Page:The Principles and Practice of Medicine.djvu/567

Rh

. ''Acute Rheumatism. Fever, probably due to a "materies morbi" in the blood, and accompanied by inflammation of the joints and some of the fibrous tissues''. Rheumatic fever is very common in temperate climates, but is only occasionally met with in the tropics. It is of much importance, on account of the severe suffering which attends it, and the probability of inflammation being set up in the heart and its membranes.

Symptoms.—The attack commences with fever, which may continue for twenty-four hours before there is any appearance of local inflammation ; or the latter may occur at the same time as the fever, or in rare cases precede it. The chief peculiarity of the febrile disturbance is, that the skin, though hot, is usually moist, and sometimes covered with profuse sweat, which has a sour smell. The tongue is in general much furred, and the pulse full and sometimes strong and firm, but more frequently soft and compressible. The bowels are generally constipated, and the urine scanty and high coloured throws down a co- pious deposit of lithates. The tongue rarely or ever becomes dry, and there is no delirium.

The joints which are affected are the larger joints, viz. the hips, knees, ankles, wrists, elbow, and shoulders. The pain, which is greatly increased by pressure, and attended with redness and swelling, is very severe, especially at night. The inflam- mation often leaves one joint and attacks another, and it is peculiar in seldom ending in suppuration, ulceration, or gangrene. In most cases the symptoms increase till about the tenth or twelfth day, when the fever begins to subside ; the local inflammation! gradually ceases, and in about a month or five weeks the patient is well, and the joints restored to their natural state. In severe attacks however the duration of the disease may be much longer, and more or less swelling and stiffness may re- main for several weeks or even months after the fever has ceased.