Rheumatism (Gr. , a flow, discharge).
Acute rheumatism is an inflammation of the joints, characterized by general fever, by pain, heat, redness, and swelling of the joints affected, and by a tendency to leave one joint suddenly and fasten upon another. The affection sometimes commences by chills and fever, and general uneasiness; and these symptoms (rheumatic fever) may last for 24 hours or more before the local manifestations show themselves. More frequently the local symptoms make their appearance at the same time with the fever, and occasionally they are present some little time before it supervenes. The pain in the joint or joints affected, commonly but little felt while the patient is perfectly quiet, becomes intense on the slightest motion, so that he is rendered completely helpless. The superficial joints become swollen and tense, they are hotter than natural, and the skin covering them is generally more or less reddened. The swelling is sometimes mainly caused by effusion within the capsular ligament of the joint itself, at others by the inflammation and thickening of the fibrous tissues external to the joint.
The pulse is generally full, strong, and moderately frequent, rarely rising over 100 beats in a minute; the skin is warm, and copious sour perspirations are commonly present; sweating was present in rather more than four fifths of the cases noted by M. Louis. The tongue is thickly coated, the bowels somewhat constipated, and the appetite completely lost. The inflammation at first affects one or two joints, rarely three; after a variable time it commonly leaves the joints first affected as suddenly as it attacked them, and fastens on some other articulation; often however new joints are attacked without the disease leaving its original seat. As a rule, the larger joints are the ones most liable to be attacked, the knees, elbows, ankles, wrists, and hips; more rarely the smaller joints of the toes and fingers become affected. Besides the articulations, acute rheumatism frequently attacks the heart, not by metastasis, or transference of the inflammation from one part to the other, but by seizing on the fibrous textures of the heart as on one of the series of textures liable to the disease.
Sometimes the pericardium is attacked (pericarditis), sometimes the lining membrane of the heart's cavities (endocarditis). (See Heart, Diseases of the.) The younger the patient, the more liable is the heart to be affected; so that when rheumatism occurs previous to adult age, the heart is attacked in a large majority of cases. The rheumatic constitution is frequently hereditary, and rheumatism is peculiarly a complaint of cold, damp seasons and climates; but beyond this we know but little of the causes which induce it. The disease sometimes disappears in 10 or 12 days, sometimes lasts for months, while in other cases again it may lapse into a subacute or chronic state and continue indefinitely. Rheumatism, when uncomplicated, is rarely attended with immediate danger to life; but by damaging the heart it often lays the foundation for incurable disease. Occasionally fatal cases are met with. - Acute rheumatism has been treated in a great variety of ways. Bleeding, mercurials, mercurials with purgatives, opium, sulphate of quinine, and nitrate of potassa in large doses have been at various times resorted to.
Of these methods, those by large doses of sulphate of quinine and by nitrate of potassa have seemed to have an influence in controlling and cutting short the disease, and the treatment by quinine appears to be successful in the acutest and most violent attacks; but they are both subject to inconvenience and dangers which counterbalance their advantages. The treatment which is most generally relied on is the alkaline. Tartrate of potash and soda (Rochelle salt) or acetate of potash is given in full doses short of producing purgation, until the urine is rendered alkaline. Occasionally a purgative may be required, or an opiate may be given at night to produce sleep. The treatment by lemon juice, advocated by Dr. Garrod, is in truth an alkaline treatment, the acid citrate of potash contained in the lemon juice being eliminated by the kidneys as a carbonate. - Chronic rheumatism presents itself under two forms. In one the joints are swollen and painful, the pain being aggravated by motion; there is no general fever, and the appetite may be good and the digestion sound.
The affection is exceedingly obstinate, attacking new joints without leaving those first affected; it frequently attacks the smaller joints, rendering them permanently swollen and deformed, while the immobility to which the joints are sometimes reduced may cause atrophy of the muscles connected with them. The treatment is unsatisfactory; sometimes alkalies or diuretics are of service, sometimes iodide of potassium seems of use; while the native sulphur waters, such as those of Sharon, St. Catharine's, the Virginia sulphur springs, etc, used both externally and internally, are frequently of great service. In the second variety of chronic rheumatism, sometimes termed passive rheumatism, the joints are neither red nor swollen, but simply stiff and painful, the pain being increased by motion, but not preventing labor or exercise. It is aggravated by cold and damp and relieved by heat. Warm salt water baths, and the use of flannel and stimulating liniments, afford some relief. Where it is possible, removal to a warm climate is advisable.