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.)
23/804
![of its quality arising from redundancy of fibrine. I ha\ie already established the fact that, under the influence of a state of general hypersemia, every organ becomes excited ; that death may result from such excitation ; and that a super- abundance of blood is found all over the body, but in no part is there any serious lesion, any alteration of texture. In such cases there exists that state of pyrexia, termed by nosologists in- flammatory fever. But if, instead of being simply in excess, the blood contains more fibrine than ordinary, its exciting power will be still greater, and what it did in the former case merely by its increased quantity, it will now do by its alteration of quality. In fine, he applies the doctrines thus propounded to the particular disease which is the subject of the present essay. '< Now if we mark the symptoms and progress of acute rheumatism, we find that very often a well-marked febrile action with a strong reaction, but without any symptom whatever of local affection, precedes the pain. In a word, there is first an inflammatory fever, and then rheumatism. Next observe the extreme mobility of the rheumatic pains. They run along in a manner wherever the blood is dis- tributed ; the application of leeches often removes the pain from one part, but it soon shifts to an- other, and not unfrequently it quits the articu- lating tissues and fixes on ditferent internal organs, producing, by the derangement of their functions, symptoms more or less severe. It often happens that bleeding from a large orifice puts an end to the disease, as if by diminishing the mass of blood it proportionally diminished the stimulus that promoted all these shifting irritations. The doctrines here advanced we believe to be founded in truth, and capable of furnishing much valuable guidance in the investigation and treat- ment of disease. In such copious extracts we may appear to have made too free with the pages of an author whose works are so generally known, but we could not resist the temptation of fortify- ing, by the authority of so distinguished a patho- logist, principles which we have long maintained, and which we have endeavoured already to illus- trate in the articles Gout and Plethora. They will suffice, we trust, to justify the assertion lately made, that whatever importance may attach to the exciting cause of acute rheumatism, the pre- disposition induced by a plethoric state of consti- tution is far more entitled to the practitioner's attention. [As stated, however, in the article Plethoha, M. Andral has pointed out the marked difference between the condition of the blood in it and in in- flammation, and has shown that the increase of fibrin in it obeys the same laws as in the ordinary phlegmasisE. He analyzed the blood of forty-three bleedings : in one of which the fibrin marked four, —the healthy proportion being three in 1000 ; in six, it marked five ; in fifteen, six ; in thirteen, seven ; in three, eight; in three, nine ; and in two, ten. When, however, the rheumatism was sub-acute, it oscillated between four and five; and when decidedly chronic, it did not exceed the healthy proportion. A recent writer. Dr. R. B. Todd, (^up. cit.) regards both acute rheumatism and gout to be diseases of the blood, the pheno- mena of which are due to the presence of a mor- bid element in it, generated under the influence of particular causes, <' by an abnormal chemical action of the blood itself. It does not often happen that opportunities oc- cur for examining the textures around the joints, whilst the rheumatic affection is active in them. As the disease rarely proves fatal, except by the supervention of inflammation in some of the fibrous or muscular tissues, seated internally, the mischief there is generally so predominant, that, for some time before death, the joints cease to be the source of suflTering. Under these circum- stances, it is not surprising that pathologists should differ as to the precise seat of acute rheu- matism of the joints. It has been already re- marked, that it invades every muscular and fibrous tissue, and that alternately the serous membranes may be implicated. Such may be the case in the articulations,—the synovial, which is a serous mem- brane, becoming affected last. On dissection, no decisive appearances may be met with. At times, the veins around the joints have been found gorged with blood; the ligaments, periosteum, and syno- vial membrane being injected, and thickened, with small collections of matter in the surrounding cel- lular tissue, and accumulations of pus or serum in the cavity of the synovial membrane. (Ferrus, art. Rhumatisme, in DicL de Med. 2de. edit, xxvii. 567, Paris, 1843.) It is clear, that the hyperaemia of acute rheuma- tism—active as it is—can scarcely occasion any great organic changes, inasmuch as, in the course of a few hours, it shifts its seat, and leaves behind no evidences of its previous existence. This mobility has, indeed, given rise to the opinion, amongst many, that the disease is essentially seated in the nervous system; that the sanguiferous system is affected secondarily, and that it is very probable the nervous filaments of the diseased parts are more considerably involved than any other tissue. Dr. Mackintosh, (^Principles of Pathology, &c. 2d Amer. edit. ii. 461, Philad. 1837,) who sup- ports this view, remarks, however, that he has seen cases, which presented symptoms similar to those of rheumatism, in which, after death, the lymphatics of the limb were found inflamed, and filled with a puriform fluid. Some, again, have considered acute rheumatism to be nothing more than acute inflammation of the lining membrane of the arteries. The whole disease is certainly peculiar, and appears to be more neuropathic than ordinary inflammation. Its extremely changeable character sanctions this idea, and the remedies are not always those which we should think of pre- scribing in ordinary active phlegmasia.] Diagnosis of acute Rlieumatismt—This may be briefly disposed of. The only disease with which it is liable to be confounded is gout, in treating of which the distinctive character of each malady has been sufficiently noticed. For- merly discrimination in this respect was deemed of high importance, the prevailing theories of gout demanding a course of treatment very dif- ferent from that to which rheumatism was sub- jected. In the present day a juster pathology of gout assimilates the treatment of both diseases sufficiently to render extreme accuracy of dis- crimination of very slight moment. Prognosia of acute Rlkeumatism. — The](https://iiif.wellcomecollection.org/image/b21116799_0023.jp2/full/800%2C/0/default.jpg)
