No open-access location is known for this record yet.
No open-access location is known for this record yet.
Robert Adams (1791-1875) Robert Adams (Figure) was a member of the great school of surgeon pathologists which flourished in Dublin in the nineteenth century and included Abraham Colles and Robert William Smith. Although he was a distinguished surgeon, Adams is remembered for his description of medical diseases; that is, the Stokes-Adams syndrome, bradycardia and transient vertigo as a sign of fatty or fibrous myocarditis, and rheumatoid arthritis, which he defined as a specific disease separate from gout.Figure 3: Robert Adams. (Reprinted with permission from Br Heart J 29:46-48, 1967.)Adams was born and educated in Dublin. He began his medical training as an apprentice to William Hartigan and George Stewart, who were leading Dublin surgeons. After receiving a medical degree from the University of Dublin in 1832, Adams joined the staff of the important hospitals in Dublin where he became well known as a practitioner and teacher. He had a role in the formation of two proprietary medical schools in Dublin. He served as president of the Royal College of Surgeons in Ireland and the Dublin Pathological Society. At the age of 70 he became Regius Professor of Surgery in Dublin and surgeon to Queen Victoria. In 1857, Adams published his most important contribution, A Treatise on Rheumatic Gout, or Chronic Rheumatic Arthritis of All of the Joints. This was accompanied by a separate collection of illustrations of the pathologic anatomy of the disease. These publications established rheumatoid arthritis as a disease entity separate from gout. Selections from the illustrations rather than the text were chosen because they show the high water mark of gross pathology immediately before microscopic pathology began its dominance. With unlimited cadavers available, and no limits on the extent of their dissections, these surgeon pathologists produced some of the most interesting illustrations of gross pathology ever published. Illustrations of the Effects of Rheumatic Gout or Chronic Rheumatic Arthritis on all the Articulations with Descriptive and Explanatory Statements by Robert Adams, contain 11 plates accompanied by pages of commentary. Plates VI and VII were chosen to be reproduced. Leonard F. Peltier, MD, PhD EXAMPLES OF THE EFFECT OF CHRONIC RHEUMATIC ARTHRITIS ON THE HANDS. Fig 1. (Right) The right hand of an adult who was a severe sufferer from this disease. The prominency of the head of the first metacarpal bone is here conspicuous, and the acute angle of junction of this bone with that of the first phalanx of the index finger is well seen, as is also the enlargement of the knuckles and the adduction of the hand to the ulnar side. The basis of the first phalanx of the little finger was partially subluxated forwards. The emaciated appearance of the back of the hand and the abnormal prominency here of the extensor tendons, and the characteristic appearance of the wrist, viewed from behind, are all shown. The left hand of this patient was similarly affected.Fig 1Although the fingers are usually found thus flexed and adducted, we occasionally observe their median joints the seat of an abnormal extension, which renders the fingers curved in the longitudinal direction, with their convexity towards the palmar aspect of the hand, and without any adduction (see Treatise, page 221, Fig. 12). When, however, this abnormal extension of the median joint of a finger exists, it is very usually found that its last phalanx is at the same time drawn into a state of flexion. (See Treatise, page 237, Fig. 17.) Fig 1. (Left) shows the skeleton of the hand of a female, M. Keefe, who had for many years been afflicted with chronic rheumatic arthritis in all the joints, as a constitutional disease, and who, at the age of 33, died of an acute affection of the larynx (Treatise, page 268). The first phalanx of the little finger is dislocated forwards to the palmar surface of the head of the metacarpal bone. The metacarpo-phalangeal joints had all cartilage of incrustation removed, and the articular surfaces were united to each other by means of a red, vascular, and soft tissue, such as is often seen to unite the articular surfaces of other joints, in the constitutional form of this disease. PLATE DESIGNED TO ILLUSTRATE SOME OF THE ANATOMICAL CHARACTERS OF CHRONIC RHEUMATIC ARTHRITIS OF THE HIP-JOINT, FORMERLY KNOWN BY THE NAME OF "MORBUS COXAE SENILIS," A DISEASE EVIDENTLY BELONGING TO THE SAME CATEGORY AS THE OTHER SPECIMENS DELINEATED IN THE PRECEDING PLATES. Fig 2. (Upper Left) Drawing taken from a cast of the head of the right femur, which had been for ten years affected by this disease, in the case of the late Mr. Mathews, the celebrated comedian.-(Treatise, page 59.)Fig 2The trochanter major bulged out externally. The head of the femur is depressed, and has lost its globular form. The neck was much shortened, more particularly on its posterior aspect-circumstances which accounted for the degree of shortening and eversion of the limb mentioned in the history of this case. The cartilaginous incrustation had been removed from the articular surface of its head; the bone was rough in some places; and spots of eburnation existed in other parts of the head. Bony granular nodules had beset its corona. Although there is no drawing here adduced of the acetabulum in this case, a cast of which is now before me, I may mention, that the abnormal condition of the fundus of the acetabulum was an exemplification of what I have elsewhere stated (see Treatise, page 77):-"I have found the cavity of the acetabulum rendered uniform, not by wearing away of its walls down to the level of the fundus of the Haversian fossa, but by the formation of a plate or lamina of bone, which stretched across from one margin of the fossa to the other." In this instance the handle of a scalpel could be introduced between this new lamina of bone and the original Haversian fossa. In the words of G. Sandifort, applied to a similar specimen-"Hac lamella ossea haec altera cavitas separata est, a superficie articulari."-("Museum Anatomicum," vol. IV. page 39.) Fig 2. (Upper Right) Head of right femur, which had been affected by this disease. Some of the recent appearances this disease presents are displayed: the capsular ligament was thicker than natural. The synovial lining of it shows numerous longitudinal plicae (the retinacula of Weitbrecht), hypertrophied. At the lower part of the neck of the femur numerous soft productions, or vascular fimbriae, existed.-(Museum, Richmond Hospital.) Fig 2. (Lower Left) Acetabulum of an adult who had long suffered from this disease. A-Acetabulum, much enlarged; its fundus is furnished with no depression for the Haversian gland; it is formed into a uniform hollow cup, beset with numerous pores; and the interior surface of this cavity also presents some spots enamelled with ivory-like deposit. The acetabulum in this specimen has a circular, uninterrupted margin, or brim, all round. Near to the thyroid hole the acetabulum was perforated beneath this rim, or margin, by a rounded foramen, through which the proper vessels of the round ligament and head of the bone had penetrated. This foramen, in this instance, and as it usually is, was preserved, the rest at the ordinary notch, near the thyroid foramen, having been filled up. Fig 2. (Lower Right) Posterior view of the head, neck, and superior extremity of the right femur of an adult who had been long affected with chronic rheumatic arthritis of the hip, as a local disease. See also Fig. 3, Treatise, page 81, where a view of a similar case is given, both verifying the observation of Mr. B. Bell, that in some specimens of this disease it would appear as if the head of the femur had been forced down by some great pressure from above; so that at last the head of the bone rested upon the upper part of the trochanter minor.-(Bell on "Diseases of the Bones," p. 93.)
Loading…
Stored only when both papers are in the corpus — 17 citations exist upstream.
Imported from OpenAlex (CC0) — nothing here is generated.