A treatise on diseases of the joints

Front matter

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I I idBI

THIS IJOOK ISTJHEGIFTOF

Preface To Second Edition

For some considerable time a Second Edition of my Treatise on Diseases of the Joints has been called for, and indeed, though never ceasing to study clinically and anatomically these affections, I began twelve years ago more especially to prepare my materials and myself for its production. Soon after 1861, whether the appearance of my First Edition was the stimulus, or merely fortuitously I know not, many excellent essays were published, and much careful investigation was undertaken here, in America, in Germany, and in France ; moreover, personal experience and research had provided me with a quantity of material. Hence, it became more and more evident as time went on that the Second Edition must undergo such enlargement and revision, that it appeared to me better to re-write the whole book. In its present form, therefore, the Treatise contains but a few words here and there of the First Edition.

Nevertheless, the lines of 'construction are, to a considerable, extent, the same; especially does experience show me, that the distinction which I at first drew, but which has been much criticised, between such maladies as commence in the synovial membrane and such as begin in the bones, must be maintained by him who would afford to his patients the full

VI PREFACE TO THE SECOND EDITION.

' benefit of a treatment founded on accurate and scientific .diagnosis.

Plainly may it be foreseen, that the doctrine of certain absorptive diseases discussed in Chapter IV; will meet with criticism, even with scepticism. I, myself, long doubted if such pathological sequence stood in the true relationship of cause and effect ; but, even while thus hesitating, several perfectly characteristic cases, following each other in rapid succession, left no room for ambiguity.

The volume should, if possible, have been smaller in bulk ; but even as it is, much that might have been said has been omitted. I hope, however, that the book may not be found either tedious or wearisome ; if only it meet with a reception as favorable as that of the earlier edition, my aspirations as to its fate will be amply fulfilled.

Richard Baewell.

32 George Street, Hanover Square, London. TV.

February, 1881.

CONTENTS,

CHAPTER I. Physiological Anatomy

PAGES

Constituents — Classification of joints — Histology of bone — Articular lamella — Cartilage — Development of limbs — Of joints— Genesis of synovial membrane — Peri-articular tissues and ligaments— Vascular and nervous supply 1-22

CHAPTER H

Acute Synovitis.

Pathology : Morbid anatomy — Changes in secretion — Leucocytes in synovia, — Purulent synovitis — Dry synovitis. Symptoms : Not constitutional — At different joints. Treatment : Best — Counter-irritants — Depletives— Puncture 23-45

CHAPTER HL

Suppurative Synovitis.

Pathology: Cell-broods — Cell-emigration — Fringe hypertrophy — Rupture of synovial membrane — Shedding of cartilage — Adjacent and neighboring abscess-i- Malpostures —Dislocations. Symptoms : Rigors— Pyrexia — Pain — Fixity — Distortion — Prognosis. Treatment : Of joint-wound — Purges— Depletives — Narcotics — Incisions — Question of amputation 46-63

CHAPTER IV.

Pyemic Joint Disease and other Absorption Diseases.

Pathology : Venous origin of pyaemia — Microzymes — Secondary abscess — Urethral and utero- vaginal pyaemia. Symptoms : Of pyaemia— Urethral — Antepartum— Post-partum — Catamenial — Typhoid fever and exanthematous synovitis. Treatment : Quinine — Sulpho-carbolate of soda — Parenchymatous carbolic injections — Examples 63-93

V1U CONTENTS.

CHAPTEB V.

Strumous Synovitis.

PAGE*

Pathology : Struma — Granulation-tissue - Invasion of neighborhood — Ligaments — Inflammation and ulceration of cartilage of bone — Reparative processes— Anchylosis— Three sorts of abscesses — Malpostures — Luxations — Contraction and contracture of muscles. Symptoms : Types of struma — 1st stage : Commencement of disease — Form of swelling — Locality of pain — 2d stage : Starting-pain and bone-invasion — 3d stage : Repair or destruction — Forms of luxation. Treatment : General— Rest— Posture — Extension — Counter-irritation — Parenchymatous injections — Movement — Actual cautery — Management of abscess 94-137

CHAPTER VI.

Subacute Rheumatic Synovitis.

Pathology : Mono- and poly-articular organizing tendency — Thickening of tissues — Relationship to hydarthrosis. Symptoms : Origin — Lithic diathesis — Peculiar shape — Silken crepitus. Treatment : General — Medicines and diet — Asthenic and sthenic form — Rest — Position — Counter-irritants — Oleate of mercury— Blisters — Puncture 138-156

CHAPTER VH.

Syphilitic and Gouty.

Of syphilitic — Two forms — Difficulty of Diagnosis — Combination with other syphilitic symptoms which guide treatment. Pathology : Gout —Lithic diathesis — Lithate of soda — Deposit in fibrous tissues — Cartilage — Bone. Symptoms : Tonic and atonic — Sort of pain — Influence ofjead —Changes of form. Treatment : Colchicnm — Atropine — Digitalis — Iodine — Alkalies — Diet — Natural waters and baths 157-164

CHAPTER Vm

Hydarthrosis or Hydrops Articuli.

Pathology: Distinctions — Different forms of hypertrophied fringes — Peculiar thickening — Not oedema — Multiple false bodies. Symptoms : At different joints — Stretching of ligaments — Subsequent looseness — To distinguish different forms. Treatment : By evacuation — Incision — Injections 165-179

CONTENTS. IX

CHAPTEE IX.

Movable Bodies in Joints.

PAGBS

Pathology : History — Constituents — Genesis — Traumatism. Symptoms : First invasion — Sudden seizure — Acute synovitis — Hydarthrus — Attached or nonattached. Treatment : Fixation by pins and bandages — Subcutaneous and free excision — Statistics — Mode of operating — Cases and specimens 180-196

DISEASES COMMENCING IN THE BONES.

CHAPTER X.

Acute Ostitis.

PATHOLOGY : Commences in or near epiphysis — Traumatism — Effusion — Intra-osseous pressure — Diastasis— Mode of joint-affection — Abscess of soft parts. Symptoms : Rigors — Pyrexia— Pain — Dusky redness — Great tumefaction — Distortions of diastasis— Pyaemia. Treatment : By excision or expective — Strong tincture of iodine — Support — Management of diastasis 197-21d

CHAPTEE XI.

Chronic Ostitis.

Pathology : Macroscopic inflamed bone —Enlargement of Haversian canals — Mechanism of bone-absorption — Different views — Enlargement of lacunas — Fatty ostitis — Infantile softening and induration — Ostitis of immature epiphysis. Symptoms : Sort of pain and swelling — Early starting-pain — Table of diagnosis — Necrosis and caries — Diagnosis— Mode of joint-implication — Caries necrotica — Diastasis — Shortening — Occasional lengthening — Mode of repair. Treatment : General — Aetual cautery — Extension — Splint — Paracentesis ossium — Sequestra removed 214-251

CHAPTER XH.

Arthritis Deformans.

Pathology: Nomenclature — History of — State of various tissues. Bones: Form-changes by atrophy and hypertrophy — Osteophytes— Marginal hyperplasia — Porcelanous deposit. Symptoms : Poly- and mono-articular forms — Sorts of pain and swelling — Synovial crepitus — Changes at different joints. Treatment : Tonic — Arsenic: — Mercury — Local baths— Natural, sulphur, and other waters 252-266

X CONTENTS.

CHAPTER XITL

Inflammation and Degeneration of Cartilage.

PAGES

No joint disease beginning in cartilage — Chondritis — Inflammatory fibrillation — Shedding— Degenerative fibrillization of— Effects of immobility on cartilage — Ecchondrosis — Hypertrophy — Atrophy 267-273

CHAPTER XTV.

Hip-Joint Disease.

Pathology : Frequent origin in epiphysis or junction — Morbid anatomy — Acetabular hip disease — Intra-pelvic abscess — Pressure effects— Knee-pain — Lengthening, shortening, and flexion explained — Abscess — Place of pointing — Luxation often slow — Diastasis — Hip disease and phimosis. Symptoms : 1st stage : Modes of limping— Of pain and tenderness — Fixity of thigh — 2d stage : Diagnosis of lengthening, shortening, and of flexion — Interpretation of knee-pain — Qf swellings— Diagnostic table — 3d stage: Shortening abscess —Caries — Signs of recovery. Treatment : Early — Splints— Extension — Counter-irritation — Puncture of joint— Intra- pelvic abscess— Dangers — Management. .274-316

CHAPTER XV.

Sacro-iliac Disease.

Pathology : Spinal and joint form — Caries — Necrosis — Abscess. Symptoms : Diagnosis from Morbus coxae — Examination by movement — By pressure — By swelling — Search for place of caries. Treatment : Best — Counter-irritants —Opening abscess — Search for sequestra — Trephine over the joint — Mechanical support 317-323

CHAPTER XVI.

Affections of Sheaths and Btnts^i.

Bursa? — Their localities— Acute and chronic inflammation — Housemaid's knee — Deep bursas — Sheaths — Palmar sprains — Painful crepitation — Dropsy — Melon-seed bodies — Ganglia, anatomy of —Cysts in popliteal space 323-338

CHAPTER XVH.

Hysteric Pseudo-Disease of Joints.

Pathology : Hysteria not coexistent with the fit— Phases at different stageB— Prognosis. Symptoms : Peculiarity of pain— Absence of inflammation— Usual localities. Treatment : Partly mental— Uterine states — General hygiene — Coccydynia— Operation for 339-350

CONTENTS. X3

CHAPTER XVm

Restoration of Crippled Joints.

PAGES

Causes of joint stiffness — Diagnosis in various joints — Behavior of muscles— Results of certain diseases — Sudden force — Division of tendons, etc. — Manipulation at different joints — Caution to avoid subluxation — After-treatment for attainment of different aims — True anchylosis — Osteotomy — Hip — Knee — Elbow — Nature's modelling — Care in selecting cases, etc 351-382

CHAPTER XIX.

Genu Varum and Valgum.

Anatomy of — Selection of cases — Separating internal condyle — Division of femur — Also, when necessary, of leg bonea — Mode of opeiation — Occasional subsidiary twists of the limbs 383-389

CHAPTER XX.

The Removal op Diseased Joints.

Circumstances which justify removal — Amputation and excision, and causes of preference for each — Comparative safety of excision — Selection of cases — Points to be observed in excision — Reparative processes after excision — Tendencies of union at different joints — Statistics, operation, results, and other information concerning — Excision of the shoulder — Elbow — Wrist — Parts about the hand — Hip, knee, and ankle 390-447