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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    fingers of phthisis, empyema, or heart disease. And although in parrot-beak clubbing the enlargement is mainly antero-posterior and dorsal, whereas in the more ordinary form it is mainly lateral and palmar, intermediate con- ditions are occasionally met with. Moreover bone changes in the forearm and leg are sometimes found associated with the ordinary type of clubbing. Marie’s description, based partly upon the Gouraud case (No. 11) and that of W. Hagner (No. 2), gives the impression that the nail bed is raised by bony overgrowth ; and this may sometimes be the case. But Therese and Lefebvre’s case (No. 19) and Freytag’s case (No. 34), which were typical during life, had no enlarge- ments of the terminal phalanges after death. Arnold’s post- mortem examination of the Hagner case showed that there was very little enlargement there ; and other accepted cases do not give the impression that bony overgrowth is the chief cause of the peculiar shape of nail and finger end. It is well known that ordinary clubbed fingers are much less marked after death. The same has been noted in some cases of osteopathy, e.g. Springthorpe’s case (No. 59). Periodical variations in size are also to be found during life both in ordinary and in parrot-beak clubbing (Cases 19, 64), and in each case the enlargement may sometimes be more or less rapidly removed by suitable treatment of the primary disease. We may therefore safely conclude that in both kinds of clubbing the alteration is mainly due to changes in the soft tissues and their vascular supply. Freytag (Case 34) describes dilatation of the capillary loops under the nail with enlargement of the interpapillary processes, but no other alteration in the skin ; no sclerosis of corium or subcutaneous tissue ; no endarteritis obliterans, and no thickening of nerve- sheaths. In Therese’s case (No. 19) there was slight hyper- trophy of the horny layer, papillae, and connective tissues of the derma. The clubbing in osteopathy is usually best marked in the thumb and middle finger, although the index is sometimes as much or more altered than the medius. In the foot the big toe is always disproportionately affected. The appearance of the toes is of the same kind as of the fingers, but less characteristic, owing to boot-pressure and other causes.