Nutrition in wasting diseases of children and adults / by David Walsh.

  • Walsh, David.
Date:
1904
Catalogue details

Licence: In copyright

Credit: Nutrition in wasting diseases of children and adults / by David Walsh. 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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    [4] (D. Walsh) Radiogram of Hand in Chronic Osteo- arthritis. connection with pulmonary osteo-arthopathy. In my experiences the joint changes in these cases are the essential feature, and the thoracic trouble an accidental complication of more or less severity. For some years past I have had a large experience of osteo-arthritic cases at the Tallerman Free Institute. Scores of chronic osteo-arthritic or rheumatoid conditions were seen ; a fair number, perhaps 25 per cent, of them, showed marked wasting, but I can recall only two or three in which there was serious advanced disease of heart or lungs. At the same time slight valvular murmurs were common enough, as might be expected from the frequent history of rheumatic fever in osteo-arthritic cases. It may be of interest to insert here a radiogram which I have taken of the left hand of this patient. It shows in various joints—as about the phalanges and wrist—the typical light bony out- growths near the articulations, with destruction of cartilages and partly of epiphyses well seen in the first and fourth metacarpo - phalangeal joints. These appearances differ markedly irom the bone changes in chronic gout, where parts of the bones are cut cut sharply as if by a gouge. The thumb is dislocated from the metacarpal bone and its metacarpo - phalangeal joint is dis- organised. The styloid process of the ulna is hypertrophied (it is tender to pressure). The wrist bones generally are obscured by effused material. The figure is a good specimen of the condition of bone met with in rheumatoid or, as it is nowadays more commonly called, “ ostco- arthritis, while the typical fusiform thickening of the fingers in that disease is particularly well shown.