Osteo-arthropathy and its relationships : with abstracts of recorded cases, and a note by Dr. E. Legrain on cases observed in the Sahara : also a case of hyperplastic osteo-arthritis / by F.R. Walters.

  • Walters, F. Rufenacht (Frederick Rufenacht)
Date:
1897
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Licence: Public Domain Mark

Credit: Osteo-arthropathy and its relationships : with abstracts of recorded cases, and a note by Dr. E. Legrain on cases observed in the Sahara : also a case of hyperplastic osteo-arthritis / by F.R. Walters. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    there was double the usual proportion of lime salts without any increase in magnesia salts ; but I regard this as a case of acromegaly. Rauzier's case (No. 22) showed increase in quantity with low specific gravity. My own case (No. 64) had on several occasions a remarkable diminution in the daily quantity, and in urea, with deposit of lithates and oxalates. In Redmond's case (No. 17) there was excess of phosphates. Case 36 also showed slight albuminuria ; Case 43 diminution of phosphates and urea, with a trace of albumen. In Case 13 (not quite typical) there was towards the end a great diminution in urea, chlorides, and phosphates. The genital organs present no enlargement and no con- stant changes. Functional incapacity or inactivity is usually present; but that would be expected wherever the system is much exhausted by long illness. In Posmantir's case the left testicle was atrophied; but this is a doubtful case. The condition of the heart and lungs will be considered with the aetiology. Here it need only be mentioned that the former was often and the latter were almost invariably affected, and that in several cases the veins were either dilated and varicose or thickened. According to Lefebvre the arteries and veins at the wrist in Therese's case (No. 19) were normal under the microscope. Diagnosis.—Where only the finger ends are affected it will be necessary to distinguish osteo-arthropathy from ordi- dary clubbing of heart and lung disease. The relation which these bear to one another will be considered later on. Ordinary clubbing may also be associated with other forms of bone and joint disease. Chronic rheumatism of the smaller joints will be distinguished by the history and effects of treatment. Rheumatoid arthritis causes more distortion, and gives rise to lipping and nodular projections near the affected joints, which are altered in shape in a more or less characteristic manner. The conditions grouped together by Bouchard under the name of pseudo-rheumatism require con- sideration. They usually come on in the course, or as a sequel of some well-marked febrile disease, such as scarlatina, variola, typhoid fever, gonorrhoea, or pyaemia. They are fixed and oligo-articular, unlike acute rheumatism ; are more liable to affect large joints than small, and are frequently