Clinical records from the Glasgow Royal Infirmary / by Geo. S. Middleton.

  • Glasgow Royal Infirmary.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Clinical records from the Glasgow Royal Infirmary / by Geo. S. Middleton. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    the nose. The tongue is very greatly enlarged in length, breadth, and thickness, and its surface presents many irregular fissures. The arch of the palate is flat and very broad. The uvula is not apparently enlarged, and the tonsils seem normal. The ears are large and flat, and the cartilages are so hardened as to give the impression that they could very easily be broken. There is no such hardening of the car- tilages of the nose or of the eyelids. [This hardening of the aural cartilages was supposed to be due to infiltration with calcareous salts, but it is very doubtful if that is the cause; for the pinnae of the ears are translucent, and Dr. Coats informs me that, according to his wide experience, tissues infiltrated with lime salts are not translucent.] The head is well covered with a thick growth of hair, somewhat harsh in character, originally dark brown, now mixed with grey. The hair of the beard is thin and short, but otherwise apparently normal. The eyebrows are somewhE^t thin. When he is made to sit on the edge of his bed, there is a general rounding of his back with a slight degree of lordosis. The neck is somewhat thickened. The thorax is very greatly deformed, which is perhaps best seen when he lies on his back. In this position the trunk forms a sort of pyramid—the base formed by the shoulder and pelvic girdles, and the apex by the xiphoid cartilage. The sternum is carried forwards so that the xiphoid forms a very marked prominence. The latter measures 2 inches transversely, and feels as if ossified. The margin of the costal arch is very prominent, thick, and rounded, and almost all the ribs are thickened and broadened. At the junction of the costal car- tilages with the osseous ribs there is some thickening, but very different from the rachitic rosary. The clavicles are large and thick, and their sternal ends seem unduly movable. The hands present typically the broad, spade-like character, and the fingers are broad and flat, without tapering or any- thing of rheumatic deformity or of the natui'e of clubbing (see Plate). The palmar aspects are well padded with soft cushiony tissues, and the skin presents a markedly furrowed