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.

    12/26 (page 10)
    ^10 little fingers were more flexed at the two terminal joints, and still hyperextended at the first. The forearm extensoft appeared to be wasted. Both ulnar nerves were tender to pressure. On testing the interossei with electricity, they showed diminished reactions to both the faradic and galvanic currents, but probably no qualitative change to galvanism. The patient is now (May 1st) in much the same condition. The nodules at left elbow are, however, much larger. It has been noticed for a week or two that the lower ends of both ulnar bones are distinctly thickened near the styloid process. ^ In this patient then, suffering from an attack of acute rheumatism, as proved by the articular affection, the sweating, the pyrexia—varying from 99° to 102°—the crops of subcutaneous nodules and the existence in all probability of endocarditis, we have (1) tenderness and swelling over the ulnar nerves with atrophy and paresis of the abductor indicis and other interosseous muscles supplied by these nerves; (2) probably similar atrophy of the interossei of the left foot supplied by branches from the posterior tibial; (3) temporary ana38thesia in the region of the internal saphenous nerve. It would be tedious to relate other cases in detail, so perhaps you will take my word for it, that the following were truly examples of what is understood as articular rheumatism. Case 2.—Another patient of Dr. Dreschfeld's, who had a severe attack of acute rheumatism accompanied by endocarditis, pericarditis, and pleuro-pneumonia, also presented marked wasting of the interossei. The hands were good examples of what might be called the typical rheumatic hand. Thus, when at rest, the metacarpal portion looks concave, the knuckles form a prominent anterior barrier of this shallow hollow, and the wrist the gradually sloped posterior boundary. The general concavity is interrupted (in this patient) by the extensor tendons of the middle and ring fingers. The concave metacarpus is well seen by looking at it from the ulnar side; then, instead of a straight or slightly convex line as in health, a concave one is seen, which is especially marked over the first space, owing to atrophy of the abductor indicis. In this patient there was also slight thickening of the left ulnar nerve. There was distinct wasting of the muscles on the front of the legs, and purpuric spots were present on the outer sides. Case 3.—A lady, under my own care, with rheumatic fever, which began in December, 1886, and was very severe and complicated by peri- carditis and left pleurisy. Almost at the outset she had partial anaesthesia in the distribution of the ulnar nerve on one side, and also along the inner side of the same arm, corresponding to the distribution of the inter- nal cutaneous nerve ; this aneesthesia lasted three or four days. There was wasting of all tho thumb muscles and of the interossei; and the