John Scott on the treatment of diseases of the joints, and of ulcers and chronic inflammation : a new edition, with an introduction and a chapter on the constitutional origin and treatment of diseases of the joints / by William Henry Smith.

  • Scott, John, 1798-1846.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: John Scott on the treatment of diseases of the joints, and of ulcers and chronic inflammation : a new edition, with an introduction and a chapter on the constitutional origin and treatment of diseases of the joints / by William Henry Smith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    by rest; shortly, however, the pain becomes both fixed and permanent, and is aggravated by every movement of the joint. The patient consequently limps in walking, more especially when he first begins to move the limb; he keeps the knee bent, and the heel raised, the toes only coming in contact with the ground. He is compelled to keep the limb in this position, in consequence of the great pain experienced by the compression of the ulcerated surfaces in any attempt to extend the leg. For the same reason he can bear the limb to be moved by his hand, when he cannot raise it by means of its own muscles. These symptoms occur before there is any tumefaction of the soft parts about the articulation. The pain becomes more severe in proportion to the progress of the dis- ease, and the patient is very much harassed and distressed by spasmodic contractions of the muscles on the affected limb. He will usually point to the head of the tibia as the chief seat of the pain, which, in the generality of instances, will continue to harass and distress him for several months before the soft parts are affected. It will be particularly aggravated by any position of the limb in which the articulating surfaces are compressed against each other. When, however, tume- faction of the soft parts does occur, it is slight in degree, and by no means proportionate to the pain. It arises from in- flammation and thickening of the cellular membrane external to the cavity of the joint, and is unattended by fluctuation. In some cases, where a portion only of the articulating surface is diseased, the patient will experience relief by placing the limb in such a position as shall take off the pressure from the ulcerated surface, and throw the weight on that which is not affected. This accounts for his being in pain in certain positions only of the limb. After the disease has existed for a considerable time, fluid is in some instances effused into the cavity of the joint in consequence of the whole synovial membrane becomino- ultimately inflamed. At length, the ulceration in the earth lages extends to the bones themselves, which become carious • matter is effused into the cavity of the joint, attended with an aggravation of all the symptoms, and ulceration of the syno-