Definition

An acute fever that is caused by absorption of toxin from intestinal decomposition in those of gouty diathesis, characterized by inflammation of one or many joints, with a marked tendency for inflammation involving the fibrous tissues around the joints.

Etiology

Rheumatism is found in almost every country. Damp weather is supposed to be a cause. People working in mines that are wet, and people living in countries where there are many rainy months, are supposed to have rheumatism because of this dampness. Any weather conditions that depress and enervate will precipitate an attack of rheumatism--not as a cause per se, but rather as an exciting cause. The foundation for rheumatism is laid at the table, and in neglect of the body in the way of bathing and clothing. There is usually a history of constipation, and in some cases colitis. Some authors declare that the disease prevails most in dry years, or during a succession of dry years. The same may be said of rainy seasons and a succession of rainy season. Any continuous or monotonous weather causes enervation, and this often is the last straw in precipitating an attack of rheumatic fever.

The disease may be found in children as well as in adults. Children who have been overweight, and have been recognized as exceedingly healthy, are inclined to take on rheumatic fever. If the weight has been excessive, so that nutrition has been gradually perverted, very great care and proper nursing will be required to bring the patient back to normal. If parents have been careless, and such patients have had one or two relapses, there is danger of heart complications springing up that will ruin the patient for life.

Symptoms

The disease usually begins like an ordinary fever--perhaps with a chill and vomiting. In other cases no stomach symptoms whatever will be found, and ill-defined pains may start up in a joint, in either the lower or the supper extremities. As in the case of nearly all fevers, there is a chilly sensation to start with, and in some cases real chills, like ague, which may lead those in attendance to believe the subject has an attack of malarial fever that will pass off in a short time. This, of course, is true only of cases developing in malarial countries.

Within twenty-four hours after the disease is developed, one or more joints are swollen, red, and very sensitive to touch. The pulse will not be more than 90 to 100. The temperature may run from 102° to 104° F. Some cases will desire to eat; but, as a rule, there is not much appetite. Constipation is usually present, and the urine is very decidedly acid. The perspiration from such patients has a very strong, acid odor, permeating the whole house.

The mind is usually clear, except in cases that show an excessive temperature; then patients may be delirious.

As I allow my mind to run back, one case in particular comes to me. It occurred perhaps sixty years ago. I was called to see a woman about twenty-eight years of age, the mother of one child--a fine-looking woman, of medium stature, but a little overweight. One ankle was badly swollen and very sensitive, and she suffered a great deal of pain. At the second call, twenty-four hours after the first, the swelling had gone out of the ankle into the knee. In another twenty-four hours it had gone from that knee over into the other knee. On the fourth morning the pain and swelling were in her left elbow. The husband, and the patient too, clamored for relief. They insisted on having something to rub on the joint to relieve the pain. I was young and afraid to take any chances. I explained to them that the tendency for the disease was to migrate, that I did not care to do anything which would favor its jumping from one place to another, and the proper thing to do was to keep a comfortable dressing on the inflamed joint, and otherwise let the patient alone. In the evening of the fourth day I received a note, telling me that they had sent for another physician, and that he was not afraid to give them relief. Relief was experienced, and in twenty-four hours the patient was dead. That early in my professional career I had it demonstrated to me that it was very dangerous to use local applications, rub inflamed joints, or tamper with palliatives of any kind; and from that day to this I never have treated rheumatic-fever patients in that way.

Treatment

There is not much to do in rheumatism, except to stop building it. Patients should not take anything internally except water, and they should be encouraged to drink water very freely--a half gallon or more each day. A solution of bicarbonate of soda (common baking-soda), one ounce to the pint, may be applied with absorbent cotton; or gauze may be wet in this solution and bound on the inflamed joint. Then, over this dressing, cotton may be wrapped. Arrangement should be made to prevent the bed-clothing from resting on inflamed joints. Where it is possible to give patients a hot bath, this should be done as often as every three hours, if the suffering is very great. When a patient is put into the bath, the water should be at a temperature of 100°. Then hot water may be added until the patient's limit of endurance is reached. From time to time more hot water may be added, to keep it as near one temperature as possible. The bath may be from one-half hour to one hour in duration, depending upon how soon relief is obtained and how well the patient bears up under it. If there is a tendency for the heart to palpitate and the pulse to run high, or if there is any feeling of faintness which cold-water sipping and putting cold water on the head do not relieve, the patient should be removed to his bed. At least one bath of long enough duration to bring full relief should be given daily, and as many more as the patient's strength will permit.

The excessive sweating and the amount of acid that is thrown out of the system cannot be disposed of in any way better than through frequent bathing and frequent change of clothing. By no means should such patients be allowed to lie in clothing wet with perspiration. If necessary to change clothing every three hours, it should be done. In this way the patient is enabled to throw off a severe attack in a very reasonable time. This treatment is satisfactory, because it hurries the patient to a recovery without complications of any kind--which is more than can be said of any other treatment given for the disease. That being true, it would be well for those who have faith in drugs to try my simple plan.

After the disease is thoroughly under control, the patient may be fed as outlined for typhoid fever.