CAWS.
We fully concur in Peter's opinion, and although we admit that rheumatism presents some peculiarities in pregnancy and the puerperal state, we do not think that it can be regarded as identical with gonor rhceal rheumatism, and we believe, much more, in the general influence of the puerperal state than in a local influence brought about by the vaginal, urethral and uterine discharges of the pregnant woman.
Symptoms.—The disease often begins with chills, which may be several times repeated and which are generally slight. In some cases, on the contrary, they are very violent. At other times they are absent.
Pain generally succeeds the chill. Sometimes very intense, it is, so to speak, the initial symptom. Sometimes it 'is dull and only excited by movements or pressure. In cases of great intensity it has been observed to persist during several weeks, with the same severity, thus depriving the patients of all repose and of all sleep. It then corresponds to the painful form of Vachee and of Fournier. Now fixed in one joint, now migratory, it is soon accompanied by marked swelling of the affected joints, due to the serous effusion into these and to inflammation of the peripheral fibrous tissues and of the bones themselves. Generally, these pains are more migratory than the swelling, which, once fixed upon a joint, lasts much longer than the pain and seems to persist for a certain time after the cure.
Seat.—The disease may affect many joints, to a variable degree. It is, however, rarely erratic and generally fixes itself upon one joint, particu larly the knee, the elbow, the wrist or the ankle. There is, ordinarily, neither redness nor heat, but the articulations attacked are swollen, pasty, shiny, of a pale or violet color, or sometimes devoid of color. There is a sort of characteristic obscure cedema, accompanied, where the serous effusion is pronounced, as in the knee, by an elevation of the patella and a real fluctuation: At the same time the febrile reaction, which exists at first, yields quite rapidly, and the disease more resembles a hydrar throsis than a true rheumatism. The temperature rarely exceeds 102° F.
The sweats are not profuse, and, although the patients lose some strength and grow pale, pregnancy still pursues its regular course, except in rare instances. Generally, the rheumatism of pregnancy is subacute, in mding, at first, three or four joints and then settling in one of them, while the general symptoms disappear. The swelling and pain on pres sure constitute the disease. Often, rheumatism is chronic from the first. The fever is hardly noticed; at first, the swelling and discomfort are confined to a single joint, the ftwelling is pasty, and the color of the skin unchanged. We have noted two or three examples. In these cases, the disease is indefinitely prolonged.
Among the twenty-three cases reported by Tison. the disease lasted from 1 month to 1+ months, 5 times; from 2 to 3 months, 4 times; from 4 to 5 months, 4 times; from 5 to 6 months, 4 times.
In one of his cases, Tison saw three attacks of rheumatism developed in the same woman, the first before, the second during and the third after pregnancy. The first lasted fifteen days, the second five months with endocarditis, the third, also with endocarditis, several weeks.
Terminations.—Among Tison's twenty-three cases, there was only one death, and in that case there was metro-peritonitis. Recovery is the rule, but recovery with anchylosis. Tison has seen it eleven times out of thirteen cases, three of them with nodosities; in four cases, 'stiffness and swelling remained; three times the patients left the hospital uncured; in only five cases was the cure complete. Sometimes labor causes great im provement, but at other times it has no influence on the rheumatism. Whatever Vaille says, the termination by suppuration is rare in preg nancy, but not rare after labor.
Prognous.—This is grave, for although life be not endangered, anchy lois follows in two-thirds of the cases, and complete recovery occurs in only one-quarter of the cases. It is graver in proportion as the disease was localized, at first, and has lasted a long time.