§ 153. Acute rheumatism, rheumatalgia.

A joint of an upper or lower extremity, or all the joints of the extremities, suddenly swell and become painful, generally without any precursory symptoms; in a few cases of violent rheumatism the vertebral articulations from the head to the pelvis are likewise affected, or the muscles of the trunk, the heart, pleura, etc. The pain is violent, sticking or tearing, aggravated by pressure or motion; the swelling is at times great, at times inconsiderable, generally soft and not very red. The affection is generally seated in the joints, tendons and ligaments; the muscular and similar tissues are likewise liable to rheumatism. It is peculiar to this species of rheumatism, to wander from one joint to another. Simultaneously with or shortly after the appearance of the local affection, the patients are seized with chills followed by intense heat, which is permanent; the skin is hot and dry, or covered with viscid sweats which do not afford any relief; the pulse is at first full, 100 or 120, tight, hard, and, after the disease has lasted for a time, becomes fleeting, small, contracted; the thirst is violent; the urine dark-red and fiery, burning while passing through the urethra, saturated with free uric acid; the appetite has disappeared, the tongue is generally coated whitish or yellowish, with slimy, bitter taste and obstinate constipation.

§ 154. Young and vigorous individuals are most liable to acute rheumatism. It may be occasioned by keeping the body too warm, increasing the sensitiveness of the skin to an undue extent, sedentary life in closed rooms, want of exercise, etc. Exposure to a draught of keen air while sweating, is a sure means of having acute rheumatism. It lasts from 7 to 21 days, and longer; it is liable to become chronic. Recovery takes place with profuse sour sweats, and copious se-dimentous urine. Relapses are very frequent. Death takes place by the suppression of miliaria, which had made its appearance, or by metastatis to some internal organ, brain, heart, lungs.

Rheumatism may lead to exudations in the adjoining cellular tissue, induration, anchylosis, suppuration, paralysis, etc.

The prognosis depends upon the permanency of the local affection, upon metastasis to some internal organ, the setting in of miliaria and anasarca, the complication with nervous symptoms.

§ 155. As regards the treatment of rheumatism, I refer the reader to § 36. In regard to the treatment of the local affection, the following remarks will be found useful.