Rheumatic Subcutaneous Nodule Formation.

A WEALTH of literature has sprung up, particularly in the last few years, dealing with subcutaneous nodule formation in acute rheumatism and rheumatoid arthritis, but there is still much difference of opinion as to whether the two are closely related or whether the tissue changes are non-specific and unrelated aetiologically. As Keil (1938) writes, in a very full and comprehensive analysis of the literature on the subject, the alleged relation between rheumatic fever and rheumatoid arthritis has been adduced principally on the basis of (1) the occasional resemblances in their clinical features, including the occurrence of subcutaneous nodules; (2) the similarities in pathological changes seen in the tissues about the joints and in the sub-cutaneous lesions; (3) data revealed by immunological methods, which, however, are still in the early stages. There are many facts which suggest that the two conditions are of similar aetiology, but clinicallv the differences between the two conditions are marked, and workers have pointed out histological differences in the structure of the nodules in the two conditions (Collins, 1937). This last author quotes the work of Massell, Mote, and Jones (1937), as does also Keil, who suggests that their work be verified using similar methods of control. These workers noted the importance of trauma in nodule formation in rheumatism, and attempted to reproduce these lesions by injections of the patient's own blood into the subcutaneous and deeper tissues of the elbow. For the next ten days the patient was instructed to rub the injected elbow on the bedclothes for some minutes six times a day. By these means they produced nodules two to three weeks later which they found clinically indistinguishable from those seen in rheumatic fever, and were thus able to study the different stages in nodule formation by histological examination after biopsy. Eighty-two patients suffering from rheumatic fever or chorea 196