On the Nosological Relations of Chronic Rheumatic (Rheumatoid) Arthritis
Authors: D. Duckworth
Journal: BMJ (1884)

THAT a debate should be opened on the subject of rheumatoid arthritis at a meeting of the British Medical Association in Ireland,.seemsto me peculiarl3 fitting.And when it is remembered'that this town is not only the 'most flourishing centre, of lrish commercial intelligence anad enterprise, but also the.seat of one of 'its most active and 'successful academic institutions, the 'discussion of this'question has no common' interest attached ta it.Two reasons, at least, should make a stranger like myself, who can claim no Irish blood. in his veins,' particularly chary of introduding such a subject on'Irish soil to such an audience as is now -before me.The first is that the m'aladyin qustion is exceed- ingly common' in this part of the Queen's dominions 'and, therefore, familiar in no ordinary degree to the profession in -Ireland; and the second-reason is, that no men' have done so much to elucidate and make this disease truly classical as Irish'physicians and surgeons.I, there- fore,naturally feel some .diffidenice in coming befbre you-to-day.It occurs to me, however, that the fact of my being' a stranger w"lill enable me to do that justice to the -subject which the natural modesty of an Irishman might prevent his -claiming for his own countrymnen, and therefore it is that I begin by saying 'that-the labours .ofRobett Adams, Robert W.' Smith, of.Colles and Wilmot, of Dublin, and of that eminent Irishman, Robert Bentley Todd, of London, have, in relation to this malady, been greater -nd more: useful than thoSe of any other workers-elsewhere.Nor should-I, 'on this spot, be un- mini.dful of the valuable researches of Peter Redfern iinto the abnormal conditions of articular cartilage, a subject intimately related to the question before us.Let us venerate 'thesegret names to-day, and try to follow up, with all becdming modesty,' their shocessfnl search after tuth.The time atmy disposal forbids me to enter upon even a brief summary of-the work dbne on this subject, nor shall I attempt t6 enumlerate in.any detail the particular a-nd minute pathologiceil conditions which make up the whole morbid entity evierywihere, or almost everywhere, recognised as rheumatoid arthitis.This di$order 'is-now-so well known and distinguished from other articular affecti6ns, that it seems well-nigh"an useles task' to disctss the special 'haracteristics of it.And yet I think those who know 'most about' the malady -ould be the; first to aver.that we want both more knowledge of the wholb stjedt, and also more light tbirown upon the relations which the disese bears to other forms of arthritis.In this address, then, my endeavour will be to treat of the malady as a whole, and in particular to discuss its 'relation to other forms of 'arthritis, whether 'of rheumatic or -of' other 'origin.'At the outset, I think I may affirm that London, as a sphere of observa- tioli, affords, perhaps, the largest opportunities for study of all forms of articular trouble.We see all forms, and have no lack of instances- of each.We see the joint-troubles of all nationalitie we' have a large feld forobservation amongst the Irish,'who form a considerable; part of our hospital and workhouse inmates and _'attendiuts.We see, without any doubt, the -largest number of gouty cuses anywhere met with.on the habitable globe.'We have scrofulous cases in abundance, and no lack of unequivocal rheumatism.We see more than this ini- the comaninglings and coalescence of all these forms of disease, and some of ns, at any rate, do not fail to take no'te of tliese.We see, what is very interesting and important, the influence of London life upon-persos who come to ns from Ireland Scotland, and pro'incial districts, from -the colonies and elsewhere, and vwo bring with ther their peculiar heritage and morbid tendencies, to be not seldom modi- fie,d, more or-less, by the peciuliarities of life in our evast 'metropolitan wildergess.An honest observer, seeking the truth in London,-mat rest assured tat he jas:a large and fair field for his study of arthritis i; all its forms.'