The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 4).
- Date:
- 1845
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 4). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![practice in a malady which is more prevalent, causes more suffering, and leads to more decrepi- tude than almost any other, must be vacillating, imperfect, and unsuccessful. It will materially abridge the present article to refer to certain general principles of pathology al- ready detailed in the articles Gout and Pletho- ra. These principles apply directly to rheuma- tism, and through them alone can its pathology be adequately unfolded, or its treatment rationally explained. Acute rheumatism principally attacks the young and vigorous. The period of life most subject is said to be from puberty to thirty-five years. Though no age is exempt, it yet more rarely oc- curs in the very young, or in advanced life. This circumstance alone would seem to indicate some connection between rheumatism and fulness of habit, or that approximation to plethora which was formerly noticed as exuberance of health ; and if rheumatic seizures be duly scrutinized, they will be found to take place in those who from plethora, whether absolute or relative, are prone to fever or inflammation on any exciting cause being applied. The extraordinary health so often remarked by patients as having immediately preceded the rheu- matic attack is sufficiently intelligible. But direct evidence of the state of constitution in which at- tacks of rheumatism occur is amply shown in those who, having had the disease, are liable to its recurrence, and on this account compelled to watch the premonitory indications of an attack. In these, constitutional disturbance of a febrile kind, marked by all the phenomena formerly de- tailed as denoting the transition of plethora into febrile excitement, will be invariably found to exist for a sensible time before the disease presents its full character by the establishment of a local inflammation. And to these premonitory indica- tions should the earliest attention be given, for it is in this stage that relief can be most speedily and effectually afforded. By reducing plethora and subduing febrile action in this stage, the local inflammation may be wholly averted, and thus may be prevented not only the injury which the joints, when affected, are liable to sustain, but also the susceptibility to impression from slight causes which reiterated attacks of rheumatic in- flammation never fail to leave. The local inflammation of acute rheumatism undergoes a change during its progress which seems to have escaped observation. It exhibits at different stages two conditions, which may be conveniently distinguished as primary and second- ary. The former is the immediate result of the rheumatic seizure, and must be attributed to the specific cause, whatever it may be, from which the disease derives its distinctive character. It differs from common inflammation in being more tran- sient, for it is capable of rapid subsidence without any trace of its attack remaining. When this inflammation migrates from joint to joint, the oc- currence of a fresh inflammation is oftentimes followed by a quick subsidence of that which im- mediately preceded. Still more signally does this rapid subsidence take place if active treatment for the relief of the constitutional inflammation be resorted to immediately on the attack occurring, Vol. IV. —4 c and before the secondary inflammation has had time to supervene. In this respect the primary or specific inflammation of rheumatism has a close analogy with that of gout, from which it differs, however, in having a stronger tendency to pass into inflammation of a more ordinary and perma- nent kind. This specific inflammation is promptly relievable by constitutional treatment, no local ap- plications being at all needed. When from the severity of the attacks, or from neglect or delay in having recourse to suitable discipline, the specific inflammation lingers in a joint, a secondary inflammation results, more per- manent in its nature, which does not immediately subside on the constitutional inflammation being subdued, and which generally leaves some traces of its existence, in effusion into the cellular mem- brane or bursae mucosae, or in more or less thick- ening and rigidity of the ligaments and other membranes surrounding the joints. The distinc- tion here noticed is important, because it has a sensible influence on the local treatment of rheu- matism, both acute and chronic. Causes of acnte Rheumatism.—The chief, if not the only exciting cause, is the application of cold to the body when unusually heated. Cold is more liable to produce this effect when com- bined with moisture, whence a cold and humid atmosphere, and wet or damp clothes, are the most frequent sources to which rheumatism can be traced. Partial cold, as when parts of the body are subjected to currents of cold air, is very apt to give rise to rheumatism. When the body is pre- disposed, a very transitory exposure of this kind will suffice to bring on an attack ; if the current be sustained for any time, few will wholly escape some contingent suffering. Of the fact that rheu- matism is so excited there can be no doubt. When it is reflected, however, that for every instance o( rheumatism so induced, numbers continually en- dure a much or greater exposure to the alleged cause without any disease ensuing, too much im- portance should not be attached to it. [Other causes have been enumerated, such as the repercussion of eruptions, the stoppage of an accustomed flux, &c. These may exert an influ- ence, if a predisposition exist; but such influence is not easily appreciable. Recently, it has been affirmed by Messrs. Maddock and Sigmond, that where there is a disposition to acute rheumatism, the use of copaiba may develop it.] Of far greater moment is it to regard the predis- position, without the concurrence of which either no rheumatism will take place, or it will be slight and partial, exhibiting none of the constitutional disturbance and febrile exciternent which charac- terize acute rheumatism. A predisposition is said to be given by many circumstances, as age, tem- perament, climate, season of the year. Even he- reditary liability has been classed among the pre- disposing causes, and possibly vvilh reason, [and it is affirmed by Dr. R. B. Todd, (Practical Remarks on Gout, Rheumatic Fever, &c. Lond. 1843,) that the children of gouty parents are more liable to the disease than those who have not laboured under the gouty diathesis.] Each of these merits attention, but the circumstance common to all of them, and that which has most influence in pro-](https://iiif.wellcomecollection.org/image/b21116799_0021.jp2/full/800%2C/0/default.jpg)
