One hundred cases of rheumatoid arthritis
Goldie, Edward Milliken
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In choosing Rheumatoid Arthritis as a subject for my Thesis, I hardly ejected, nor I fear, have I succeeded in bringing out many original points.Since the beginning of Century much has been written on the subject by some of the most able observers. The most nota¬ ble of these is Charcot, who wrote his Thesis on the subject in 1853. My only apology for presuming to send in a Thesis on the same subject is that in one respect I can claim to have rivalled the Thesis of Charcot. My defence is that my statistics are based upon a larger number of eases than his were. Obviously whatever statistics I have obtained are for numerical reasons more reliable that those obtained upon a smaller number of cases.But although much has been compiled on Rheumatoid Arthritis there is a very large amount of uncertainty as to the nature and diagnosis of the disease amongst the ordinary rank and file of the profession.I say this in all humility as until I took up this subject specially I was often in doubt as to whether certain cases were examples of Rheumatism, Rheumatoid Arthritis, or Gout.That the differentiation of these three diseases is Important to all medical man is obvious when we consider how different should be the treatment of each disease,and how frequent is the occurrence of these three maladies.I will now epitomise a few of the more important points brought out in my Thesis.HEREDITY: As to this influence my figures tend to show that heredity does not enter very largely into the causation of Rheumatoid Arthritis.I included all klnds of Rheumatic Joint trouble and gout and yet common as are these diseases I obtained only a percentage of 27 under this heading.SEX: The most notable points brought out bore are that so many of my Female patients (51 per cent) had had miscarriages, that 50 per cent had had six children and upwards and that 23.6 per cent had had as many as 10 children and upwards.These figures tend to confirm the general opinion that the genito-urinary system in women often affords a means of entrance for the poison of Rheumatoid Arthritis.DRINK: The unusually large proportion of Male cases obtained by me I think may be partly accounted for by the habit of excessive drinking amongst this class of patients.Ho less than 40 per cent of the men examined by me acknowledged themselves heavy drinkers - mostly ale.In the connection it is interesting to note that in 10.7 per cent of my cases (all males) the arthritis started in big toes.CHEMISTRY: This I have been able to bring out clearly in many of my photos. It is a point of great diagnostic importance especially in some doubtful cases.ULNAR DEFLECTION: I have often noticed that this sign is best marked in the little finger where it should be first looked for. This finger is often deflected a considerable distance before the other fingers have appreciably moved. Some of my photos bring this out.HEBERDEN'S NODES: These were present in 96 per cent of cases. They are often of great diagnostic assistance.TACHYCARDIA: Another striking point brought out in my statistics is that 21 per cent of the cases having healthy heart valves had a pulse rate of 100 and upwards.In conclusion I should add that my 100 cases represent almost all varieties of the disease. About 70 of them were obtained In the large Infirmary where I am working containing 770 beds and having an admission of upwards of 3,000 per annum. These 70 were made up of a few well marked chronic cases and a larger number of less marked cases, many of which were admitted for some disease other then Rheumatoid Arthritis. I am indebted to the Medical Superintendents of four other Infirmaries for about 30 cases.