PULMONARY OSTEOARTHROPATHY. In this disease there is hypertrophy with deformities, but of the osseous system only; no amenorrhcea nor enlargement of lower jaw. The third phalanx of the fingers is much enlarged, like a drum stick, the nails are lengthened, widened, striated longitudinally, curved over the finger-tip. The carpus and metacarpus are almost normal, while the wrist is en larged and deformed. The same lesions occur at the feet, and the lower portion of the leg may be larger around than the calf. The long hones, especially of the leg and forearm, are enlarged. The joints are swelled and move with diffi culty. Kyphosis exists, when present, only in the lower dorsal or lumbar re gion. The face is normal, except that the upper may be enlarged. Some chronic thoracic lesion is present. (Marie.) Case presenting certain features like those occurring in hypertrophic pneumic osteoarthropathy. La vielle (Jour. de Med. de Bordeaux, Jan. 7, '94).
Pulmonary osteoarthropathy may give rise to some little difficulty in diagnosis, principally owing to its rarity. It is
most likely to be confounded with acro megaly, but in the latter disease there is no alteration of the nails nor are the finger-ends nor the carpus and meta carpus much thickened. The chief char acteristics of the disease are great en largement of the hands, wrists, feet, and ankles, associated with. and secondary to, some chronic pulmonary affection, such as phthisis, chronic bronchitis, and empyema. In the joints the changes are effusion with enlargements and ulcera tion of the cartilages and articular ends of the bones. Marie is of the opinion that these changes are due to toxic poi soning, but Thorburn looks on them as tuberculous. The evidence either way is slight and indefinite. G. A. Bannatyne (Lancet, Feb. 23, 1901).
It is doubtful where acromegaly can be separated from pulmonary osteoar thropathy. (Arnold.)