ACUTE ARTICULAR RHEUMATISM To these are added as further characteristics the frequent involvement of the serous membranes, especially of the endo- and pericardium, as well as the specific influence of salicylate preparations on these joint ailments.
Various forms of poly arthritis were formerly included in the de scription of acute articular rheumatism. These diseases, now designated as rheumatoid (Gerhardt) are known to be sequelx of a variety of in fectious diseases, the specific irritants or toxins of which have produced them. Although they arc probably closely related to rheumatic joint diseases, they will be treated in a special article, because thorough scientific and therapeutic knowledge covering them is of special interest.
Particularly characteristic of acute articular rheumatism in child hood, is the milder and shorter course of the joint manifestations, while involvement of the heart and lasting injury to it is more frequent than in adults. Furthermore, we notice especially in children predilection for certain areas, for example the joints of the cervical vertebre; as well as such complications as the formation of subcutaneous nodules and chorea minor.
articular rheumatism is a disease found all over the world. Its appearance is commonly uninfluenced by such factors as natural phenomena, character of the soil, and underground water. Nevertheless, frequent observations have shown that single epidemics or a succession of epidemics occur from time to time, although con tagion by transmission has hardly in any case been proven. It is a remarkable fact that brothers and sisters can be attacked almost simultaneously, and judging from a series of observations extending over a number of years, the disease has been found quite frequently to seek its abode in certain houses. In a very few cases, and even these admit of doubt., transmission from the affected mother in child birth has been reported.
4.5'3 If we are inclined to give sonic credence to the statement that acute articular rheumatism is an infectious disease, probability becomes a certainty when we closely observe the clinical phenomena, the fever, the complications relative to the endo- and pericardium, the pleura and the skin.
A specific causative factor has, as yet, not been found. For the
present it must remain undecided whether in rheumatic polyarthritis we have to deal with a case of attenuated sepsis which might be caused by various germs (strepto-, staphylo-, or diploeocei) or whether it is a case arising from an inherent exciting cause.
Moreover, there is another question to be determined, whether the manifestations in the joints (and of the serous cavities) are the result of the causative agent itself, or of its toxin.
Menzer asserts that the oral cavity is the portal of entry (as do also Singer and Meyer) and considers the inflammation in the joints and serous cavities as reactive reparative efforts of the organs attacked by the causative agents (streptococci).
Although the real etiological factor of the disease is yet unknown, we do know a number of predisposing causes, which are co-operative in the development of the disease. In the first place "catching cold" must be mentioned, the influence of which, not only in a first attack, but also in cases of relapse, can not be doubted. Very often the onset of the disease follows a single severe exposure or wetting, particularly of the feet. Cold damp dwellings play an important part in the devel opment of infection. A constant influence of the seasons upon the num ber of .cases has not yet been proven. No doubt hereditary influences may here play an important part. They arc absent in sonic cases. It is by no means rare that in certain families rheumatic diseases run through several generations with an increasing ratio. That a trauma tism of the joints can directly change to true articular rheumatism, has often been observed, especially in children (Biedert, Marfan, Boseck). The sex of the children seems to be without noticeable influence.
As to age, it may be said that the latter half of childhood is by far more frequently attacked by the disease than the earlier; in fact its appearance is even rare before the fifth year. We have however seen it come as early as the second or third year of life, and even in the nursing period some well substantiated cases have been recorded. Even if the disease has been cured, it increases the predisposition to subsequent attacks.