Abstract

A clinician's experience in 1906 evaluating and managing a new patient with inflammatory polyarthritis would be very different compared with today. While common conditions of inflammatory polyarthritides such as rheumatoid arthritis or systemic lupus were known, the clinician's ability to establish a specific diagnosis would be based solely on his clinical acumen and without much benefit of laboratory tests such as the rheumatoid factor or antinuclear antibody, as early precursors of these tests were not even described until the 1940s. Radiological imaging may have been possible, but was only reported by Sir Wilheim Roentgen in 1895 and was likely not widely available in physicians' offices. If an anti-inflammatory drug was prescribed, a relatively new drug called aspirin was available commercially and the patient would likely receive treatment with an antimicrobial as it was "common knowledge" that infections were the likely cause of the "atrophic" arthritides including rheumatoid arthritis. Since antibiotics as we know them today were still a quarter of a century from discovery, a clinician would resort to heavy metals, arsenical products or even antisera to treat suspected infections. In a few short years, clinicians would report on their experience with gold salts to treat "mycobacterial" infections, the putative cause of rheumatoid arthritis. While the reliance on parenteral gold salts to treat rheumatoid arthritis would dominate the twentieth century as an effective form of therapy, the original rationale to kill mycobacteria would no longer be maintained. If the antimicrobial therapy was ineffective, a clinician may resort to removing the tonsils, appendix or gallbladder to eradicate the source of the infection, or treat the patient with colonic lavage to wash out the precipitating organisms.