1923. 



No. 16. 



HF NELROI.OGICAL ASPECT OF LFPROSV 



67 



13. Also the nails, however, frequently show trophic disturbances of 

 various kinds; in some cases they may show considerable thickening; in 

 others they are diminished in size; in others again they are continually 

 cracking up and breaking oft". 



As regards the pathogenesis of these trophic disturbances opinion is 

 divided. Some hold them to be the outcome of central lesions — others regard 

 them as the result of the polyneuritic changes. 



Personally I am most inclined to adopt the latter view, although I 



Fig. 38. (Case No. 44. A. A.i Lett toot. 

 The metatarsal hones have practically dis- 

 appeared. The big toe is inserted more 

 proximally than the others. — A perforating 

 ulcer is found in the planta pedis. 



Fig. 39. iCase No. 44. A. .\.> 

 Volar aspect of right hand. Ex- 

 cessive atrophy of thenar and 

 aati-thenar. The index finger 

 mutilated. 



cannot agree with Harbitz. when he, also defending this view, savs that 

 loss of joint sense is of prime pathogenic importance for these lesions. Clinical 

 examinations show that this loss of joint sense does not e.xist in the majority 

 of cases, and it has been pointed out in a previous chapter that even 

 profoundly mutilated stumps of fingers are as a rule moved with a sur- 

 prisingly good coordination, which would be impossible if the joint sense 

 was not intact or nearly so. 



What, in my opinion, is the chief point in favour of the assumption 

 of a neuritic origin of these trophic disturbances is their localisation. Thev 

 are, as we have seen, practically confined to the most distal parts of the limbs. 



