ADDITIONS TO THE REVISED EDITION OF 1880. 571 



of the lumbar vertebrae by means of a broad metal plate), neither 

 this treatment nor long-continued faradization of the diseased muscle 

 had any decided effect. 



ADDITIONS TO THE REVISED EDITION OF 1880. 



DISEASES OF THE ORGANS OF LOCOMOTION. 



1. P. 527. 



Without doubt the articular inflammations in acute rheumatism 

 are not due to purely local causes, but evince a general morbid pro- 

 cess. This is shown by the inflammation of numerous joints distant 

 from each other, its disappearance from one on attacking another 

 which was previously unaffected, the frequent implication of the 

 heart and other internal organs, the remarkable sweating, etc. The 

 nature of this apparently constitutional disease has not yet been 

 solved, but there have long been two theories about it : 1. A hu- 

 moral theory, according to which there is a change in the blood 

 and fluids of the body, where from imperfect assimilation there is 

 an excess of lactic acid ; 2. A neuropathologic theory, which refers 

 the disease to a morbid excitement of the vasomotor trophic nerve- 

 centres ; this view finds some support in the tendency to symmet- 

 rical occurrence, and in the well-known dependence of certain other 

 joint-affections on spinal diseases. 



From its frequence and severe consequences, acute articular rheu- 

 matism is one of the most important of diseases, and ranks along 

 with consumption, pneumonia, bronchitis, typhoid fever, etc. It 

 is rare in childhood, more frequent from the fifth to the fifteenth 

 year, and most so between fifteen and thirty-five ; after that its oc- 

 currence as -a first attack is more rare. Both sexes are about equally 

 liable. A considerable percentage shows a hereditary predisposi- 

 tion, especially among the younger cases. There seems to be a 

 greater tendency to its development after certain diseases, such as 

 scarlatina, dysentery, and in the puerperal state, after abortions, etc. 



2. P. 535. 



In those cases with high fever and cerebral symptoms, we may 

 resort to cold baths, as spoken of in the treatment of typhoid fever. 

 In place of wrapping the joints in wadding or applying narcotic 

 liniments, firm bandages may sometimes be applied with benefit ; 

 for this purpose we may use pasteboard moistened and moulded, or 

 gutta-percha, placing plenty of wadding under them ; after the ap- 

 plication of such firm dressings the pain sometimes subsides very 



