Leyden" records the case of a man, aged sixty-four, who suffered from arthritis deformans, which, among other parts, involved the lumbar spine. One night the patient was suddenly attacked with intense pain in the left thigh, and on the following morning could not stand on account of it. The pain gradually passed off, leaving a sen sation of deadness in the limb.
A middle-aged woman, at present under my care, who has multi ple arthritis deformans, and pain and stiffness of the cervical and dorsal spine, complains of a pain extending down the left arm to the fingers, which she describes as of a burning character " like mus tard," and has also a sensation of numbness in the ring and little fingers of the left hand.
Jibior Sensury Symptoms.—Numbness and tingling of the bands and feet are not at all uncommon symptoms, and may be met with very early in the disease, even before there is any recognizable affec tion of the joints of the part. I have seen many cases in which such symptoms were experienced, and Homolle" and Howard " have both called attention to their occurrence in the early stages of this malady.
Disturbance.—In chronic cases of arthritis deformans there is little or no febrile disturbance, but when the disease assumes its acute or subacute form the temperature may be considerably raised. In many cases the curve conforms to the hectic type, showing a normal temperature in the early part of the clay, and a rise of two or three degrees toward evening. Sometimes, as Kahler " has pointed out, the variations in the amount of febrile disturbance appear to be inde pendent of any changes in the condition of the joints.
Cirettlatopy Distwbances.—One of the phenomena of arthritis de formans observed by Spender is the undue frequency of the pulse, which is a very frequent and early symptom, and which is quite in dependent of any rise of temperature. It is quite a common thing to meet with a pulse rate of over 100 beats in the minute, and some times, as Duckworth says, there is associated with this palpitation of the heart.
The tension of the pulse tends to be low rather than high as it is in gout.
The following table gives the rate of the pulse in 25 cases of mul tiple arthritis deformans, taken without any selection: The Urine.—Little special study has been devoted to the urine of patients suffering from arthritis deformans, nor is it likely that such a study will yield very important results. Albumin is not present unless there is intercurrent disease of the kidneys. A diminution of the earthy phosphates has been observed by Drachmann," and Angel Money speaks of unusually wide variations in the amounts of urea and uric acid excreted.
Visceral Les of the most characteristic features of ar thritis deformans which lends powerful support to the view that its development is more probably dependent upon nervous influences than upon any systemic poison, is the absence of any visceral lesions which are developed with sufficient frequency in its course to be re garded as primary manifestations of the morbid process which pro duces the articular lesions.
I am aware that in making the above statement I am running counter to the views of observers whose opinions are entitled to the highest respect, such as Charcot, Besnier," and liahler," but I believe that the statement will nevertheless be confirmed by the experience of most physicians who have been brought much into contact with the disease under discussion.
The supposed relationship of arthritis deformans with acute rheu matism has led to a careful search for cardiac lesions developed in its course, and the extremely limited amount of success which has at tended upon this search appears to me only to emphasize the fact that cardiac lesions are not ordinary accompaniments of the malady.
I believe that I am justified in expressing the belief that valvular heart lesions are not more common among the subjects of arthritis deformans than among others who do not suffer from that malady, and I cannot recall a single instance in which there was satisfactory clinical evidence of the development of valvular lesion in its course which could not be equally ascribed to concomitant atheroma, or of pericarditis which could not be attributed to intercurrent renal disease.
Undoubtedly we meet with valvular lesions in patients with ar thritis deformans which are apparently of rheumatic origin, but these can almost invariably be traced to antecedent attacks of true rheuma tism. Even when this is not the case the origin of the heart trouble in a rheumatic attack cannot be excluded, for we know that in early life serious endocardial lesions may date from an attack of rheuma tism in which the joints may entirely escape.
I might quote in support of the views here enunciated the state ments of various authorities whose names may be set in the balance against those of observers who have maintained the contrary.
There is no more convincing evidence that the renal disease which sometimes complicates arthritis deformans, and is among the more frequent causes of death among the patients, is anything more than an intercurrent disorder; and in this same category may be classed bronchitis and phthisis which also hold somewhat prominent places among the causes of death.
Affections of the organs of special sense are sometimes met with, and sclerotitis, iritis, and conjunctivitis have been described as com plications; but it is a significant fact that Fuller, who at one time looked upon them as such, expressed, in the later editions of his work, the view that the cases upon which hiS opinion was based were really examples of gonorrhoeal rheumatism, of which these affections of the eye are not uncommon manifestations.
Deafness may result from the invasion by the disease of the articu lations of the small bones of the ear, and is then an. actual manifes tation of the disease.
There is certainly no form of skin disease which stands to ar thritis deformans in any such relation as that in which eczema stands to gout.