Trophoneurotic changes in bones and joints in leprosy / Francis Harbitz.

  • Harbitz, Francis Gottfred, 1867-
Date:
1910
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Licence: In copyright

Credit: Trophoneurotic changes in bones and joints in leprosy / Francis Harbitz. 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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    TROPHONEUROTIC CHANGES IN BONES AND JOINTS IN LEPROSY * FRANCIS HARBITZ, M.D. CHRISTIANIA, NORWAY It is well recognized that in leprosy, especially its anesthetic form, marked deformities of the hands and feet may develop. Such cases are generally designated as “lepra mutilans.” Many, perhaps the majority of these cases, are dependent on ulceration, necrosis, and chronic suppura- tive inflammation, which in turn are indirectly due to a chronic leprous neuritis with its accompanying anesthesia and analgesia. Necroses or ulcers form, phalanges gradually slough off, and finally the characteristic, clubbed hands and feet of leprosy are formed. The accompanying illus- trations of such hands and feet show their appearance in some very pro- nounced cases. This explanation does not hold in all cases, however, as some of these deformities are to be ascribed to a peculiar trophoneurotic influence which is probably directly exerted by the neuritis on the tissues, especially those of the osseous system, and which may result in atrophy of bone of characteristic appearance, and in certain joint affections. The first to call attention to the occurrence of such atrophies of bone in leprosy was the late Prof. H. Heiberg,* 1 whose work on this subject, published in 1886, has received little attention, although it contains interesting observations and touches on questions of importance in physi- ology and general pathology. Since then, little has been written on this subject (Deycke, Hirschberg and Bichler). I therefore have desired to renew the study of this problem2 and questions arising with it, and will present the results in the following pages. I feel especially inclined to do this, having had at my disposal most excellent, and in some respects, unique material, partly from our pathologic institute in Christiania, and partly from the leprosy hospital in Bergen, which latter material was * An abstract of this paper, illustrated by specimens, photographs and dia- positives, was read before the Second International Leprosy Conference, held at Bergen, Norway, Aug. 16-19, 1909. 1. Heiberg, H.: Om lepra mutilans og trofoneurotiske forandringer ved spedalskhed, Klin. Aarborg., 1886, iii. 2. I have discussed this subject once before, in my competitive thesis for the professorship in pathologic anatomy and general pathology, encitled Om de pathologisk-anatomiske forandringer af neurotrofisk oprindelse, Christiania. 1900, A. W. Brogger’s Buchdruckerei. This work is especially devoted to micro- scopic investigations of these atrophies.