Rheumatism, rheumatoid arthritis and subcutaneous nodules / by C.O. Hawthorne.

  • Hawthorne, C. O. (Charles Oliver), 1858-1949.
Date:
1900
Catalogue details

Licence: In copyright

Credit: Rheumatism, rheumatoid arthritis and subcutaneous nodules / by C.O. Hawthorne. Source: Wellcome Collection.

    27/70 (page 13)
    suggest which alternative should be selected, but rather to collect and produce evidence to show that, in cases that are beyond dispute cases of rheumatoid arthritis, there may and do appear fibrous tumours which are essentially the same as those affirmed to be characteristic and decisive results of rheumatic influence. The existence of swellings or tumours in the immediate neighbourhood of joints affected by what is now called rheumatoid arthritis, was noted in some of the earliest descriptions of the disease, and even in descriptions written prior to any attempt to separate the condition from rheu- matism. Sydenham, as already quoted,speaks of the knuckles becoming “ knotty and protuberant (as in gout).” Heber- den’s chronical rheumatism is distinguished from the acute variety by its “ more permanent swellings ”; whilst to Haygarth, the special feature of the disease was the develop- ment of the “ nodes,” which led him to suggest the term “nodosity of the joints.” That these “nodes” were osseous in character there can be little doubt. Haygarth himself says of them “ they feel as if they were enlarge- ments of the bones themselves ” (Op. cit., p.155), and as he found them in connection with all the joints (Op. cit.. p. 153), it is reasonable to conclude that his descriptions apply to those bony outgrowths which in more recent times have been termed “ osteophytes.” The swellings which not infrequently are found at the bases of the terminal phalanges of the fingers, and which are known as “ Heberden’s nodes,” may here be noted, because, though Heberden himself did not suggest that they had any relation to his “chronical rheumatism,” they have been claimed as one form of the disease now under consideration. Heberden40 described them under the term “ digitorum nodi,” and confined his assertions concerning them to the statement that “ they have no connection with gout, being found in persons who never had it,” but Charcot, A. B. Garrod, Kent Spender, Osier, and A. E. Garrod, all agree that these nodes are a variety But, as the sequel will show, the occurrence of subcutaneous fibrous tumours is by no means limited to those cases of rheumatoid arthritis which carry in their history suggestions of rheumatism in its generally admitted forms. Hence for these cases, at all events, the dilemma as above stated practically remains. 411 See note at end of Essay.