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.

    901/976 (page 881)
    been made by himself, and with simply a negative result. If any amount of active inflammation is present, the fibrin is increased, and the clot becomes firm, cupped, and buffed The serum has the ordinary properties of the serum of healthy biooct, and yields no uric acid. The analysis of the urine has likewise given negative results. The perspiration has not been examined, but there is no reason to suppose that any peculiar alteration would be found in it. Morbid Anatomy of Rheumatoid Abtiiritis.—The morbid anatomy of this disease has been very elaborately worked out by Dr. Adams, to whose volume the reader is referred for full details of the various changes which take place. In the present article a summaiy only ot the results found in different cases, and different stages of the malady, will be given. If a joint is examined in an early stage of the disease, when swell- ing is prominent, a considerable increase of synovial fluid is found, and the joint exhibits the same appearances as in cases of ordinary inflammation; the lining membrane is often red, from over-injection of the bloodvessels. It is not an easy matter to obtain an oppor- tunity of examining joints in this condition, as Rheumatoid Arthritis is seldom fatal, except in its very advanced stages; but the superven- tion of other maladies sometimes enables us to do so. No deposits of urate of soda are found in any stage of this disease, and I am per- suaded that the statements to the contrary are erroneous, and, as yet, there has been certainly no proof given in support of such assertions. Of course it is not impossible that a patient may have had gout in a joint, and that afterwards the same articulation may become the seat of Rheumatoid Arthritis; but this, if indeed it ever occurs, is most rare, and would not in any way favour the idea that deposition of urate of soda is a phenomenon of this form of inflammation. When the effusion in a joint has been absorbed, the capsular mem- • brane is usually found thickened. In the hip, or shoulder, the round ligament or tendon of the biceps is probably destroyed; inter-articular cartilages are sometimes absorbed; and a case has recently come under my observation in which the articulation of the jaw exhibited this alteration in a very complete degree. If the fluid becomes ab- sorbed before much serious change has taken place in the internal structures of the joint, the ligaments have generally undergone so much lengthening as to allow of unnatural mobility, thus rendering dislocation easy. From almost the very commencement of the inflammatory action, the articular cartilage begins to suffer, a slow process of absorption takes place, the cartilage appears to split up into fibres, vertical to the surface of the bone; little depressions are observed, and these at length coalesce, and the bone is left in part uncovered ; as the disease proceeds, the whole surface may be thus denuded, and as the osseous surfaces are brought into contact with each other in the movements of VOL. i. 3 L