THE DURATION OF RHEUMATISM.
Next to pain and the heart complications- one of the most notice able features of rheumatism is its prolonged duration when not influ enced by treatment. That the chronic form should be thus charac terized is no more than one would expect in an ailment to which the term chronic is applicable. It is in connection with the acute and subacute forms that this feature calls for special notice. The long duration of acute rheumatism has been remarked by every one who has written on the subject. It is this which imparts, or used to im part, to the ailment many of its horrors.
Till very recently it was no uncommon thing for the disease to last for months, and only in exceptional cases did the patient have less than three weeks of suffering. " In my last attack I was in constant agony for six weeks." "Every attack has laid me up for three or four months." Such till within very recent years were the common experiences of those subject to the disease. A considerable variety in the duration of different cases has always been Doted as a leading feature in its natural history. Some are exceptionally long; others exceptionally short. Hence the mean duration of the malady varies with the varying experience of different observers. But all agree in calculating this by weeks rather than by days.
Pinel says that it lasts from seven to sixty days.
Scudamore remarks that "In a case of which the issue is favorable, the fever and pains are brought to a close at the end of the third week; and in slight attacks at an earlier period; but when the course of the disease is untoward, a period of two months scarcely serves to exhaust its power in producing even acute symptoms." "How long," says Macleod, "a case of acute rheumatism of me dium severity might endure if left to itself, I am unable to say ; but, with the common methods of treatment, probably five or six weeks may be about the average duration of rheumatic fever." According to Chomel, the disease rarely disappears before the twentieth day, and is sometimes prolonged for three months.
Bouillaud stated that under the modes of treatment adopted up to the time at which he wrote (1840) the mean duration of acute rheu matism was forty to fifty days; hut that under the influence of the treatment to which he had recourse (bleeding coup 8u• coup) it was reduced to less than half that time, i.e., about three weeks.
Fuller says that his own observation led him to believe " that even when unattended by any internal affection, the disease, under ordinary methods of treatment, endures from four to five weeks." Garrod puts it at "from teu clays to three or four weeks." Niemeyer gives the duration of mild cases as " one or two weeks ;" and of severe ones as " many weeks." Senator says that "as a rule acute polyarthritis runs its course in from three to six weeks." Lebeit gives the statistics of 108 cases of which-10 lasted from 5 to 15 days, 58 lasted from 16 to 35 clays, 32 lasted from 36 to 55 clays, and 8 lasted from 56 to 80 days.
In Dr. Bristowe's work on "Practice of Medicine," published in 1876, the duration of acute rheumatism is thus referred to : "There is no definite limit to the duration of acute rheumatism. Sometimes the patient recovers completely in the course of a day or two, or of a week ; more commonly the disease persists for several weeks ; and not unfrequently it becomes chronic, or is continued by successive relapses for a much longer period than that." In the St. Thomas' Hospital reports for 1872 Dr. Peacock gives a statistical account of the cases treated in that hospital during the previous year. He there states that the largest proportion of cases recovered in the fourth week. This may be accepted as consistent with general experience.
With regard to hospital statistics on this subject, however, it has to be remarked that the proportion of acute to subacute cases is larger in private than in hospital practice. The explanation of this is to be found in the difficulty or even impossibility of removing a very acute case to hospital during its very acute stage, and such cases are very acute from the commencement. Over and over again have I seen cases of subacute rheumatism brought into hospital with a his tory of acute rheumatism of several weeks' duration. The explana tion of the delay in sending them generally was that they were too ill to be moved. And one can quite see the force of that, for a man who cannot bear the weight of the bedclothes, who screams with agony at the least shake of his bed, or at the lightest touch by a friend, is one whom it would be impossible to subject to the move ment and disturbance inseparable from conveyance to another locality.