Licence: Public Domain Mark
Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
104/642 (page 80)
![modified, in other instances, by some peculiar diathesis of the jiAtient, e.g., the scrofulous. Tlie vaiioties of sub-acute rheimiatism derive their distinctive characters, in great measure, from the circmnstance tliat, in some cases the fibrous structures around the joint, in others the synovial membrane, is the seat of the local inflammatory action. In acute rheumatism the two are more intimately blended; in the sub- acute form it is not difficult to distinguish the thickening of the ligamentous structures, which are firm and resisting, from the puH’y elasticity and feeling of fluctuation comimmicated b}’ the presence of fluid in the cavity of the joint. The first is more fre- quently met with in the smaller joints of the wrists and fingers; the other, by far the most frequently, in the knee, where the accumulation of fluid is sometimes very remarkable. Among the complications of sub-acute rheumatism gonorrhoea is one of the most important, especially in the male sex. It is a very frequent association of that form in which the swelling and redness seem to indicate very acute action, while the absence of pain and of fever, and the limited nature of the aflection, really lead to an opposite conclusion. A very serious aflection of the brain is occa.sionally seen as a complication of synovial rheumatism, when, during its progress, the sudden absoi-ption of the fluid is followed by delirium and coma. In sub-acute rheumatism afl'ections of the lungs and heart are much less common than in the acute fonn. Symovitis is the disease which most nearly resembles sub-acute rheumatism ; and from this, as we have already seen, it can only be distinguished by analysing the causes of the aflection: the local action is the same in each. Other diseases of the joints are more liable to be confounded with chronic rheumatism, under which head their distinguishing characters will be more fully con- sidered. Hero we have only to notice, that in certain cases in which the knee-joint is affected with absolute thickening and degeneration of the synovial membrane, the external aspect closely resembles that which is produced by the presence of fluid in synovial rheu- matism. The history of cases of joint-disease is generally obscure, and extends over a long period; their progress is insidious, and they are especially distingui.shed from rheumatic affections by the ab.seucc of pain in their commencement. The degeneration of the ’synovial membrane last alluded to is, indeed, almost painless throughout: its shape sufficiently characteri.scs it as an aflection of the synovial membrane, while the feeling of el.asticity and absence of fluctuation show that there is no accumulation of fluid. § 3. ]\hisc%dar J?het(malism.—Pain and stiffness of rlicumatic origin may also attack tiic muscular struc-](https://iiif.wellcomecollection.org/image/b24989812_0104.jp2/full/800%2C/0/default.jpg)
