Well, here are some of the other papers of interest that I found in the archives. There was “Colchicum in rheumatism,” an astute letter written in 1831 by a certain Mr. Tweedie of Guy’s Hospital in London, England, who discusses the benefits of using powdered colchicum root given every four hours for the treatment of rheumatism. It seems to lessen painful musculoskeletal symptoms but created other, quite familiar issues: “The stools are for the most part characteristic; they are of a peculiar loose, yellow nature, such as are seldom, I believe, seen under other circumstances.” Plus ça change, plus c’est la même chose.
In 1909, Robert B. Osgood, MD, another noted orthopedist (of Osgood-Schlatter disease fame) from MGH published a “state-of-the art” review, entitled, “Recent progress in the treatment of various conditions called rheumatism.” He reviews many of the ancient and more modern theories of rheumatism and rheumatic fever. We learn that bloodletting is so passé. The author also eagerly dismisses the work of a well-known figure at the time, Dr. Alexander Haig of England. Dr. Haig authored Uric Acid in the Causation of Disease, in 1903. This 900-page tome was published for six editions, so clearly there was an audience for his theories that explained most joint afflictions on a metabolic derangement of urate production.
What else was being published in the British literature? In 1899, there was a succinct review entitled, “Why people go to spas,” in Nature. This was the only article that I could find in the early archives of that venerable journal pertaining to arthritis.
However, around the same time, a shift in thinking occurred in England that had profound implications for what was to emerge as the field of rheumatology. In 1905, a committee was formed in Cambridge, England, to study the chronic joint diseases. Under the leadership of T.S.P. Strangeways, the Huddersfield lecturer in special pathology at Cambridge University in Cambridge, England, a serious effort was made to create some sense out of the chaos of early twentieth century clinical medicine by developing standardized methods of physical examination and data collection.
Fast forward another 30 years and one begins to see evidence of rheumatology developing into a more recognizable form. Two seminal papers were published; the first by Chester Keefer, MD, assistant professor of medicine at Harvard Medical School in Boston, on the etiology of chronic arthritis, followed by a review of the classification of arthritides by Walter Bauer, MD, associate professor at Harvard Medical School. Though primitive, these papers established classification criteria that would be readily recognizable by clinicians today. Around this time, the emergence of gold salt therapies as a viable treatment for RA was also being described by Forestier and others. Finally, rheumatology emerges from its cocoon.
The ARA Enters the Picture
So what were the topics discussed on that snowy December day in 1957? Three broad themes emerged; the first focused on the serological reactions that were being observed in patients with RA. The second series of presentations targeted the pathogenesis of lupus, focusing on complement activation and the newly described antinuclear antibodies. The third group consisted of papers discussing synovial membrane and cartilage metabolism. The authors included many investigators who became the leaders of our field: Henry Kunkel, Charles Christian, Edward Franklin, John Vaughan, and Morris Ziff, to name just a few. It must have been great for all 224 attendees to sit altogether and hear these cutting-edge presentations. They were, after all, a captive audience. There were no concurrent sessions, posters to read, or exhibits to attend that could compete for their attention. And the snow that was falling outside presumably kept them inside. I doubt that the NIH owned any snowplows!
