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being helped into the house from that old buggy he went about in, and a few months before his death, holding on to Dr. Janeway, for fear he would fall down stairs from the sick room of the patient. Their hobby was medicine, and they were consistent to the last.

OBSERVATIONS ON AN INTEREST

Not all of us are gifted like Weir Mitchell who is spending his declining years in literature, in works which will probably make his name more enduring than anything he did as a physician, nor like old Thomas Addis Emmett. But Weir Mitchell has his hobby and Emmett has his, and we all can have our own. Fortune might arrange it for us that the little farm up in the hills

of Connecticut or down in Maryland by the shores of the Chesapeake, little farms

ING CASE OF RHEUMATOID ARTHRITIS.1

BY

ORRIN S. WIGHTMAN, B. A., M. D., Clinical Professor of Medicine, N. Y. Polyclinic; Visiting Physician, Workhouse Hospital; Ass't. Visiting Physician, City Hospital. Rheumatoid arthritis has been described as an inflammatory joint disease-acute, sub-acute, or chronic-which under certain conditions is apparently of an infectious nature and origin, and under other conditions of unknown cause.

Its slow and insidious progress often

masks its real seriousness, and cases are frequently in a condition of helplessness. before the real danger is appreciated.,

where the chickens and ducks and the cows and the gardens, with the open air and sunlight could wake up in its various coloring, the picture of a hobby. And those of us who love the sea and its rivers, either the great steamship to carry us to lands of our dreams, or the trim little yacht, listing gently to leeward in the evening breeze, with our hand on the tiller, the other holding the pipe, and eyes looking out at the evening of day and of life with all the happiness and contentment that comes from knowing that our work is done.

301 W. 88th St.

The case which suggested this paper, i most instructive, and rather than specula upon the etiology of which we know so 1 tle we will endeavor to draw conclusio from facts.

The patient, Mrs. H——, a mar woman of 27 years of age, with no dren, has a family history of rheuma on both sides. As a child she had s fever, and later adenoids were ren otherwise she has been perfectly hea

In April, 1910, her right knee wo casionally become hot and painf later became swollen. The greatest ance was in the weakness she exp in it while, or after walking. "give out" as she expressed it, a while she developed a slight li At the suggestion of friends, osteopathy, taking a full cours

Many, if not most, of the cases of shoulder pain variously diagnosed as circumflex neuritis, rheumatism, etc., are instances of subacromial or subcoracoid bursitis. With involvement of the former bursa there is usually tenderness just beyond the acromion, usually somewhat anteriorly; in the latter there is marked tenderness just external to the coracoid tip. Pain on rotation of the arm may be present in either; it is most constant in subcoracoid bursitis.-Amer. Jour. of Surgery.

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1 Read before the Clinical Socie York Polyclinic Medical School February 5th, 1912.

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, Vol. VIII

, 1913

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Showing the spatula shaped shadow of synovial infiltration with little true joint involvement and no periostitis.

[graphic]

Fig. 2. Case Mrs. T. H. (Osteo-Arthritis) (Rheumatoid Arthritis).

of the hand. A true periostitis. Also the ankylosis of the distal small joints. Showing the progressive enlargement of bony growth along the shaft of the phalanges

[graphic][merged small]

Showing the spatula shaped shadow of synovial infiltration with little true joint involve-
ment and no periostitis.

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