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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![prognosis is so dependent on the promptitude with which suitable treatment is resorted to, that any remarks on the natural course or duration of the disease are of little worth. Generally speak- ing, there is little immediate danger to life, there being no inflammatory disease of equal intensity which so little deranges the vital functions. This, most probably, is owing to the disease expending its violence on the joints and other external parts, and being little prone to attack the viscera. The peculiar character of the inflammatory action too, and the little liability which it has to pass into suppuration, or undergo the other changes conse- quent to phlegmonous inflammation, may account for the safety with which even the metastasis of rheumatism to internal parts is borne. It is cer- tain that such metastasis is not attended with so much danger as the severity of the symptoms would seem to denote. In early life we were often appalled by the metastasis of rheumatism from the joints to the heart, an organ more pecu- liarly liable to this transition than any other. More extended experience abated such fears, by showing that the immediate danger was by no means commensurate with the suffering expe- rienced. [Still, the pericarditis and endocarditis of acute rheumatism must be regarded as most dan- gerous complications—if they may be so termed —of the disease ; for even if the patient recovers, which is often the case, from the immediate attack, cardiac lesions are apt to remain, which may lay the foundation for disease afterwards. M. Bouillaud (Traite Clinique du Rhumatisme articulaire, Paris, 1840,) has aflSrmed, that about one half of those who suffer under acute articu- lar rheumatism are affected with pericarditis; and we know that endocarditis is a common accom- paniment. One of the most important points, therefore, in the management of acute rheuma- tism is to watch the supervention of the morbid action in the fibro-serous tissues of the heart. It is not necessary to repeat here the symptoms of pericarditis and endocarditis (See PEniCAnni- Tis) ; but the occurrence of dyspnoea, wirti more or less anxiety, jerking, or feeble and rapid pulse, and tumultuous action of the heart, ought to direct the attention of the practitioner to that viscus, and if he discover, by the physical signs and functional phenomena, the existence of in- flammatory action there, it must be treated as if the disease were unconnected with rheumatism; for nothing is better established, according to M. Andral, (Cours de Pathologic Interne,) than that, although primary rheumatism, seated in the fibrous and muscular tissues around the joints, is remarkable for its great and rapid change of seat; secondary rheumatism—if it may be so termed— loses this mobility when it fixes upon a serous membrane. Dr. Graves (^Clinical Lectures, Amer. edit. Philad. 1842,) states, that rheumatic fever may exist without the affection of the joints; and that pericarditis may occur as a primary symptom before the appearance of the articular swelling. This is probable. The writer has certainly seen many cases in which the signs of pericarditis were amongst the earliest phenomena.] If an attack of rheumatism be treated at the onset with due activity and discrimination, it may be relieved in a very few days without the affected joints sustaining any injury. But both with respect to time and local ravages, much will depend on suitable discipline being resorted to and adequately pursued, ere the specific inflam- mation of the joints becomes complicated with that which we have termed secondary. The specific inflammation we have repeatedly seen subside in twenty-four hours, leaving behind but little trace of its accession. When secondary inflammation, however, has been suflered to su- pervene, the case is materially altered, and greater obstinacy of local affection may be expected. It might be laid down almost as an axiom, that the severity and duration of the disease are propor- tionate to the degree of plethora present, the ac- tivity of inflammation, and the length of time during which the morbid actions are suffered to prevail unrestrained. If the plethora be great, inflammation high, and much delay take place in resorting to efficient means for correcting the con- stitutional derangements, then would it be diffi- cult to assign limits either to the constitutional disturbance or local ravages, both of which may continue, though with abated force, for months or years, to undermine health and cripple the limbs; in other words, acute rheumatism may then pass into chronic of the most inveterate and intractable kind. Thus, though acute rheuma- tism rarely destroys life by its immediate seizure, however violent, this furnishes no excuse for su- pineness or inactivity in the treatment; for if not radically relieved in its early stage, the disease, even when of no extraordinary violence, may be- come so confirmed as to yield afterwards with difficulty to the most active and judicious use of remedies, while progressive disorganization of joints may entail protracted suffering and lasting decrepitude. It is true that a slight rheumatic seizure may, like a gouty paroxysm, pass away without medical interference, the efforts of the constitution sufficing for relief. But this is not its general character; and to rely on such a contingency would be in the highest degree rash and inexcusable. When- ever an attack of acute rhematism occurs, the constitution must need some relief, which enlight- ened practice will never withhold. To neglect of this principle may be ascribed a very large pro- portion of the decrepitude which the victims of rheumatism so continually present. There is no truth of which we are more thoroughly persuaded, than that if rheumatism were at its onset treated as its real nature demands, and if due care were afterwards taken to guard against its recurrence by prophylactic measures judiciously directed and adequately pursued, there need not from this malady be one case of disorganized and crippled joints for every hundred that are so afflicted. The effects of the earlier treatment will, therefore, in general, decide the prognosis. There is inflamma- tory fever to subdue, local inflammation to remove. If early bloodletting in subduing the fever make prompt impression on the local affection, so that both pain and swelling quickly subside, thus marking the local inflammation as still retaining its specific character unmixed with secondary effects, speed and effectual relief may be con-](https://iiif.wellcomecollection.org/image/b21116799_0024.jp2/full/800%2C/0/default.jpg)
