Licence: Public Domain Mark
Credit: Syringomyelia. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![Fir;. 19. involved are relaxed or destroyed, with a consequent mobility of the adja- cent ends of the bone. Such was the condition in a patient of Dr. Alexis Thomson, of Edinburgh. (Fig. ]5.) A similar condition was also seen in Dr. Dercum's case at the Philadelphia Hospital. (Fig. 18.) Dr. Thomson calls attention to the fact that it is clearly the duty of the surgeon in all cases of unusual forms of joint-disease, repeated dislocation, or spontaneous fracture, to investigate accurately the sensibility to pain and temperature,— features which will occupy our attention later,—for otherwise this disease will continue to escape recognition in surgical practice. (d) The Bones.—Lastly, we may have serious alterations of the shafts of the bones. Fractures occasionally occur spontaneously, or by slight efforts or accidents. These fractures, like the arthropathies, are painless, and hence may escape detection for a considerable length of time. Union is delayed, and there is a great liability to vicious or redundant callus. In some cases the fracture remains ununited, and a false joint forms. One of the best illustrations of fractures of this kind is that of Schultze,. cited by Thomson and Bruhl. It occurred in a healthy man, aged twenty-four, in whom the first evidence of syringomyelia was a spontaneous fracture of the humerus, caused by an energetic muscular effort. Be- cause of the loss of sensibility to pain this patient only knew of his fracture by the noise of the break and by the loss of power in the limb. He subsequently fractured his left radius and fifth metacarpal,—all bones of the upper extremity. After death, at a later period, of septic meningitis, Schultze found that all the fractures had united in a satisfactory manner, and that there was no abnormal fragility of the bones, such as might have been reasonably expected. He en- deavors to explain the liability to fracture in these cases by the loss of the muscular sense and of sensibility to pain, allowiug the patient to exert more muscular effort than is required for the object in view or than the bone can stand. Lastly we may have trophic changes in the bones, particularly of the hands and fingers, that partake of the nature of acromegaly.1 (2) Deviations of the Spinal Column.—Changes in the spinal column have been observed in so many cases of syringomyelia that they have come Scoliosis in syringomyelia. (Cursch mann's case.) 1 See cases of Marie, Holsckevnikoff, and Peterson.](https://iiif.wellcomecollection.org/image/b21218754_0040.jp2/full/800%2C/0/default.jpg)
