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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![mild gout, leaving as little trace of its visitation. It must be admitted, however, that such speedy decline is not the general character of this local affection. Notwithstanding the abatement of fever, some pain, heat, and swelling will continue to affect the joint for a longer or shorter time ; and in order to understand the treatment which this requires, it is necessary to bear in mind what was formerly slated respecting the change of character in the local inflammation. If on fever becoming subdued by the means directed, the local inflam- mation declines, no topical treatment whatever is needed, nor is it expedient that any should be resorted to. Decline of inflammation thus ob- tained affords conclusive evidence of disease being arrested at its source, and relapse need not here be apprehended ; while, if the local inflammation be checked by topical remedies, its abatement af- fords no such assurance, and if the constitutional derangement be not thoroughly rectified, repeated renewal of the local inflammation with successive migrations from joint to joint will most probably ensue. But independently of this consideration there are other objections to the early use of topi- cal remedies which ought not to be overlooked. Repellent applications may remove inflammation from any particular part; but only to transfer it to some other, if not to the heart, stomach, or other internal organ. Local bloodletting would beget less danger of this kind, but neither is it free from objection. The inflamed part is ill suited to sustain the operations by which blood can be abstracted. We have seen leeches when applied to a rheumatic joint prematurely and without sufTicient regard to the constitutional state, exasperate every symptom, and cause in- crease of inflammation both in the skin and cellu- lar membrane, ending in extensive sloughing, with troublesome ulceration, and followed by thickening of the ligaments with rigidity and con- tractions of unusually obstinate kind. So long as it is possible, therefore, to procure decline of local inflammation by the constitutional treatment, we consider it the belter practice to abstain from to- pical remedies. When inflammation continues in the joint, however, after fever has been sufficiently subdued, thus manifesting its having passed into what we have distinguished as the secondary state, it then becomes necessary to regard it as a local disease, and by appropriate topical treatment to avert those ravages which its continuance would occasion. The means are cupping, leeches, warm fomenta- tions, poultices, cold lotions, modified according to the degree of inflammation, the sensations of the patient, and the effects produced. By such means, the local inflammation in this its secondary state may be so corrected as to prevent organic lesion, and preserve unimpaired the mobility of the joint. [The application of methodical compression around the aflected joints by means of a flannel bandage is often productive of great relief. It was advised many years ago, and has been revived. (See the writer's New Remedies, ilh edit. p. 183, Philad. 184.3.) It is especially serviceable where there is great effusion. It has been recommended, that the compression should be made by means of compresses covered with mercurial cerate ; and that j a position and attitude should be given to the limb that would be most favourable to resolution. An elevated position would certainly tend to prevent the engorgement of the parts. The writer has seen good effects from compression where it could be borne, and a simple flannel bandage is ail-sufficient.] We would here impress, as we formerly did when treating of gout, the importance of an early renewal of motion in the affected joints, as indis- pensable for re-establishing their health and pre- serving their flexibility and power. From neglect of this, much protracted confinement and ultimate decrepitude continually result. On the subsidence of inflammation, the parts so lately disturbed are indisposed to motion, and some pain attends the early attempts at its removal. Yet leaving them at rest is not the means by which the power of motion is best restored. Exercise of the parts is necessary not only to restore those which have been morbidly affected to their healthy functions, j but to preserve in due energy and activity the muscular apparatus by which they are moved. By exercise healthy circulation is maintained, effusion prevented, absorption promoted and flexi- bility preserved. By it, too, the muscles sub- servient to the motions of the joint are kept in a healthy and efficient condition. When, from too great apprehension of exciting pain or renewing inflammation, quiescence is too long continued, the ligaments and other parts surrounding the joints become rigid; if these be kept bent, con- tractions take place, and the mobility of the part becomes permanently impaired; while the several muscles, from want of exercise essential to tiie maintenance of their nutritive and healthy actions, progressively waste and lose power. This latter contingency is, we are persuaded, much more fre- quently owing to the continued inactivity to which the muscles are consigned than to any morbid action induced in them by the disease ; and as we before observed, so satisfied are we of the mischiefs resulting from long-continued rest after rheumatic inflammation, that we would \n our own person much rather hazard any renewal of inflammatory attack, than suffer those derange- ments to proceed which spring from a state of inaction too long continued. [Capsular Rheumatism. — When rheuma- tism is seated in the lining membrane of the joints, and bursoe of the tendons, it is termed cap- sular. The parts most liable to its attacks are the feet and hands. It is recognised by the en- largement of the joints, which is circumscribed, owing to the distension of the synovial capsule with fluid ; and is thus distinguishable from the smaller and more diffused swelling of ordinary rheumatic fever. In its history, too, it diflers generally, as Dr. Macleod {On Rheumatism, &c., London, 1842) has observed—affecting seve- ral joints, but commonly becoming more especially fixed in a limited number, and ultimately local- ized, and, in some cases, inducing permanent changes of structure, or disorganization. When death occurs in the acute stage, the joints are found to contain an increased quantity of syno- via : when the disease has been more prolonged, distensions and nodosities are seen, similar to what occur in gout. Deposits are often formed in such cases on the carlilages of the joint,—which](https://iiif.wellcomecollection.org/image/b21116799_0031.jp2/full/800%2C/0/default.jpg)
