This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1912 Excerpt: ...painful. This time he had true chill. Physical examination showed that the left pupil was larger than the right, though both reacted ...Read MoreThis historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1912 Excerpt: ...painful. This time he had true chill. Physical examination showed that the left pupil was larger than the right, though both reacted normally. The heart was normal. There was slight dulness below the right scapula, with slight increase of vocal and tactile fremitus, and a few rales. Expiration was everywhere rough and prolonged. The abdomen was negative. The right knee was swollen, hot and shiny; the leg was kept bent at a right angle, and motion was painful. A similar condition was found in the right foot and ankle. Both feet were pronated. There was marked clubbing, cyanosis, and curvature in both planes in the fingers and thumbs, and to a less degree in the toes. Scattered over the chest and back was a reddishbrown, macular eruption, the spots about the size of the little finger-nail. Discussion.--There seems to be no way by which we can connect the mother's consumption or the patient's alcoholism with the present symptoms. The joints are obviously not tuberculous, and alcohol does not attack articular structures. Though it would be natural to connect the former attacks of urethritis with the present joint pains, the gap of twenty-five years between the two renders this impossible if the history is taken on its face value. In looking over the body for any other lesion which we can connect with the joint symptoms, we notice the irregular pupils, the clubbed-fingers, and the cutaneous eruption. If the clubbing of the fingers be assumed to be such as is described, it is not likely to have any connection with the arthritis. Bony outgrowths near the finger-ends (Heberden's nodes) bear some resemblance to clubbed-fingers, but could hardly be mistaken for them. Such outgrowths, if present, might incline us to conjecture that the right knee and ankle were the se...Read Less
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