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.

    917/976 (page 897)
    I RHEUMATISM. 8J/ according to Haller, the blood yields a thick and firm clot in this disease, but others assert that under the huffy coat the clot is found to be loose and friable; probably both are correct in different instances. Andral and Gavarret analysed the blood in fourteen cases of rheu- matic fever, and found the maximum amount of fibrin to be 10 2 parts in the 1000; the minimum 2-8 parts; the mean was 67; healthy blood yields, according to these observers, three parts per thousand. The serum of the blood does not appear to be very sensibly altered in composition; Andral and Gavarret found an increase in the solid residue left by evaporating this fluid, the mean amount was 8G'0 per thousand against 80'0 per thousand in healthy blood. The same chemists found a diminution in the total solids; thus the mean in the above-mentioned fourteen cases was 194-6 parts of solid matter to 805-4 parts of water in the 1000 parts of blood ; whereas in healthy blood the ratio between the solid residue and water is 200-0 to 790-0. In several analyses which I have made of the blood in acute rheumatism, I have found the amount of fibrin notably increased— namely, from four to six parts in the 1000—and the clot has usually been buffed and cupped. The serum in thirty-five cases was found distinctly alkaline in reaction, it presented a healthy appearance, its specific gravity was somewhat less than in health, and in no case was any uric acid detected either by the thread experiment described in the article Gout, or by the ordinary method of separating this acid from blood. The absence of uric acid or urate of soda is important, as it at once shows essential difference between gout and Rheumatism. Urea does not exist in the blood in acute rheumatism in quantities larger than in health, except in cases in which the kidneys have been either previously affected, or have become congested during the progress of the disease. As above stated, the serum was always distinctly alkaline in reaction ; this fact was particularly observed and noted, as it has been affirmed that the serum is sometimes acid in rheumatic fever. There are, as yet, no recorded observations indicating the amount of the alkalinity. Ho abnormal principle has been found in the blood; lactic acid has been assumed to exist in it, but no proof has been given of its presence. In the sub-acute and chronic varieties of Rheumatism, no marked alterations are found ; the fibrin is increased but slightly, and only in proportion to the amount of the febrile disturbance. In ten cases the maximum of the fibrin was 54, the minimum 2-6, and the mean 38 parts in the 1000 parts of blood. Urine in Acute Articular Rheumatism.—Examinations of the urine in acute rheumatism have been frequently made with the following- results :—To the eye its appearance varies much in different cases ; as a rule it is high coloured and scanty, clear when first passed, but speedily becomes turbid from the deposition of urates; when copious it sometimes remains bright even after it is cold. These characters vol. r. 3 m