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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![pained joints are without redness, when they are cold and stiff,—when they cannot easily be made to sweat, or when, while a free and warm sweat is brought out on the rest of the body, it is only clammy and cold on the joints,—and when especi- ally the pains of these joints are increased by cold and relieved by heat applied to them, the case is to be considered as that of purely chronic rheuma- tism. If the character of chronic rheumatism is to be derived from the most numerous and pre- dominant instances, then we would say that the former of these descriptions is far more applicable to the disease, as generally met with, than the latter; for though all the phenomena recited as indicating the continuance of febrile and inflamma- tory action may not attend, it rarely happens that some or other of them are not present. As the former condition is capable of indefinite duration, for it may endure for years, and is hence strictly entitled to be called chronic,—it could not, where any distinction were made, be classed with the acute disease lately treated of; while, if it consti- tute any part of the chronic malady, a definition professing to characterize this ought assuredly to embrace it Perhaps the more perfect representa- tion of the disease, if it be necessary or beneficial to make any such distinction, would be to include both descriptions under arthrodynia, subdividing this into sthenic and asthenic. In this view the sthenic arthrodynia is by far the most frequent form in which the disease presents itself; and, what is no less important, it is that which, if un- relieved or improperly treated, is productive of the greatest mischief and of most distressing results; for under it the disease both local and constitution- al, however indolent it may appear, is yet suffi- ciently active to continue and extend its peculiar ravages, deranging the general health, enfeebling and crippling the body through progressive disor- ganization of joints, and consequent wasting of muscles. In the asthenic form, the mischief is already done, and, however the body may suflfer under the ravages sustained, there is no longer the active constitutional derangement inflicting further injury, which forms so essential a part of rheumatism. In the latter form there is little to do but support the general health, and remedy, as far as may be, the local lesions. But sthenic arthrodynia both admits of and demands more corrective treatment, the judicious, discriminating, and persevering use of suitable remedies being capable of accomplishing much, both in renovating health, and restoring power of motion to the still inflamed though rigid and contracted joints. With the consideration of this form we shall now pro- ceed. [The chronic form of rheumatism is often de- scribed as being frequently the sequel to the acute. This does not accord, however, with the experience of the writer. So far as his observa- tion has gone, the subjects of acute rheumatism rarely suflfer from the chronic form ; and, on the other hand, persons who are constantly more or less crippled by chronic rheumatism may pass through life without suffijring from the acute.] It is a prevailing impression that a chronic disease cannot be inflammatory. How this origi- nated it is needless to conjecture; but, however the misconception arose, it is a familiar truth that \ the term chronic conveys to most minds not the simple idea of duration, which alone it expresses, but something the opposite of inflammatory; some state to which the treatment proper for in- flammation cannot be applicable. The pure chronic rheumatism of CuUen as described in the foregoing extract, is unquestionably of this latter character; but as the disease comprises, in addition to this, the subacute or sthenic condition also noticed by him, it is necessary to understand the term chronic, when its application is thus extend- ed, in that restricted sense alone which rightly belongs to it. Practitioners who are accustomed to regard chronic rheumatism as asthenic, and to treat it accordingly, are little aware of how long a deci- dedly inflammatory character may attach to it. Years may elapse, yet a distinctly febrile state, indicated by its appropriate phenomena, prevail, accompanied with evidences of disorganizing in- flammatory action on the joints. And so long as this state endures, is there progressive deteriora- tion of general health, and increasing structural derangement of joints. It gratifies the writer of this article to see this fact unequivocally stated by Dr. Elliotson, in his excellent clinical lectures de- livered at St. Thomas's Hospital. He acknow- ledges the inflammatory character, and also the great length of time for which this may be retained, specifying this form of rheumatism as active in contradistinction to the term acute, which in its strict sense could not apply to it. The same cha- racter was long ago indirectly recognised by Sagar, when, in his definition of chronic rheumatism, he stated the blood drawn to exhibit a huffy crust. In this form, however subdued the symptoms may be, the characteristics of rheumatism, as they have been exhibited in the acute disease, are distinctly traceable. There is a febrile state of the general constitution, arid more or less of inflammatory action in the joints; and the principles of treat- ment are precisely similar, though they require to be modified in their application so as to adapt this to the derangements, both constitutional and local, which need relief. It will assist in comprehend- ing the real nature of this form of the disease to bear in mind what was formerly stated in treating of relative plethora. Certain delusive appearances were then noticed, as misleading practitioners from a right conception of the state of circulation or condition of heahh existing ; and to similar delu- sions has it been owing that the febrile character of active or sthenic arthrodynia has been so fre- quently overlooked. An apparently feeble and compressible pulse induces the persuasion of de- bility ; the enfeebled powers of the body sanction the conclusion ; and relief is sought from a class of remedies which, in such case, cannot give other than transient relief, if, indeed, they do not aggra- vate every symptom. Were we sure that the doctrines of plethora formerly illustrated were rightly understood, we could at once close the discussion of the constitutional state prevailing in sthenic arthrodynia, by representing it briefly as that of relative plethora. It differs from the con- dition formerly described as relative plethora, only in having the local inflammations with their con- sequences superadded. In order to determine ac- curately this state of constitution, it is necessary](https://iiif.wellcomecollection.org/image/b21116799_0033.jp2/full/800%2C/0/default.jpg)
