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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![Dr. Macleod found to be of urate of soda, as in gout. In cases of old synovial rheumatism, how- ever. Dr. Chambers found them to consist of car- bonate of lime. At times, suppuration has been observed in the joint; but these cases are rare. Partial rheumatism of the joints, when of great intensity, is almost always of the capsular kind. This form of rheumatism is said to occur gene- rally in persons of feeble or debilitated constitution; or in the robust, after great and protracted men- tal or corporeal exertion. It is said, also, to super- vene on gonorrhoea and other venereal affections, but in the latter case almost exclusively, accord- ing to Dr. Macleod, where long-continued courses of mercury have been adopted. It is very rare for metastasis to take place to internal organs, and when it does, it usually passes to the pleura or membranes of the brain, and proves fatal in a very high ratio. Of 81 cases of capsular rheumatism, recorded by Dr. Macleod, 47 occurred in men, and 34 in women. These were much more equally diffused over the different periods of adult age than acute rheumatism, and much more prone to affect persons under forty than genuine gout; at the same time, it appeared to be more the dis- ease of middle life than either rheumatic fever or muscular rheumatism; — from forty to forty-five years of age giving twenty-two out of eighty-one cases, or rather more than one-fourth, which is a much larger proportion than holds good with re- spect to either of the two others. The average duration of capsular rheumatism was found to be more than twice that of acute rheumatism. I'he general treatment, both internal and ex- ternal, is that recommended under Rheumatism and Gout.] What remains to be said respecting acute rheu- matism, and the sequelae occasionally left by it, will be more properly noticed in the division of the sub- ject which treats of the chronic form of the disease, to the consideration of which we shall now proceed. II. CunoNic Rheumatism. It would simplify the consideration of this form of the disease, if it were limited to that morbid condition to which analogy with the acute affec- tion discussed in the foregoing pages would jus- tify the name of rheumatism being applied. So many and various, however, are the derange- ments loosely classed under this generic term, that to give any history of the disease which should comprise the whole, would present a mass of con- fusion, if indeed it were not utterly impracticable. It has been too much the practice to pronounce as rheumatic every chronic pain of which the nature is obscure, or to which no other specific character is assigned. Practical writers have not overlooked this tendency; it is noticed by Heberden in the following very expressive passage : Multi dolo- res quibus nomina nondum propria imposita sunt, quanquam inter se distent, ex causis longe diversis orti, tamen ad rheumatismum pariter referuntur. In order to ensure as much clearness as possible in the following observation, it will be expedient to commence with that modification of disease which, presenting all the essential characters of rheumatism, differs from the acute affection already treated of only in being less violent in its symp- toms, and of longer duration. The distinctive characters of this malady are a febrile state of the general system, with more or less of pain and swelling in certain tissues and joints. And in this, precisely as in acute rheuma- tism, the continuance of febrile action undermines the general health, while the local inflammation, however indolent, disorganizes the joints, occasion- ing eventual decrepitude. The pain and swelling of joints with progressive thickening of the liga- ments, and elfusion in the several bursa, sufficient- ly evince the morbid actions from which such effects result. But, coincident with these will generally be found in the instances now referred to, evidences of constitutional derangement suffi- ciently marked to denote that a plethoric and febrile state of the circulation is also present. A quickened pulse, some increased heat of skin, and a furred tongue, are in greater or less degree the invariable attendants of chronic rheumatism of the joints so long as the disease in them continues to advance. It, no doubt, occasionally happens that in the course of time all febrile symptoms disap- pear, and the morbid action in the joints ceases to make further ravage. In such cases there is no longer rheumatism, but only the disorganization produced by it; and the distinction is important, for where such ravages alone remain, so far as they are concerned, constitutional remedies can be of no avail, and any treatment, to be effectual, must have special reference to the local lesions by which the free motion of the limbs is impeded. In the larger proportion of cases, however, the disease is strictly rheumatic, that is, it consists of a constitutional derangement having a febrile character, and of a local inflammation seated in the joints. This condition may be, and frequently is, the sequela of acute rheumatism ; but it may be fully formed without any particular acute attack having preceded. CuUen regarded it in the former hght, as appears from his definition of arthrodynia being introduced as rheumatism: sequela. In the definition itself he somewhat incongruously represents this as ensuing to violent sprains and luxations, though why the pains re- sulting from such accidents should be deemed rheumatic it is difficult to imagine. In this defi- nition, too, which ought to embrace every form in which chronic rheumatism presents itself, he states somewhat too positively the absence of fever and of swelling, — pyrexia nulla, tumor plerumque nuUus; characters which do not apply generally to the disease, and which seem to have been introduced as an antithesis to the definition of acute rheumatism. This imperfec- tion obliged him, when treating of chronic rheu- matism, to enter into explanations rather at vari- ance with his own definition, and in the follow- ing passage he describes more correctly and intelli- gibly the transition of the acute into the chronic stage. The limits between the acute and chronic rheumatism are not always exactly marked. When the pains are still ready to shift their place,— when they are especially severe in the night time, —when at the same time they are attended with some degree of pyrexia, and with some swelling, and especially with some redness of the ioints. he disease is to be considered as still partaking the nature of acute rheumatism. But when there IS no degree of pyrexia remaining, _ when the](https://iiif.wellcomecollection.org/image/b21116799_0032.jp2/full/800%2C/0/default.jpg)
