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.

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    the doctrine that rheumatoid arthritis is not rheumatism. Manifestly one or other conclusion must go by the board. The special clinical features of the rheumatic nodules, as emphasised in the earlier part of their career, were, in addition to their undoubted rheumatic significance (1) their small size ; (2) their non-occurrence after puberty ; (3) their rapid evolution and temporary duration ; and (4) their painlessness. On the other hand, in the majority of cases in which subcutaneous fibrous growths have been noted in rheumatoid arthritis, these have been of some consider- able size, have occurred almost necessarily in patients at or near to the middle period of life, have been slow in development and of prolonged or permanent dura- tion, and have caused more or less pain. In reference to the latter point it may be suggested that the occur- rence or non-occurrence of pain depends mainly on the situation and size of the tumour, for obviously the more considerable the projection the more likely is the tumour to receive irritation from external influences. This is supported by the fact that in the first two cases related in connection with this essay there were both large and small tumours, and that the latter led to no complaint, the patients not always being aware of their existence. Further, in the second case, a tumour of moderate size which was well protected by subcutaneous fat on the inner aspect of the olecranon had never been a source of annoyance to the patient. And in any view of the matter, the existence or non-existence of pain can scarcely be insisted upon as a vital distinction between growths which are identical in structure (see on), and are closely related in other respects. It may be noted, too, that in a few cases typical rheumatic nodules have been painful. One such case is reported by Judson Bury,50 another by Futcher,50 and Mahomed,57 describes a case of subacute rheumatism with large subcutaneous nodules showing evidences of more or less irritation. With reference to the other distinctions that have been drawn between the subcutaneous tumours of rheumatism and those of rheumatoid arthritis some clinical On Peripheral Neuritis.” By Jas. Ross and Judson S. Bury, P- 341. ^ “ John Hopkins Hospital Bulletin,” October 10, 1895. “ British Medical Journal,” 1883, Vol. I., p. 622.