CHRONIC ARTICULAR RHEUMATISM 



247 



abdominal muscles; Clarke described a disease confined to the costovertebral 

 joints of the twelfth pair of ribs. Anatomically the process produces changes 

 in the ligaments of the intervertebral sheaths and of the vertebral joints in 

 varying combinations (Schlesinger) ; the nervous disturbances are partly due 

 to compression of the nerve roots, partly to chronic meningitis (Bechterew). 

 Etiologically we must consider primary and secondary chronic arthritis, arthri- 

 tis deformans, gonorrhea, syphilis and other infections. Whether the affections 

 confined to the ligamentous apparatus and intervertebral sheaths are to be 

 classed as chronic arthritis may be questionable. Baumler calls attention to 

 the fact that stiilness of the hip-joints and lower vertebral articulations in 

 consequence of the patient's increased weight may lead to disease of the upper 

 vertebras. E. Bennecke lays stress upon the action of frequent, though insig- 

 nificant, trauma upon the vertebral sheaths and bony structures. In conclu- 

 sion, similar clinical pictures are presented by contracture of the lumbar 



Fig. 4.— Rontgen Picture Showing Heberden's Nodes upon the Index and Little 

 FiNGEH, WITH Exostoses of the Second and Thibd Phalanges. 



