Four cases of rheumatic nodules : with comments / by Dyce Duckworth.

Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Four cases of rheumatic nodules : with comments / by Dyce Duckworth. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    It is probable that the cases described by Drs. Bai-low and Warner constitute a class by themselves occurring chiefly in young persons. The nodules appear almost suddenly, and within a few weeks pass away. They have been termed ephe- meral by MM. Troisier and Brocq.* In several cases which have been brought before the Clinical Society by Dr. Stephen Mackenzie, Dr. Drewitt, Dr. Fowler, and myself, the nodules have been of larger size, of slower growth, and of persistent character. It is certain, however, that cases of ephemeral nodules are met with in adults, associated too, as in the case of young patients,with cardiac lesion. Thus Dr. Barlow has met with a case in a man, set. 25,t who later on developed a cardiac murmur. Dr. Samuel West has related to me a similar case, and others were mentioned in the discussion on Dr. Fowler's case. They have also been found attached to periosteum. Drs. Barlow and Warner found that the nodes were subcu- taneous and that the common attachments were to tendons, djep fasciae, and, in one case, to pericranium. Again, some r.odules have been met with having distinct attachment to the f^rue skin. Some of the larger nodules felt of firm cartilaginous hard- ness in Case 3, and this was also the character of those in a case recently shown by Dr. Fowler,J yet their structure was found to consist of wavy bundles of fibrous tissue. It is noteworthy in relation to this point to find that Dr. Angel Money in his report of the microscopical appearances of a nodule removed from the back of the elbow of a ghl, aet. 10^ years, who had several in connection with rheumatism and heart-disease^ and who died of the latter, remarks that the tissue much resembled that of fibro-cartilage.§ This is the variety of cartilage that might be looked for, considering the common situations of selection of these nodules. The life-history of these larger and persistent nodules has yet to be observed. Treatment does not appear to be of much avail. I have seen the best results from repeated paintings of iodine liniment, and Dr. Barlow has found repeated blistering useful. The ephemeral variety call for no special • Eevue de Medecine, Paris, 1881, p. 297. t Lancet, Jan. 19, 1884, p. 115. X Ibid. § Path. Soc. Trans., vol. xxxiv, 1883, p. 49. Dr. Monej kindly showed mo these specimens. They were rich in tracts of dense fibrous tissue, forming a refracting reticulum enclosing cells. Many nucleated cells were also seen which appeared to be developing into fibres. One could not pronounce with certainty that there were true cartilage cells amongst the bundles.