Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
With these local symptoms there is an accompanying train of
constitutional symptoms which may eventuate fatally. At first there is
a chill, or a sensation of chilliness after which the temperature
quickly runs up several degrees, and either remains so, or goes down
and up several times in twenty-four hours, as in other septic
conditions. The pulse may be strong and full at first, but soon
becomes rapid and weak. In very acute cases, death from septicemia may
occur in a few days.
In ordinary cases, drainage of the pus, either naturally or
artificially, will result in a remission of the symptoms both locally
and generally.
+Treatment.+ In this, as in other suppurative processes, safety lies in
the prompt opening of the abscesses and the evacuation of the pus,
thus accomplishing free drainage, with subsequent disinfection by
means of applications or irrigations. Immobilization of the parts and
rigid antisepsis will generally yield good results as to life, though
recovery with ankylosis is the rule. In the most severe cases,
constitutional symptoms are so grave as to warrant immediate
amputation above the infected joint.
+Tubercular Arthritis.+ The great majority of chronic joint diseases are
tubercular in origin, the tubercle bacilli being deposited in any of
the joint structures, or in structures contiguous to a joint; with
children, very frequently in the bone substance.
Whether the tubercular process originates in the joint cavity itself
or outside of it in the surrounding tissues, destruction of the
articular ends of the bones is usual.
The parts become thickened and edematous; there is a gelatinous or
cheesy appearance, in which the membrane, cartilaginous bone ends,
capsule, and ligamentous structures all share. Frequently the synovial
membrane is studded with miliary tubercles and its cavity is filled
with an abundant serous secretion. The contour of the joint becomes
globular or spindle shaped, because of the atrophy of the parts above
and below it and the swelling of the periarticular structures. The
skin becomes white and thick because of the obliteration of the
superficial vessels and because of its edematous infiltration.
+Symptoms.+ Pain is, as a rule, but slight in the strictly synovial
stage of tubercular arthritis, but when the bones are involved, it is
severe, though acute symptoms, such as heat and redness, are lacking.
Deformity is a constant accompaniment of the disease; its degree is
greater or less according to the joint affected, the extent of the
disease, and the treatment pursued. It is due to the natural tendency
to assume the position of greatest ease; to the softening and
destruction of the ligaments, and to the effort on the part of nature
to immobilize an injured member by means of tonic contraction of the
muscles. These causes often result in the creation and persistence of
a malformation and malposition of the part.
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