The relations of chronic villous polyarthritis to the dumb-bell shaped bacilli / by Max Schueller.

  • Schüller, Max, 1843-1907.
Date:
1906
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Licence: In copyright

Credit: The relations of chronic villous polyarthritis to the dumb-bell shaped bacilli / by Max Schueller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of resorption and secretion of lime. It is the anomalous secretion of lime, principally in the cartilaginous, later also in the synovial tissues of the joints, which leads to necrotic changes in microscopic spots anil to a simple inflammatory reaction and small cell proliferation beneath these spots, but not those foci around small vessels, as in the chronic bacillary villous process. I was enabled to demonstrate this by histiochemical conversion of the surplus of lime into the characteristic crystals of lime oxalate in the cartilage as in the less numerous solid and hard synovial excres- cences of arthritis deformans. As a matter of fact they are not necessarily present and not a characteristic feature in arthritis deformans. I had taken many photomicrographs of slices of arthritis deformans as well as of slices of characteristic villous excrescences and of synovials from chronic bacillary villous synovitis, and pre- sented them before the Hufeland Medical Society on July 0, 1899. The paper read on that occasion, with illustrations, appeared in the Berliner k’in. Wochenschrijt, 1900, Nos. 5, 6, and 7, and was entitled “Polyarthritis Chronica Yillosa and Arthritis Deformans.” I could convince myself later on that neither the hard villi in arthritis deformans nor those in pure syphilitic cases, nor the rarer ones in other forms of arthritis had dumb-bell shaped bacilli, with one exception, namely, in some cases of chronic villous polyarthritis in joints which at a former period had undergone syphilitic changes. Here I found the characteristic villous excrescences with dumb-bell bacilli, beneath them occasionally deep lacunous defects or flat cicatrizations in the cartilaginous or osseous parts of the joint, and these conditions were seen not only directly at operation on such joints, but even by means of Roentgen rays. In these cases there were also present syphilitic parasites, although, judging from their hyaline condition, syphilis was no longer active in these joints. Antisyphilitic treatment in such cases had no effect. It is possible that preceding syphilis, tertian- as well as hereditary, had given a predisposition to invasion of dumb-bell bacilli into the joints. I do not know of any special relation of chronic villous polyar- thritis to articular rheumatism. Among the great number (230) of my own observations I found only very rarely cases with a history of acute articular rheumatism. In the great majority of the cases the affection began per se instantaneously, with villous excrescences which progressed slowly The process took place first in one or in a few joints, as a rule at first in the smaller ones, then gradually in others; sometimes, however, larger joints—the knee for instance— were the first. In my large experience with this form of arthritis I could establish with certainty that it never began with fever and swelling. I do not believe that the well-studied disease, which we are accustomed to call acute articular rheumatism, is ever caused by invasion of dumb-bell bacilli. In my earlier experiments I succeeded occasionally in producing acute serous or seropurulent inflammation