Volume 4
A system of medicine / by many writers ; edited by Thomas Clifford Allbutt and Humphry Davy Rolleston.
- Date:
- 1905
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.
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![9 gLind a small uon-motile bacillus was found, which could not be identified. The most recent investigator in this field is Fayerweather. In three cases which he groups as examples of “ infectious polyarthritis chronica villosa” he obtained organisms from the synovial fluid and tissues of the affected joints, which were in all instances the oidy organisms so found. All three micro-organisms were bacilli, but they were all diilerent. Two of the organisms when injected into the joints of rabluts produced arthritis similar in character to that present in the joints from which they were derived. Full description of the organisms, of the cultural properties, and of the animal experiments carried out, as well as of the clinical features of the cases, will be found in Fayerweather’s original paper. Modes of Onset.—There is no uniformity in the mode of onset of rheumatoid arthritis. It may commence as an acute malady, apt to be mistaken for rheumatic fever and sometimes not to be distingui.shed from it at the onset, which only reveals its true nature by the intract- ability and persistence of the arthritic lesions. Such errors in diagnosis are sometimes rendered much easier bj' a histoi-y of antecedent attacks, of a transitory character, and separated from each other by intervals of com- plete or nearly complete recovery. Only after several such premonitor}' attacks, recurring at short intervals, may the relentless character of the disease ultimately manifest itself. The converse error is also possible, for patients with subacute rheumatism may continue to drag themselves about, and do their daily work, so that their swollen and painful joints, not having a fair chance of recovery, become the seats of such per.sistent, inflammatory changes that the presence of rheumatoid arthritis is natur- ally suspected. In such a case a period of rest in bed, with adeejuate treatment by salicylate, will usually serve to distinguish the class to which the case rightly belongs. In a larger class of cases the onset of rheumatoid arthritis may be described as subaciite, a number of joints are aftected in cpiick succession, but swelling may be insignificant at first, and febrile distui'bance minimal or limited to a slight evening rise of temperature. In such cases the slightness or absence of swelling of the joints may prove deceptive, and may lead to a more favourable diagnosis than is borne out by the subse- quent course of events. Here, as in acute cases, the implication of joints which are little liable to true rheumatism may prove a valuable aid in distinguishing the nature of the disease. Lastly, in cases of a more chronic kind, a single joint may be at first attacked, and only gradually does the malady increase its hold and s])read to other parts, whilst symptoms of constitutional disturbance may be .almost wholly absent. Such attacks, although apparently benign in theii’ earlier stages, are wont to prove the most inti'actable of all, possibly because the limitation and comparative mildness of the attack do not necessitate rest. It cannot be too strongly insisted that rheumatoid arthi’itis, in the sense in which the n.ame is here applied, is not a steadily progressive](https://iiif.wellcomecollection.org/image/b21295359_0004_0029.jp2/full/800%2C/0/default.jpg)
