The Symptoms of Acute Rheumatism

Slight chilliness for two or three days, followed by fever, or fever from the first; pain in one or more joints, most frequently in the knee, ankle, wrist, or shoulder, which increases rapidly and becomes very severe; great tenderness of the affected joints; pain greatly increased by motion; joint swollen; pulse ninety to one hundred a minute, sometimes more rapid; frequent respiration; sour saliva and perspiration; considerable thirst; scanty and high-colored urine, usually with reddish sediment; tongue coated.

Acute rheumatism is a very common disease. It is rarely immediately fatal, but very often leaves the patient with difficulties which, sooner or later, terminate his life. This occurs whenever the heart becomes affected by the disease, which not infrequently happens. This does not occur by a metastasis or change of the seat of the malady from the joints to the heart, as is often supposed, but by an extension of the disease to the lining membrane of the heart In consequence of inflammation, the valves of the heart become thickened and contracted so that valvular organic disease of the heart is the result Rheumatism is the most common cause of this form of heart disease. The extension of the disease to the heart is indicated by the occurrence of acute pain in the left side, in the region of the nipple, disturbance of the pulse, increase of fever, and increased frequency of respiration, in fact, all the symptoms elsewhere described as occurring in endocarditis. Only one, or all the joints in the body, may participate in the inflammation. The joints are generally affected symmetrically; that is, the ankles, wrists, knees, elbows, or shoulders, will be affected on both sides at the same time. When this is not the case, analogous joints upon the same side, are likely to be affected, as the ankle and wrist, the knee and elbow, the hip and shoulder, etc. Sometimes the disease appears to be very fickle, changing constantly from one joint to another without any apparent cause, the change taking place within a few hours.

By a careful investigation of the subject nearly twenty years ago, our instructor in the practice of medicine and physical diagnosis, Dr. Austin Flint, of Bellevue hospital, New York, showed that rheumatism is a self-limited disease; that is, one which will recover of itself, without any treatment whatever, and in from two to eight weeks, the average duration of the disease being about four weeks. Dr. Henry Sutton, of Guy's hospital, England, in his investigations found the average duration, in forty-one cases, two weeks. In two subsequent series of cases, the duration was nine to ten days.

The Causes of Acute Rheumatism

The causes of rheumatism are not thoroughly understood, but it is generally believed that exposure to cold and wet are the most common exciting causes, while free living, especially the large use of meat, and sedentary habits,-conditions which favor the production of an acid condition of the blood, particularly the accumulation of uric acid,-have much to do with producing a predisposition to this malady. Dr. Murchison holds that inactivity of the liver is a predisposing cause of rheumatism. A tendency to the disease is undoubtedly inherited in many cases. Rheumatism seems to be very closely allied to gout, a disease from which it cannot always be distinguished. Indeed, some very eminent observers, among whom may be classed the learned Dr. Fothergill, of England, hold that rheumatism and gout are one and the same disease.