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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![rheumatic pericarditis have been recently pub- lished by Dr. Davis, the senior physician of the Bath hospital. He seems, however, to have trusted to general antiphlogistic regimen, without calling in the aid of mercury. The principles advocated in this article display the merits of mer- cury as an adjuvant; and the experience of the writer fully confirms their truth and practical uti- lity. But independently of this acute seizure there is continually found in connection with rheumatism inordinate action of the heart, with evidences of actual enlargement or hypertrophy of that organ. The treatment of this affection, we can from much experience say, is best con- ducted on the principles inculcated in this article. Moderate bleedings are indispensable, the blood being almost invariably buffed and cupped. In judging of the state of circulation, the pulse at the wrist would mislead, for it may be soft and compressible even when the action of the heart is tumultuous. The carotid should here be exa- mined as furnishing a more certain criterion. Free bowels and antiphlogistic discipline are indi- cated by the same necessity which calls for ab- straction of blood. Mercury with opium is also required to produce its specific effects, by which alone the morbid action can be effectually or per- manently subdued. The use of this requires to be cautiously conducted, for its slowest operation is that which is here most beneficial. The morbid condition is generally of slow formation ; the changes wrought are not of a nature to be sud- denly rectified; and attempts to accelerate the case beyond what nature permits, would beget mischief and lead only to disappointment. Cup- ping and leeching over the heart are valuable aux- iliaries, and blisters are occasionally needed. In fine, when inflammation both general and local is allayed, and the action of the heart still continues inordinate, or is too easily excited, the application of belladonna to the side, in the form of plaster, aflbrds a valuable means of quieting the heart's motions, and of procuring rest from a disturbance which is always distressing. rin this as well as in every form of rheumatism, the iodide of potassium, given in large doses, has been greatly extolled. (iVew Remedies, 4th edit. p. 396, Philad. 1843.)] By the cautious adaptation of such means, and steady perseverance in their use, the disturbance of heart here treated of may in time be effectually relieved. Time, however, is required, for the dis- ease yields slowly; and though impression be made on it by the early procedures, months may elapse ere perfect tranquillity of circulation can be restored. The patience, however, which can await this result, and pursue steadily the means of accomplishing it, will be amply rewarded. There is one more form of rheumatism which requires to be noticed, namely, that which is called rheumatic gout; and so far as a name is con- cerned, this appellation, though only a popular term, is not misapplied. So much has this disease in common both with gout and with rheumatism, that it is scarcely possible to regard it otherwise than as a hybrid malady, in which the elements of both these diseases coexist. Its accession cor- responds most with rheumatism; its ravages have a greater resemblance to those of gout. The en- largement of joints to which it is so prone presents much more of the character of gout than of rheu- matism. Dr. Haygarth has described this disease, and proposed to denominate it nodosity of the joints. Of its history and treatment there is lit- tle to be said beyond what has been already ad- vanced under the heads of gout and of rheumatism. It is more frequent in women than in men. Its commencement is often marked by active fever, and in proportion as this is disregarded or inade- quately treated, are its ravages more severe and inveterate. But in many it advances by a slow and insidious progress, disorganizing the joints without materially deranging the general health. The local swellings long retain the character of active inflammation, being hot, red, and painful. They in general surround the whole joint, and, so far as mere touch can determine, they seem to arise from a general enlargement of all the struc- tures constituting the joint. It seems strange that the structures actually enlarged have not been long since ascertained by actual dissection ; yet we are not aware of any account of them, founded on anatomical examination, having been published. In 1805 Dr. Haygarth had not met with any such account, as appears from the following paragraph of his treatise: In this disease the ends of the bones, the periosteum, capsules, or ligaments which form the joint, gradually increase. These nodes are not separate tumours, but feel as if they were an enlargement of the bones themselves. This point might be anatomically ascertained without any difficulty or doubt. The disease, according to Dr. Haygarth, does not appear to shorten life; the first patient whom he saw so affected reached the age of ninety-three. As to treatment, this must be regulated accord- ing to the state of constitution and local symp- toms, and on the principles inculcated in this arti- cle. By local treatment much relief may be ren- dered. Frequent leeching has much effect in abating heat, swelling, and pain. In the purely chronic stage, successive blisters contribute much to reduce swelling and restore flexibility. As the hands particularly suffer from this malady, it be- comes necessary to blister each finger separately, and even each joint ; a process, which, however irksome, is yet ultimately recompensed by the in- creased power of using the hands which may be thus obtained. [Under the name Rheumatic Dermalgia, Mr. Beau (^Note sur la Dermalgie, in Archiv. general, de Med. x. ii. 120, Paris, 1840) has described an affection characterized by the following symptoms. The head and lower extremities are the parts most usually attacked, but the pain does not remain in one place, often changing its seat gradually, and wandering from place to place. Two kinds of pain are experienced, the one enduring, the other intermittent and severe, resembling the prick of a pin or an electric shock, and recurring about every I half minute. The enduring pain is often little more than an exaltation of the natural sensibility of the skin. Friction of the part with the finger, or with the patient's dress, always augments the pain; and if there be hair on the affected part, very severe suffering may be produced by passing the hand over the hair. Rheumatism of the skin commonly alternates](https://iiif.wellcomecollection.org/image/b21116799_0038.jp2/full/800%2C/0/default.jpg)
