected. Thus, the quadriceps, when the knee is inflamed; if the hip, the glutei chiefly waste; if the shoulder, the deltoid; if the elbow, the triceps. But it is not uncommon, Valtat says, especially in old cases, to gee other muscles affected, even an entire limb, although only one joint is inflamed. Valtat obtained similar results by experimenting on dogs. He injected irritating substances, as ammonia^ into the joints, and the resulting arthritis was always very intense, and the ensuing atrophy rapid and extensive, involving the whole limb in a few days; but, even here, the extensor muscles showed the greatest wasting. Valtat, in seeking for an explanation, rejects disuse on account of the rapidity and degree of the wasting, and shows, too, that the effect cannot be due to any local inflammation of the muscles or nerves passing to them from the affected joints, for the whole length of a muscle suffers equally; moreover, he found no signs of inflammation on microscopical