On the treatment of rheumatic fever in its acute stage, exclusively by free blistering / by Herbert Davies.

  • Davies, Herbert, 1818-1885.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of rheumatic fever in its acute stage, exclusively by free blistering / by Herbert Davies. 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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    of acute rheumatism; but as yet the evidence is too incomplete to establish this statement as a fact. Again, for what length of time does this affinity—this power of attraction between poison and tissue continue ? It is indeed diffi- cult, if not impossible, to answer this question; but the condition of the poison, its persistent fluidity, or rapid tendency to crystalliza- tion, will go far to determine the probability of its being removed by such means as blistering. There is no evidence to shew that the poison of rheumatic fever—supposed to be the lactic acid, is ever deposited as a solid, while Dr. Garrod tells us that true gouty inflammation is always accompanied by a crystalline and interstitial deposit of urate of soda, which is infiltrated into the cartilages and ligaments, and remains there for a lengthened period of time, and perhaps for life. We can readily understand, then, how the fluid poison of acute rheumatism may be readily expelled from the system by setting up large discharging surfaces in the proximity of the poisoned joint; and, on the other hand, how the same amount of benefit cannot be readily expected from similar treatment in gout when the solid crystalline urate of soda has become deposited inter- stitially and beyond the pale of the circulation. I have no doubt that in the earliest stage of the joint affection, when the urate is still in the blood stream, some amount of elimination and consequent relief might be effected by free blistering; but, unfortunately, the rapid tendency of the poison to crystallize, steals a march upon our local efforts and renders them abortive. Still there can be no ob- jection to the employment of blisters : and I have in some cases seen considerable relief effected by the application; but relapse has not been infrequent—a circumstance readily understood when we remember that we have been unable to remove a substance already part and parcel of the tissues. Dr. Garrod has established the fact that uric acid can be usually detected in the blister-serum, derived from every portion of the surface of a gouty individual, except from the skin of the inflamed joint—the gouty inflammation appearing to him to have the power of chemically destroying the virus. Is it possible that the urate does not appear in the blister-serum, obtained direct from the joint, lor the simple reason that it is rapidly separated from the blood, thrown into the tissue, and therefore really absent from the fluid ?