WHITE SWELLING, a disease of the joints, so called on account of the unaltered colour of the skin. Under this term are included nearly all those diseases of the joints which are the result of chronic inflammation in the bones, cartilages, or membranes constituting the joint. These inflammations are constantly attended with swelling, which is circumscribed ; the part is sometimes hard, resisting the pressure of the fingers, and thus leading to the impression that the bone is swollen and diseased ; or it may be elastic, and yielding to premium ; or so soft as to produce the impression of the presence of fluid. Sometimes these swellings are attended with no pain ; at other times pain is one of the earliest symptoms, and is constantly present, and greatly aggravated by the motion of tho limb. In some cases the motions of the joint are but little impeded, whilst in others they are entirely destroyed. These general symptoms however admit of dis tinction, and several forms of white swelling can now be traced to different parts of the joint as their seat.
Amongst old writers these diseases have been described under the names of spina ventosa, fungus articuli, lymphatic tumour, and other names. A common division of these diseases is also into rheumatic and scrofulous, according as they were supposed to have their origin in a rheumatic or scrofulous state of the system. The more active were referred to the former and the chronic to the latter. Many other dis tinctions are founded more upon the age, temperament, and constitution of the patient, than upon essential differences of the disease. The following are the diseases of the joints which are generally denominated white swellings.
1. Inflammation of the Synorial Membranes.—This disease may be either acute or chronic. When acute, the skiu is generally red, and the joint very painful and tender. It commences with pain at one particular spot, and in a day or two after, swelling takes place. The swelling may be felt at first to undulate, from the effusion of fluid into the membrane ; but this becomes less evident as the disease advances, from the thickening of the membranes and also from the effusion of lymph. The swelling always assumes the form and direction of the
synovial membranes. In a few days the disease subsides altogether or assumes the chronic form. When the inflammation is chronic from the beginning, the pain and tenderness are much less, so that the patient is able to walk about without much difficulty. There is little or no fever, the skin retains its natural colour, the swelling increases only slowly, and the symptoms are rendered worse by exposure to cold and exertion. In these cases, although the effused fluid may at length become absorbed, the synovial membrane remains thickened, and swelling and stiffness of the joint are the consequence, constituting a very common form of white swelling. The causes of this disease are both constitutional and local It may arise as an effect of phlebitis, gout, rheumatism, syphilis, or mercury; or it may be produced by sprains, contusions, wounds, dislocations, or fractures of the heads of the bones.
The treatment of this disease must vary according as it is acute or chronic, or dependent on local or constitutional causes. In the acute and local form of the disease perfect quietude must be insisted on, cupping and leeches to the part should be had recourse to, with saline purgatives and diaphoretics. When the akin is tense, fomentations and poultices may be used ; but where not, cold lotions will be best. In the early stage of the chronic form, leeches and cold lotions to the part may be applied and perfect quietude enjoined. In the latter stages, counterirritants may be used, such as blisters, the swine cerate, ointment of tartarised antimony, &c. When persons are well enough to move about, the joint should be kept from movement by strapping it with soap-plaster, or covering it with a bandage or a cap of leather or other material made to fit tight. Bathing with cold salt water, or 'pouring on the part cold water may he recommended. For the removal of the stiffness, shampooing, the vapour-bath, or friction with the hand, may be employed. When the inflammation arises from rheumatism or syphilis, the treatment should be the same as for those diseases.