§ 36. Simple Rheumatic Fever.

When an affection of the serous and fibrous tissues, sheaths of muscles, articular membranes, in company with the drawing, tearing, burning pains in the joints or trunk - the character of the pain varying according to the nature of the tissue which is the seat of the affection - is accompanied by a more or less violent, continuous remittent fever, we term this a rheumatic fever. The accompanying rheumatic pains may come on before or after the commencement of the fever, or may appear during the course of the disease. The pain which is experienced during those fevers has no definite and permanent character; it is sometimes tearing, stinging, boring, sometimes drawing, digging up, jerking; nor can we consider swelling and redness of the locally affected part characteristic symptoms, inasmuch as they are wanting in many rheumatic affections, such as lumbago, rheumatic affection of the intercostal muscles, etc. As the fever abates, the local affection diminishes likewise, leaving in a few cases a chronic trouble behind. The fever is a synocha, with evening and night exacerbations, which are accompanied by an increase of the local affection. An inclination to sweat is a characteristic symptom of that fever; the sweats, however, have no critical importance. The pulse is full, rather hard, accelerated, sometimes even quite hard, often unequal, especially so when the pericardium is affected, in which case the fever is very violent; the urine is scanty, yellow, reddish, and finally becomes cloudy and deposits a reddish, brick-dust sediment. The thirst is increased and the appetite diminished; sometimes the tongue is covered with a more or less thick coating of a yellowish white mucus, the taste is bitter, the patient inclines to vomit, the bowels are confined.

The 7th, 14th, or 21st day is the critical day, the fever terminating in a copious, general sweat; the duration and the commencement of the crisis are not always marked by definite periods. Schoenlein does not recognise any rheumatic fever; he terms the rheumatic affection acute rheumatism, which is distinguished from a rheumatic fever by the greater violence of the local affection, interesting the attention of the patient and the physician more than the fever; in acute rheumatism the redness and swelling occur more frequently than in rheumatic fever, especially if the affected part be near the surface of the body. The pain in acute rheumatism is more acute, more seated, the fever is more violent, and strictly continuous. It is undoubtedly improper to draw a marked line of demarcation between a rheumatic fever and acute rheumatism; if such a thing were possible, the homoeopathic treatment would not be affected by such a division.

§ 37. These fevers depend principally upon atmospheric changes, which generally communicate to those fevers an epidemic character. They occur frequently at the end of winter, at the commencement of spring, and during the damp and wet fall weather. Exciting causes are: getting wet to the skin, exposure to a current of air, repelled perspiration, etc.

§ 38. In most cases the prognosis is favourable as long as the disease remains a simple rheumatic fever. The prognosis is less favourable when the fever is accompanied with inflammation of important internal organs, or when the articulations of the spinal column are involved. The prognosis is likewise unfavourable when the fever lasts a long time, and the pericardium or the heart itself is involved in the disease; or when the fever settles upon the brain, and, in general, when the local affection easily changes its seat.

§ 39. The treatment of these fevers is just as varied as that of any other disease; it depends in every case upon the characteristic symptoms of the disease. Aconite is required only in very few cases. According to our experience it ought to be given when the fever is intense; when the inflammation, hot swelling, redness, and intense pains in the affected parts increase rapidly; in such a case Aconite is always indicated by other accompanying symptoms, such as: intense dry heat, burning dry skin; full, accelerated, not hard pulse; great thirst, flushed face, or else alternate redness and paleness of the face, anxiety and restlessness, moaning and tossing about, sleeplessness, or else sleep disturbed with anxious dreams. For such a group of symptoms, the lower attenuations of Aconite, frequently repeated, will prove the best remedy.

Rheumatic fevers which are characterized by such symptoms, belong rather to the class of acute rheumatism, whence it appears that Aconite is indispensable in that disease.

Bryonia is superior to Aconite when the nervous and vascular erethism is accompanied by tearing, tensive, stinging pains in the red and shining swelling of the articulation, becoming insupportable during movement and during the night's rest. This remedy has likewise to be repeated in such fevers, the repetition being proportionate to the violence of the fever which had remained after the exhibition of Aconite.*

Belladonna is a specific in rheumatic fevers when the brain and nervous system are greatly irritated, and the rheumatic pains wander from one part to another; swelling and light redness are always present, and the burning, stinging pains in the affected parts are most violent at night and when the parts are touched ever so lightly; if the patient should go to sleep, he is frequently roused by startings of the affected parts, or a painful drawing in the limbs prevents him from falling asleep. Belladonna is an excellent remedy when the nape of the neck, the spinal column and the small of the back are involved, when those parts are painful, stiff and swollen, when the rheumatic affection prevents every movement of those parts, and movement occasions the most violent pains; one knee-joint is likewise affected, the patient has to keep it bent and quiet, the least movement making the pain intolerable to such an extent that it will extort shrieks from the patient. (When these symptoms occur Bryonia may be used when the fever approaches more to the erethic form.) The rheumatic fevers to which Belladonna corresponds, are sometimes accompanied with tearing pains having the character of an ache, and proceeding from the inmost parts of the bones, or else darting like an electric shock towards the neighbouring articulation, where they occasion a dull pressure, which is relieved by counter-pressure, aggravated by motion, and increases in intensity daring the night. The fever has generally the form of a synocha: violent burning heat over the whole body, strong, full, accelerated pulse, a good deal of thirst, loss of appetite, accompanied by a tensive, aching pain in the forehead, with pressure from within outward, the pain being increased by moving the head; the urine is turbid and deposits a reddish sediment.