Volume 4

A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston.

Date:
1905
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    26/1069
    stotements as to the age at onset of the troubles, some unavoidable error must have crept in. Any condition which tends to lower the standard of health may act as a ilisposing cause of rheumatoid arthritis — as of other diseases more certoinly known to have a bacterial origin. Amoiig such disposing causes may be mentioned periods of worry and anxiety, the nursing of sick friends, work under non - hygienic conditions, and lowering maladies of various kinds, amongst which a prominent place must be assigned to influenza. From an attack of influenza many patients date the commencement of their artliritic troubles. As lias long been recognised and as was specially emphasised by the late Dr. Ord, disoiders of the genital organs may play an im- portiint part in determining the far greater liability of the female sex to rheumatoid arthritis. In one well-defined class of cases the onset of the disease follows at a short interval after parturition, or after a mis- carriage, and it is difficult to avoid the conclusion that in these cases the uterus has been the point of entry of an infection. In others again menon-hagia and other uterine disorders appear to act as disposing causes, just as they may aggravate the gravity of the disease when once established. Of recent years stress has been laid upon infective foci of various kinds as originatoi’S of rheumatoid arthritis, and in a small pro- portion of cases such foci are to be found, especially pyorrhoea alveolaris ; affections of the naso-pharynx and ulcerated piles may also be mentioned. i\Ioreover, in some cases treatment directed to such a focus has brought about rapid amelioration, or even complete recovery of the inflamed joints. It is doubtful, however, whether these cases ai'e really examples of the specific disease rheumatoid arthritis, assuming that such a specific disease exists, and not examples of other form.s of infective arthritis which mimic it more oi- less closely. In the great majority of instances careful inquiry and examination, which should never be omitted, fail to reveal any local focus of infection, and the onset of the rheumatoid arthritis is as little ca])able of explanation as that of most attacks of rheumatic fever. Even disposing causes are often not to be traced, and the malady commences at a time when the j)atients believe themselves to be in perfect health. Morbid Anatomy.—AVhereas our knowledge of the morbid anatomy of osteo-arthritis is very complete, the material upon which to base a description of the changes found in undoul)ted cases of rheumatoid arthritis in the active stage, as distinguished from the stage of sequels, is very scant}'. Nor is this to l)e wondered at when the rarity of a fatal ending in this stage is considered. I'he following descri])tion is mainly based upon the observations recently recorded by Dr. Hale White on a young woman under his care whose death was due to an intei-ciu-rent malady. There was much fibrous thickening outside the joints, with thickening of the ligaments. The synovial membranes were swollen and of a pinkish-red colour. The ai'ticular cartilages were, in the main, unaffected, but there was a very slight erosion of the cartilage covering the external condjde of the right