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.

    912/976 (page 892)
    those who are thoroughly acquainted with both diseases ; and hence it is, perhaps, that physical authors have not mentioned it, unless indeed we esteem it a new disease.” Cullen thus defines Rheumatism: “ A disease from an external and often an evident cause; pyrexia; pain about the joints, following the course of the muscles, fixing upon the knees and larger joints in preference to those of the feet and hands—increased by external heat.” Even since Cullen’s time there have been authors, both in this country and abroad, who have included Rheumatism and gout under the same category, amongst whom stands prominently the name of M. Chomel. The late Sir Benjamin Brodie, in his work on diseases of the joints, clearly separates Rheumatism from rheumatoid arthritis, although he designates the latter affection ulceration of the cartilages. At the present time it may be confidently asserted that, omitting purulent affections of the joints and those connected with urethral suppuration, there exist at least three well-marked articular diseases dependent on morbid states of the system; these are rheumatism, gout, and rheumatoid arthritis, and probably to them we may add a fourth, namely, muscular rheumatism. Description of Acute ancl Sub-acute Rheumatism.—To illustrate this subject we will give a sketch of an acute attack of Rheumatism, such as is daily met with in practice. A young woman, possibly somewhat out of health, is exposed to severe cold, or to cold and damp con- joined; she feels a distinct chill or rigor, and this is followed, probably during the second or third day from the exposure, by the development of the joint affection; the ankles become painful and unable to bear the weight of the body, and on examination they are found tender to pressure, swollen, unduly hot, with a distinct flush upon the surface; at the same time the system exhibits a state of febrile excitement, the pulse is rapid and commonly hard, the whole surface hot and bathed in perspiration, having a peculiar acid, at least acrid, odour. The tongue is coated with a thick creamy fur; there is loss of appetite, but increased thirst and a constipated state of the bowels ; the urine is usually scanty and high-coloured, and gives rise on cooling to a copious red deposit. The inflammation is seldom confined to one . joint, but gradually extends over the whole body. The larger joints are more frequently affected than the smaller in the earlier periods of the attack. The erratic nature of the affection is usually well exhibited ; at one time the knees and ankles, at another the elbows and wrists suffer, and not infrequently the development of inflammation in one set of joints is accompanied by its rapid subsidence in another. A symmetry is often shown in the order ot attack: the right ankle, then the left; the right knee, then the left; and so on lor the other ; articulations. It is a matter of astonishment to observe how quickly and completely the inflammation will subside in any part. A knee, for example, will one day be intensely hot and swollen, and so ex-