Page:Encyclopædia Britannica, Ninth Edition, v. 20.djvu/534

Rh 516 R H E R H E having learnt that he ia employing the figure called irony." But when it is thus urged that "All a rhetorician's rules " But teach him how to name his tools," the assumption is tacitly made that an accurate nomen- clature and classification of these tools must be devoid of practical use. The conditions of modern life, and especially the invention of printing, have diminished the importance which belonged in antiquity to the art of speaking. But few would deny that a large measure of value may still be claimed for rhetoric in the more comprehensive sense which Whately gives to it, as the art of argumentative composition. His treatise, the work of an able and also witty man, will be found instructive and entertaining even by those who do not go to it for a discipline. Nor can it fail to suggest a further remark. While abounding in fresh thought and modern illustration, it constantly reminds us that, in almost all essentials, the art of rhetoric must be regarded as the creation of Aristotle. (R. c. J.) RHEUMATISM, a constitutional disease having for its chief manifestations inflammatory affections of the fibrous textures of joints and other parts, together with a liability to various complications. Two forms of rheumatism are recognized, and will be now briefly described, namely, the acute and the chronic, the latter either resulting from the former or arising independently. In addition to these, a disease which has received the name of chronic rheumatic (or rheumatoid) arthritis, and which presents many resem- blances to chronic rheumatism, although the relation between them is questionable, may be noticed here. ACUTE RHEUMATISM, frequently called RHEUMATIC FEVER, is mainly characterized by inflammation affecting various joints, with a tendency to spread in an erratic manner, and accompanied with much pain, febrile disturb- ance, and perspiration. The nature of this disease has been extensively discussed by pathologists and physicians; but, although numerous, and many of them ingenious, theories have been advanced and supported by evidence drawn from experimentation as well as clinical observation, it cannot yet be said that any one of them has gained general acceptance. It has been held that rheumatism is produced by an excess of lactic acid in the system in connexion with morbid states of the nutritive functions. Support to this view was given experimentally by Dr Richardson, but experiments by others have led to a different conclusion. Again, it has been held that the disease is a textural inflammation due to chill acting upon the parts, either locally through the circulation or through the agency of the nervous system, whereby the nutrition of the joints and -other structures is lowered. Another view regards it as arising primarily in a profound disturb ance of the heat-regulating mechanism of the body by chill, which specially affects the muscular system, causing heat to be generated without work, one of the consequences being that impressions of pain are conveyed to the brain by the articular nerves instead of those of work performed (see PATHOLOGY). The view has been held, too, that rheumatism is to be referred to a germ or parasite, or a miasm analogous to the poison of malaria. Without attempting to discuss the relative probability of these and other theories, it may be stated that those which point in the direction of a nutritional change in the special tissues affected (the fibrous) as the result of chill or other depressing cause operating through the agency of the nervous system appear more consonant with the pathological evidences of the disease itself than those which would refer the morbid process to the influence of any poison circulating in the blood. There are certain points of importance in connexion with the causation of this form of the disease which are generally agreed upon. Thus an hereditary tendency is recognized as among the causes predisposing to acute rheumatism. The extent of this has been variously esti- mated, but it would appear to be well established that it shows itself in about one-fourth of the cases. Age is another important predisposing condition, the acute form of rheumatism being much more a disease of youth than of later life. The period of adolescence, from sixteen to twenty, is that in which probably the greater number of the cases occur ; but even in early childhood the disease may manifest itself, or at any period of life, although it is rarely observed in old age. Persons much exposed to all kinds of weather are specially liable to suffer, and hence the disease is more common among the poorer classes. Any depressing cause acting upon the general health, such as overwork or anxiety, or any habitual drain upon the system, such as overlactation, in like manner has a similar effect. Climate, too, is a factor of great importance, for, although not unfrequently met with in temperate or even warm climates, the disease is unquestionably of. more com- mon occurrence in cold and damp regions. Attacks of acute rheumatism are brought on in most instances by exposure to cold, by getting wet through, sometimes also by excessive fatigue such as in walking long distances, especially if in addition there have been overheating of the body and subsequent chill. Persons who have once suffered from this disease are very liable to a recurrence on a renewal of the exciting cause, and even apparently independently of this from such causes as digestive disturbances. An attack of acute rheumatism is usually ushered in by chilliness or rigors followed with f everishness and a feeling of stiffness or pain in one or more joints, generally those of larger or medium size, such as the knees, ankles, wrists, shoulders, <fcc., which soon becomes intense, and is accom- panied with severe constitutional disturbance and prostra- tion. The patient lies helpless in bed, restless, but afraid to move or to be touched, and unable to bear even the weight of the bed-clothes. The face is flushed, and the whole body bathed in perspiration, which has a highly acid reaction and a sour disagreeable odour. The tempera- ture is markedly elevated (103 to 105), the pulse rapid, full, and soft; the tongue is coated with a yellow fur; and there are thirst, loss of appetite, and constipation. The urine is diminished in quantity, highly acid, and loaded with urates. At first the pain is confined to only one or two joints, but soon others become affected, and there is often a tendency to symmetry in the manner in which they suffer, the inflammation in one joint being shortly followed by that of the same joint in the opposite limb. The affected joints are red, swollen, hot, and ex- cessively tender. The inflammation seldom continues long in one articulation, but it may return to those formerly affected. In severe cases scarcely a joint large or small escapes, and the pain, restlessness, and fever render the patient's condition extremely miserable. An attack of acute rheumatism is of variable duration, sometimes passing away in the course of a few days, but more frequently lasting for many weeks. Occasionally, when the disease appears to have subsided, relapses occur which bring back all the former symptoms and prolong the case, it may be for months. Again, after all acute symp- toms have disappeared, the joints may remain swollen, stiff, and painful on movement, and the rheumatic condition thus becomes chronic. After an attack of rheumatism, the patient is much reduced in strength and pale-looking for a considerable time, but should no complication have arisen there may be complete recovery, although doubtless there remains a liability to subsequent attacks. This disease derives much of its serious import from certain accompaniments