On erythema nodosum, and its connection with the rheumatic diathesis / by James Begbie.

  • Begbie, James, 1798-1869.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: On erythema nodosum, and its connection with the rheumatic diathesis / by James Begbie. Source: Wellcome Collection.

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    racter, and, to ward it off, prescribed a simple and limited, but nutritious, diet, with alterative medicine, and full doses of the nitrate and carbonate of potash. I was requested to visit her this evening (April 2, 1850), when I found the synovial capsule of the left knee distended with fluid, and the joint affected with pain and stiffness,--symptoms which had all come on in the course of twenty-four hours. In regard to rheumatic fever existing without any articular affec¬ tion,1 a case is passing under my observation while I now write, which powerfully illustrates the fact, and a short notice of which may not be uninteresting to the Society. On the 16th of January last, during the prevalence of keen frosty weather, which called many of the admirers of the art of skating and curling to the pond, a gentleman of the legal profession, approaching the age of thirty-five, of stout make, and full habit of body, and, by hereditary right, strongly disposed to rheumatism,2 repaired to Duddingstone, to enjoy his favourite amusement. He spent the early part of the day in keenly contested games of curling, in which he was alternately chilled and heated; and left the ice, complaining of an aching pain in his right side, which he at once attributed to the free and unwonted use of his arm, in pursuing his athletic exercise. Before he reached home, however, the pain amounted to a severe stitch, and towards the hour of dinner, he waited on me for advice. On examination, I considered him labour¬ ing under pleurodynia, and dismissed him with instructions to re- 1 Dr Graves (see Clinical Lectures, vol. ii., p. 159) was the first, I believe, to direct the attention of the profession to this interesting point, and, though the correctness of his views has been doubted, and men of large experience have not observed such cases, I am confident that they are b}^ no means uncom¬ mon, and that the following extract from the work of the eminent physician referred to, contains truths of great practical value :—“ In truth,” says he, “ in rheumatic fever, the quickness of the pulse, heat of the skin, tendency to profuse sweating, debility, restlessness, and thirst, may all exist without any inflammation of the joints, and may be resolved without such inflammation ever occurring, as I have witnessed in several well-marked cases of individuals liable to rheumatic fever, and who had previously suffered from attacks of fever with arthritis in the usual form, and subsequently, on exposure to cold, were seized with symptoms of pyrexia, which, in intensity, duration, and every other particular, were identical wTith their former fevers, save and except that, from beginning to end, not a single joint was inflamed.” 2 His family experience had been signally painful and disastrous. He had lost his mother in consequence of inflammation attacking the heart, previously damaged by rheumatic carditis ; he had also lost a brother and sister, in early life, by carditis accompanying rheumatic fever ; a paternal uncle, by diseased heart ; and a cousin (a daughter of this last), by acute pericarditis, uncon¬ nected with articular affection, but with all the other evidences of rheumatic fever ; and lastly, he had seen his only remaining brother, from time to time, afflicted with the malady which had been permitted to prove so great a scourge to his family.