Observations on rheumatoid arthritis, Heberden's nodes, Dupuytren's contraction, and some other arthritic conditions / by Sir Dyce Duckworth.

  • Duckworth, Dyce, Sir, 1840-1928.
Date:
[1899?]
Catalogue details

Licence: Public Domain Mark

Credit: Observations on rheumatoid arthritis, Heberden's nodes, Dupuytren's contraction, and some other arthritic conditions / by Sir Dyce Duckworth. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    features of the disorder under consideration. This fact goes in support of the individual diathetic tendency which is pre- sent, and which is significant of a textural predisposition to disease of this class. In rheumatoid arthritis there may be acute exacerbations of pain with polyarthritis, and a moderate degree of pyrexia, which may be, and have often been, mis- taken for attacks of rheumatic fever, but they lack several important features of that disorder, and certainly resist the treatment which commonly affords relief from it. The conditions which predispose to rheumatoid arthritis are well recognised, and chiefly relate to depressed health, ex- haustion from loss of blood, hyperlactation, poor living, and prolonged anxiety, together with exposure to damp and rapid alternations of temperature. They are also such as would un- failingly excite any scrofulous tendency into activity. With respect to the pathological changes induced by the disease, we have to note that they may be partial and limited, or very widely diffused over the joints. The intensity of the process clearly varies much, so that it is a matter of degree in each case. And here we have to face the fact that the ultimate results in many instances of chronic deforming arthritis tell us but little of the actual factors that have been concerned in bringing them about. To be quite certain in a particular case as to its exact pathogeny, we must have knowledge of the clinical history and conditions which determined and accom- panied the phenomena of it. A study of museum specimens, devoid of such histories, tells very inadequately their true signi- ficance, for it is certain that other forms of arthritis may closely simulate some of the changes witnessed in rheumatoid arthritis. To my mind, it is clear that gouty arthritis induces many of the characters of the latter, and I have come to regard it as an error to hold that uratic deposits are an invariable, or at least an enduring, evidence of accompaniment of true gout. If joints encrusted with urates, and damaged in most of their component tissues by gouty changes, be submitted to any solvent that will remove the deposit, it becomes a matter of impossibility to assert with confidence, in the absence of a clinical record, that such changes are the unequivocal results of gout. It is proved that joints which have been recognised as gouty during life on trustworthy evidence, with definitely associated con- comitants of that disease, may after death show no uratic deposi- tion, such having been removed in the course of time, especially in vigorous patients. The lesions in Charcot's disease, again, often recall those of some forms of rheumatoid arthritis, the process having been,