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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![vent disorganization of joints, and restore the pa- tient in moderate time to health and the free ex- ercise of limbs. But it occasionally happens that notwithstanding the full employment of all the means directed, a certain degree of fever lingers, the skin continues dry with some morbid heat, the tongue too white, and pains of acute character are still felt in the joints. When this state first met our view, so completely did the assemblage of symp- toms simulate active inflammation, that we hesi- tated whether there was not an actual relapse of disease, and a necessity for reverting to active re- medies. But the indecision was of short duration ; for assured by the treatment already pursued, and the effects produced by it, that inflammation had been successfully combated, we could not regard the supervening state as corresponding in its na- ture to that which we had already corrected, and instead of recurring to bleeding and mercury, we made trial of bark as a preferable agent, and with such benefit, that we have seen it remove, in twenty-four hours, the whole train of symptoms which we have just mentioned. Half a drachm of bark with ten grains of nitre is the combination on which we most rely, giving this twice or thrice a day ; and so effectually does it answer the pur- pose that v^■e are slow to change it. What we have now stated may serve to explain the confi- dence with which some writers have advocated the use of bark as almost a specific in rheumatism. There is undoubtedly a stage of the disease in which it may be beneficially given, but in the acute stage, to which we have hitherto chiefly re- ferred, we at least would not compromise the patient's safety by trusting to bark, while bleed- ing, purging, and mercury were applicable ; and even in what is called chronic rheumatism we would as little rely on it so long as plethora was unrelieved, the pulse high, the bowels loaded, and active fever predominant. When the general state of constitution is restored to the proper ba- lance of its several functions, should some febrile indications linger, and pains continue to infest the joints or muscles, bark furnishes then a valuable and unexceptionable means of correcting the slight remnant of disease, but not before. [The writer has had frequent opportunities for witnessing the exclusive use of both modes of treatment, antiphlogistic and tonic, and it is but proper to say, that he does not recollect to have seen the symptoms in any case aggravated, under the prudent employment of cither. In the mass of cases that occur, except in very active, vigor- ous habits,—and it is generally applicable even to them,—a combination of the two modes of treat- ment has appeared as advantageous as any other, —treating the disease during the early period, by the ordinary antiphlogistics, and afterwards en- deavouring to remedy the neuropathic condition by the cautious employment of tonics, as the sul- phate of quinia. Dr. D. Davis, late Profes- sor in the London University, has expressed a confident belief, that cinchona is the most pow- erful remedy that can be employed even in an in- cipient case of acute rheumatism, and affirms, that he does not remember a case in which the disease was not happily subdued. I have often recom- mended it, he adds, in cases of pure arthritic rheumatism during its acutest stage, and the dis- ease has always yielded to the remedy ; and ^ ^^j^® also recommended it in violent pains of the joints, accompanied by alarming complications; but never in any one case injuriously to the interest of my patient. I have, therefore, no difliculty in recommending its adoption to my medical brethren, and especially to those who are most frequently favoured with opportunities of seeing acute rheu- matism in its earlier stages. Dr. Davis prescribes the cinchona in the dose of from a scruple to half a drachm, repeated three or four times daily. He always, however, premises the free abstraction of blood. (See, also, Popham, Dublin Journal of Medical Science, Sept. 1844, p. 50.) M. Briquet, and others, have advised large doses of the sul- phate of quinia—from p to ^iss in the course of the 24 hours; and, they affirm, with unusual success. M. Briquet considers, from his observa- tion, that the sulphate is a powerful sedative, diminishing nervous excitability, retarding the pulse, and lowering the temperature. It has been objected by M. Devergie to this plan, that it is apt to cause serious disturbance in the functions of the brain and organs of sense; but care in regu- lating the dose may prevent this.] The cure of rheumatism by profuse perspira- tion has fallen so much into disuse that it can hardly be necessary to notice it. Yet it was held in high estimation not many years back, and very generally deemed the most eflectual mode of treat- ment. The late Dr. Gregory, in his lectures, used to represent sweating as the evacuation most to be relied on for the cure of rheumatism, and to bear his testimony to its ellicacy. He gave a caution, however, against resorting to it until the pyrexia had been abated by bloodletting, and stated that his test was, never to employ it until the pulse was reduced to 100. The chief agent was Dover's powder, given in doses of ten grains every two or three hours, assisted by warm cover- ing and copious diluents, the latter to be used only when the perspiration commenced. To be effectual, this required to be kept up for forty-eight hours. This practice has, we believe, been very generally, and, as we think, judiciously, laid aside, the treatment recommended in the foregoing pages being far more certain and effectual, producing less exhaustion, and leaving less susceptibility to recurrence of disease. [Recently, iodide of potassium has been recom- mended both internally and externally, and the treatment by large doses of nitrate of potassa, so highly advised in the last century by Dr. Brotkles- by, has been revived, and, it is said, with much success,—from a quarter of an ounce to an ounce being given dissolved in a large quantity of gruel in the twenty-four hours.] We have hitherto treated chiefly of constitu- tional disorder, and have considered the local in- flammation only so far as it was connected with , or dependent on the constitutional state. It is , necessary, however, to scrutinize the local alfec- [tions still further. So directly is the local dis- turbance dependent on the constitutional in the incipient stage, that if the latter be promptly and 1 vigorously treated, the former will very speedily , subside without any local treatment being needed , We have seen the local inflammation thus sub- ^side m rheumatism equally as in a first attack of](https://iiif.wellcomecollection.org/image/b21116799_0030.jp2/full/800%2C/0/default.jpg)
