Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    898/976 (page 878)
    sexes, and at almost every age, and its invasion often assumes a form very similar to that about to be described. A young woman lias become from some cause, decidedly out of health; perhaps from menorrhagia or leucorrhoea, or from haemorrhage during parturition, or from pro- longed anxiety or physical fatigue ; she is exposed to cold, and, after a few days, feels some pain in the knee; there is slight swelling and tenderness ; perhaps the temperature is a little elevated; simple rest to the joint may be followed by relief, or even a cure, for the time, the swelling abating, and the tenderness and pain vanishing; or perhaps this result may have been expedited by the application of a blister, or some other form of counter-irritation. After a few weeks or months, as the case may be, perhaps from a second chill, another joint, or even that which was previously impli- cated, becomes affected, and a similar train of symptoms arises, but with this important exception, that, in all probability, the inflam- mation does not again subside, but continues fixed to the joint, and gradually extends to others. During this time there may be no ap- preciable constitutional disturbance beyond the general ill health above noticed, but in some cases dyspepsia or nervous symptoms are exhibited. The disease, if unchecked, travels over the whole body, affecting almost every articulation of the limbs, and causing much deformity and distortion, from the enlargements and contractions which it pro- duces ; nor are its ravages confined to the limbs alone, but other joints may be attacked, especially the temporo-maxillary articulation, causing the closing of the jaw; the upper cervical vertebrae may like- wise be involved, and the neck become fixed; and thus at last the patient is rendered crippled and altogether helpless throughout the remainder of life. The above example is, indeed, one in which the disease has effected all the mischief it is capable of; fortunately, it does not always proceed to this length, but is arrested at some stage or other of its progress, and then only a limited amount of distortion is induced. The deformities produced by Eheumatoid Arthritis are not altogether characteristic of this disease, for they are produced likewise by chronic gout; but in their advanced conditions, the separation of one disease from another is usually a matter of no difficulty. The changes in the arms and hands, when severely affected, are ot the following kind :—The elbow is flexed, perhaps at an angle of 35 from full extension ; the forearm in a semi-pronated position; the joint is also much enlarged and mis-shaped, more or less rounded from the alteration and hypertrophy of the heads of the bones, as well as of the soft tissues. The wrists are rigid, almost straight, and scarcely admit of motion in any direction. , The hands are usually thin, from the absorption of fat, and from tne wasting of the other soft tissues ; the extremities of the phalanges aie nodular, as also the heads of the metacarpal bones. The fingeis a usually turned outwards, and their joints rigid, oiten complete1 y xe