A practical treatise on the diseases of children / by Alfred Vogel ; translated and edited by H. Raphael.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the diseases of children / by Alfred Vogel ; translated and edited by H. Raphael. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    m the inflamed elbow-joint tlie forearm is placed midway between pronation and supination. Swelling of the joint, as a rule, soon becomes noticeable,* which is either limited to it, or extended for some distance beyond, and is of a round, spindle form, irregular in shape and size, and soft and doughy, or hard, tense, and firm, and only later on exhibits the signs of softening and fluctuation. The skin is sometimes reddened, tense, and permeated by small and large vessels (particularly venous inosculations), is increased in temperature; or it may present no change of color, may be raised into smaller or larger folds, and be devoid of any perceptibly great amount of warmth. As the matter produced from the inflammatory product in the deeper structures and about the joints approaches the upper sur- face, the skin becomes red, not infrequently bluish, and the epidermis rises up like a blister. After a spontaneous or artificial opening has ensued, the pains subside for some time, as a rule, and the patient feels much relieved, but they invariably soon return, although not always in so severe a degree as before. In the further effects, the mor- bid picture assumes a different shape, according as to whether the dis- ease runs through an acute coiu-se or approaches more to a chronic one. In the first case, death, as a rule, ensues some time after the breaking of the abscess, under pyaemic phenomena or consumptive fever; in the second case, the malady may last for a long time, and death, at some future period, occur through exhaustion, or from a new accession of the inflammation, or the process may assume a favorable turn, and result in one of the remote terminations to be mentioned. The chronic form of the inflammation mostly begins with a mod- erate fever; the pain, as a rule, is also slight at first, and is only aggravated by prolonged exercise or by severe pressure on the joint, or the patient suffers somewhat more from them in chilly and wet weather. In this manner the process may go on for a long period be- fore suppuration and bursting occur, by which the conditions undergo a change, according as to whether a diffused inflammation sets in, or the disease retains its chronic character. If the former happens to be the case, all the symptoms of an acute inflammation of the joint with a rapid and severe course may then supervene. In addition to the unfavorable terminations described, the joint-inflammations, especially when they are treated in the proper manner, generally and locally, may present the following results: (1.) Recovery without any decided derangement of the function of the joint. This termination presupposes that the disease had not attained to a too serious degree, and that the cartilages and ligaments of the joint had suffered no extensive destruction. But, since these * [This, in fact, is often observed before the pain or any other symptom.]