A manual of medical diagnosis : being an analysis of the signs and symptoms of disease / by A.W. Barclay.

  • Barclay, A. W. (Andrew Whyte), 1817-1884.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: A manual of medical diagnosis : being an analysis of the signs and symptoms of disease / by A.W. Barclay. Source: Wellcome Collection.

    117/708 (page 83)
    rheumatism, in the majority of cases, is no more than an assertion of the existence of pain. Another source of fallacy connected with the patient's descrip- tion is, that he speaks of having lost the use of his limb, when its immobility is due to pain or to stiff- ness of the joint, as well as when it is caused by paralysis. Handling the limb is the most effectual mode of discriminating these three conditions. The history of the case may be also available for distinguishing between the various affections embraced under the head of rheumatism, as it points out the severity of the sufferings and the duration of the attack, its limitation to one limb, or its transference to others. We should never omit to inquire whether this be the first attack, both because of the bearing this has on disease of the heart, and also because the characters of the affection are apt to be less pronounced in proportion to the frequency of their repetition. The effect of both active and passive movement is of great importance in obscure and doubtful cases. The extent to which the joint may be flexed by the action of volition, and the amount of pain, if any, excited by the effort, have to be compared with the effect produced when the medical attendant himself endeavours to flex or extend the limb. If there be any imper- fection in the attempt at voluntary movement, he has next to observe whether there be any resistance to his interference, and further, to make out how far that resistance is under the con- trol of the will. It will be found in three distinct degrees:— (1) A simple act of volition, which the patient has perfect power to suspend] (2) an act partly voluntary and partly involuntary, ex- cited by the consciousness of pain on movement, which cannot, therefore, be voluntarily checked, but will cease when the patient is under the influence of chloroform; (3) a reflex action in a paralysed limb, over which the patient has no control whatever. He has also to endeavour to ascertain how far the movements of the joint are interfered with by alteration of structure inde- pendent of the resistance of muscular action. This can, in the majority of cases, only be guessed at, so few persons being able to suspend entirely the muscular resistance when a joint which has been the subject of disease is being handled. Great accuracy is unnecessary, but the fact may be easily placed beyond doubt by inducing anaesthesia, when all muscular action is suspended,