A practical treatise on medical diagnosis for students and physicians / by John H. Musser.

  • Musser, John Herr, 1856-1912.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on medical diagnosis for students and physicians / by John H. Musser. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    is rendered more conspicuous by the atrophy of adjacent muscles. (See Fig. 30.) Physicians with large experience in this affection lay stress upon the frequent involvement of the temporomaxillary articulation, which is never seen in gout. In addition to the articular symptoms other phenomena attend the process. One of the more common is increased frequency of the pulse. Although the patient is afebrile, the average pulse-rate is 100 to 120, or even higher. Moreover, the pulse is soft and compressible, in contra- distinction to the pulse of gout and rheumatism. It is worth noting that a return to the normal pulse-frequency is a sign that the progress of the disease is arrested, although the joint-lesions remain. The condition of the skin is characteristic. It is soft and often much freckled, while the complexion is fair. C. T. Griffiths has observed the pigmentary cutaneous changes, along with neural symptoms, prior to the joint-manifestations, and describes two forms : a diffuse melasmic discol- oration, and dark-brown spots resembling moles, but not raised. Moisture of the skin with clamminess is common. It is limited to the palms of the hands or may occur in the distribution of certain nerves. The sweats are not acid; they are usually local, but may be profuse. Pain inde- pendent of the joint-lesion is due to neuritis, and may precede the joint- trouble. It is not confined to the nerve-trunks, but affects the smaller branches which are distributed to muscles, as the group at the base of the thumb. Numbness and tingling are often present. The disease is steadily progressive. In extreme cases not only are the limbs crippled, deformed, and helpless, but there is fixation of the cervical spine and of the articulations of the jaw, so that the patient can not move the head or masticate food. The first phalanx of the fingers is either flexed upon the metacarpus or extended, and the terminal phalanx in like manner is either markedly flexed or extended upon the second, or these two phalanges are held in extension, while the first phalanx is, as usual, decidedly flexed upon the metacarpus. The hand is pronated and the fingers turn toward the ulnar side. (Palmer Howard and Char- cot. (See Fig. 329.) The foot is abducted and flattened, and the great toe abducted across and above the other toes. Rarely it may be beneath the other toes. The metatarsophalangeal joint is enlarged. A variety of the disease is sometimes encountered, chiefly in old persons (senile arthritis), in which the tendency is to involve one or two joints, particularly the hip, or hip and knee. It is of slow progress, and is otherwise attended with the same deformities as the usual polyarticular form. Diagnosis. Rheumatoid arthritis is distinguished from gout by the absence of heredity and by its development under the exhausting influ- ences of repeated pregnancies, lactation, poverty, and malnutrition. Rheumatoid arthritis is progressive, with occasional remissions ; gout occurs in successive attacks, with intermissions. Uric acid is absent from the blood in the former and is present in gout. Rheumatoid arthritis in the vast majority of the cases is subacute or chronic. The acute form is distinguished from acute gout by the duration of the paroxysm and the absence of intermissions; by there being less heat, swelling, and redness