Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    264/864 page 248
    Treatment—Although, the disease cannot be cured, and may get steadily worse as the patient gro-w-s older, much can be done in the way of relief. Thus the whole Ijody should be warmly clad, the diet cfirefuUy regulated, stiniidants prohibited or restricted in quantity, and a periodical visit paid to such spas as Buxton, HaiTOgate, Bath, Wiesbaden, Aix-les-Bains, or Wildbad. LocaUy, shampooing, friction, and passive movements, should be from time to time employed ; the joint should be enveloped in wool or flannel, but should not be kept at rest on a sphnt, since this will only tend to increase the stiffness. In the way of drugs, cod-liver oil, iodine,_ iodide of potassium, and guaiacum, are of the most service. Charcot's disease is an affection of the joints closely resembling osteo-arthritis. It is believed by some to depend upon degenerations in the spinal cord (locomotor ataxia), and therefore to be the result of trophic changes in the joint. Others, however, regard it merely as an osteo-arthritis occurring accidentally in a patient the subject of locomotor ataxia. The pathological changes are similar to those already described under osteo-arthntis, but the destmction of the joint is more marked. Bnefly they may be said to consist in erosion of the cartilages, softening of the ligaments, grinding away of the articiilar surfaces and often'of the contiguous portions of the shaft of the bone, induration of the remaining portions of the articular surfaces, thickening and at times pouchings of the synovial membrane, and formation of osteophytes around. Suppuration is very rare. These c'hangc^s mav affect one joint only, or may occur successively in several joints. o T1 The si(jus in a tvpical case are as iollows :—Sudden swellin-of a joint usuallv without much ])aui or any marked signs of inHammatiou, followed, on .Mibsidence of the swelling, by preternatural mobility, and the lormation of processes of bono about the articular surfaces and in the surrounding muscles and tendons. Tliere is great dclinnntv, but not much pain either on movement or liiindling. Along with the hical sigiis there are generally symptoms of locomotor ataxia, such as an unsteady gait, a' tcndencv to fall on placing the feet together with tlie eyes clo.scul, a jerking movement of the Innbs, absence of the iiatella-tondon-reflex, lightiung ]iains. s]iasniodie nmscular contractions, local aniesthesia and sweating of tlie limbs, loss of response of the pu]»il to light but no
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