The venereal diseases : including stricture of the male urethra / by E.L. Keyes.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: The venereal diseases : including stricture of the male urethra / by E.L. Keyes. Source: Wellcome Collection.

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    According to Fournier the sterno-clavicular articulation is a very con- stant seat of gonorrhoea! rheumatism, the knees very often suffer, the ankle comes next, and then the fingers and toes. The bursae, the tendons, and the muscles are involved in an irregular manner in connection usu- ally with troubles in the joints which overshadow them in importance. One of the most common forms assumed by this malady is that of a chronic hydarthrosis, most often attacking the knee-joint. This form is generally mono-articular and is apt to relapse in the same individual dur- ing different attacks of urethral inflammation. In a case of bad stricture under my care, the stricture being in the membranous urethra and having been treated by perineal section, the patient during a number of years being careless in his habits and inclined to drink, had repeated attacks of urethral inflammation not by any means always due to venereal causes. With each attack of suppurative urethritis he suffered simultaneously with some form of gonorrhoeal rheumatism, and among these had three or four attacks of hydarthrosis of one or both knees ; he had also, at dif- ferent times, the ocular, bursal, tendinous, arthritic, and muscular symp- toms of gonorrhoeal rheumatism, and rarely escaped in less than several months from any attack. My observations embrace a considerable num- ber of cases of gonorrhoeal rheumatism, and among them hydarthrosis of the knee has been very common. The ankle and the elbow suffer in the same way, but very much less commonly. Taking the knee as type, in a case of hydarthrosis, the serous effu- sion may come on almost without pain; p'erhaps slowly, sometimes very quickly. The patient finds that he has lost confidence in his knee; it seems unsteady, and perhaps hurts him upon attempting to rise or on going upstairs. With this he is apt to have other unimportant pains in different parts of the body. He now examines the knee to find what is wrong, and is astonished to find the joint distended in an oval way, man- ifestly full of fluid. Sometimes the onset of the joint inflammation is attended by consid- erable local pain, but there is no fever, no redness of the skin, no sweat- ing, no excess of urates in the urine; and after the effusion has taken place the pain moderates or disappears entirely, except when the joint is moved or handled. The urethral discharge meantime keeps on unabated. Other joints may now become implicated, but the knee continues swollen instead of getting well, as in ordinary rheumatism. Indeed, the joint first attacked is generally the last to get well, thus earning for the mal- ady the title, mono-articular, even where more than one joint is affected. The course of this hydarthrosis is often exceedingly slow. Acute sup- puration, although noted, has been rare. It has been known to prolong it- self for years, and to degenerate in strumous individuals into white swell- ing, and it may go on to an ultimate disorganization of the joint, with final anchylosis. The next form of gonorrhoeal rheumatism to be considered is the poly-articular variety. This form is nearly as common as the hydarthro- sis, and sometimes coincides with it. The affection closely resembles rheumatic gout, but it is desperately chronic in its course. A patient under my care has had three attacks of this form of gonorrhoeal rheuma- tism, each one of which lasted him in the neighborhood of eighteen months. The acuteness of the symptoms, in this form of the malady, varies greatl}'. They may be very mild, simply confined to a little stiffness of the joints upon moving, especially in the morning, or they may go on to