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being helped into the house from that old OBSERVATIONS ON AN INTERESTbuggy he went about in, and a few months ING CASE OF RHEUMATOID before his death, holding on to Dr. Jane

ARTHRITIS.1 way, for fear he would fall down stairs from the sick room of the patient. Their

ORRIN S. WIGHTMAN, B. A., M. D., hobby was medicine, and they were consis

Clinical Professor of Medicine, N. Y. Polyclinic; tent to the last.

Visiting Physician, Workhouse Hospital; Not all of us are gifted like Weir Mit

Ass't. Visiting Physician, City Hospital. chell who is spending his declining years in

Rheumatoid arthritis has been described literature, in works which will probably make his name more enduring than anything

an inflammatory joint disease-acute,

sub-acute, or chronic—which under certain he did as a physician, nor like old Thomas Addis Emmett, But Weir Mitchell has

conditions is apparently of an infectious

nature and origin, and under other condihis hobby and Emmett has his, and we all

tions of unknown cause. can have our own. Fortune might arrange

Its slow and insidious progress often it for us that the little farm up in the hills

masks its real seriousness, and cases are of Connecticut or down in Maryland by

frequently in a condition of helplessness the shores of the Chesapeake, little farms

before the real danger is appreciated., where the chickens and ducks and the cows and the gardens, with the open air

The case which suggested this paper, i and sunlight could wake up in its various

most instructive, and rather than specula coloring, the picture of a hobby. And upon the etiology of which we know so 1 those of us who love the sea and its rivers, tle we will endeavor to draw conclusio either the great steamship to carry us to

from facts. lands of our dreams, or the trim little The patient, Mrs. H-, mar yacht, listing gently to leeward in the woman of 27 years of age, with no evening breeze, with our hand on the till- dren, has a family history of rheum. er, the other holding the pipe, and eyes on both sides. As a child she had s looking out at the evening of day and of

fever, and later adenoids were life with all the happiness and content

otherwise she has been perfectly hea ment that comes from knowing that our

In April, 1910, her right knee wo work is done.

casionally become hot and painfi 301 W. 88th St.

later became swollen. The greatest

ance was in the weakness she ext Many, if not most, of the cases of in it while, or after walking. shoulder pain variously diagnosed as cir- "give out” as she expressed it, cumflex neuritis, rheumatism, etc., are instances of subacromial or subcoracoid

a while she developed a slight li bursitis. With involvement of the former At the suggestion of friends, bursa there is usually tenderness just be

osteopathy, taking a full cours yond the acromion, usually somewhat an

ment, but manipulation seemed teriorly; in the latter there is marked tenderness just external to the coracoid tip.

worse, and the family becomi Pain on rotation of the arm may be pres

insisted on her seeing a surgeon ent in either; it is most constant in sub

* Read before the Clinical Socie? coracoid bursitis.-Amer. Jour. of Sur

York Polyclinic Medical School gery.

February 5tn, 1912.



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Fig. 1. Mrs. F. C. (Gout of Hand). Showing the spatula shaped shadow of synovial infiltration with little true joint involvement and no periostitis.


Fig. 2. Case Mrs. T. H. (Osteo-Arthritis) (Rheumatoid Arthritis). Showing the progressive enlargement of bony growth along the shaft of the phalanges of the hand. A true periostitis. Also the ankylosis of the distal small joints.

how in our efforts to prevent by medica- In consultation with Dr. Hayes, we bent tion its further progress, we all too often every effort to improve the nutrition, incapacitate our strongest ally, viz.: the choosing foods having the highest caloric nutrition.

value and carefully tabulating them under The picture at this time was of an ex

caloric units. hausted woman, reduced in weight to 85 Under this plan we found she could take pounds, with a secondary anemia and a from 7'800 to 12'000 calories per week hemic murmur, constipation alternating and this is a form most easily digested. with diarrhea, all of her joints involved, Our main effort, was Food, but Food in and marked deformities in the hands. In terms of absorption. brief, a helpless invalid.

We must bear in mind, that among other Her temperature ranged at this time things she was suffering from an over zeal from 101-102 deg. at night, with severe of specific drug treatment, that she had sweats necessitating the change of the just returned from 32 baths at Hot night gown twice during the night. She Springs, Arkansas, with her digestive tract would be aroused from sound sleep by a

entirely incapacitated, and an acute gassudden, involuntary twitching of the legs, tritis so severe she could not retain food. and at other times was kept awake by a On June 25th, 1911, her weight was 9012 severe basilar headache. At this stage we pounds, a gain of 572 pounds in 6 weeks. were at times in grave doubt as to whether We found that even now 12'000 calories we were dealing with a stage of a rheuma- per week gave signs of over feeding, and tism, pure and simple. The doubt was an we kept to the lower figures. By the midhonest one, but was soon cleared up by the dle of August her temperature had come progress of the disease.

to normal, but the pulse continued high, The bowels were promptly cleaned out

and was affected on the slightest exciting with calomel and daily saline enemas:

Even with strangers excluded, it sponging with tepid water and alcohol

continued between go and 100. With the every four hours. The affected joints were abeyance of the temperature, the nervous protected by dressings against temperature phenomena subsided. She had fewer perchanges, and pillowed in cotton. Care was

iods of depression, less twitching in her exercised to avoid jarring the bed, and dry sleep, and the occipital headache did not heat by electrical pads alternating with hot keep her awake at night. moist local packs were applied at frequent As the acute inflammation in the joints intervals.

subsided, the therapeutic lamp and light Great benefit was derived in reducing the massage were used.

Later we gave her night sweats by local and general applica- modified mud baths, on the ankles, wrists tion of hot, wet salt. The salt was rubbed and hands. These mud baths required thoroughly over the entire body and al- careful oversight, as the operators in instilowed to remain there for half an hour and tutions do not always distinguish between then either removed by tepid sponging or light and strenuous treatment. The menthe patient was placed in the tub.

which was abolished in Realizing the uselessness of the salicy- May did not return for six months, and lates and iodides they were promptly dis- then in proportion to her general physical continued.

strual function which



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