This name is loosely applied to many ailments not really of rheu matic origin. Almost any obscure and obstinate pain which is not traceable to some other agency is apt to be attributed to chronic rheu matism. Under this head there thus come to be ranked many aches and ailments which, not being of rheumatic origin, have no claim to the title. Chronic rheumatism properly so-called is a milder form of the subacute variety in which there is not sufficient local inflam mation to lay the patient up, or to raise the temperature.
Just as the acute runs into the subacute, so the subacute runs into the chronic by insensible gradations. It is sometimes the precursor, often the sequence, of an acute or subacute attack. It also exists independently of them. "Remarquons d'abord qu'a un degre tres leger, et lorsqu'il n'occupe qu'un petit nombre d'articulations d'un volume peu considerable, le rhumatisme articulaire est souvent apy retique, a quelque periode qu'on examine les malades" (Bouillaud).
The malady is characterized by the occurrence of pains, obstinate in nature, and sometimes shifting in character, affecting the joints, muscles, and fibrous aponeuroses. The affected parts may be some what tender to touch, but are not, as a rule, distinctly swollen. The
pain is increased by damp and cold. It often disappears in fine and returns in wet weather. Unless the patient is in easy circumstances he may never be confined to the house, and never consult a medical man, but may go about his daily work until he gets better, or until the onset of an acute or subacute attack compels him to lay up. It is a troublesome ailment which frequently lasts off and on for months. During its continuance there is often laid the foundation of future cardiac troubles. The temperature may now and then rise to 99°, or even a little higher—making the case for the time subacute; but gen erally it is normal. The pulse is not quickened.
In the age, in the personal and family history of the patient, in the seat of the pain, in its shifting character, and in the occasional slight rise of temperature, we have the best means of distinguishing true chronic rheumatism from the other ailments, gouty, arthritic, and neuralgic, with which it is so often confounded. It is of the utmost importance that such a distinction should be made, for on the accuracy of our diagnosis depends our ability to relieve the patient, and mitigate his sufferings.