' RHEUMATISM, a constitutional disease marked by inflammation of the connective-tis sue structures of the body, especially of the muscles and joints and attended• by pain in them. It is froquently recurrent In a 'sense it covers nearly all fortes of painful arthritic and muscular disease. Four forms are recog nized in 'medicine: ' (I) Acute rheumatism (acute articular rheumatism or acute rheuma tic' acute inflammatory rheumatism, rheumatic fever) ; (2) chronic rheumatism.; (3) rheumatoid arthritis (arthritis defortnans, osteoarthritis,-- chronic. articular rheumatism; (4) muscular rheumatism or myalgia. Acute rheumatism, also a milder form known as sub acute and .chronic rheumatism –0-may insensibly 'follow one it may be and .even the different varieties may co-exist at the 'same time: Acute rhewhatisin is attended with high fever, sour sweat, scanty high-colored urine containing a large amount of urea' and swelling of the joints from exudation into their cavities and infiltration around. them. The joints are tender and hot The local symptoms may 're currently pass from one joint to another. There is, a tendency to inflammation of the endocardium (endocarditis) and. of the pericar dium (pericarditis). Predispoging causes' 'of the disease may be heredity, sudden checking of the perspiration in a cold and damp at mosphere, conditions which lower vitality such as chronic alcoholism, nervous debility; worry with exposure, insufficient food, injuries to joints, and excessive muscular work especially in a poisonous atmosphere.
More males than females have acute rheu matism, probably because of more hardship and exposure. It is quite common among farmers, longshoremen, coachmen, stokers, motormen, sailors, scrub-women, etc. It most frequently occurs between the ages of 15 and 30, is rare before the 10th year and after the 50th. The disease is rare in the tropics, common in the temperate zones; in the Umted States it is most frequent in the early spring and late fall; and it is often endemic and sometimes epidemic. The specific cause in at least the first three forms of rheumatism mentioned above is now generally believed to be a micro-organism, known as a strepto-diplococcus, the coccus yet by some writers the various forms of rheumatism are believed to be due to non-neutralized acid poisons of pro tein metabolism — auto-infection.
The theory of an arthritic diathesis as a cause, and the theory that rheumatic joint le sions are due to disturbances of the nervous system seemed to have passed away. Tonsilar
disease has come to be associated with rheuma tism and is believed by some to be due to rheumatism, for the most common habitat of the specific germ is in the tonsil crypts, where it may remain quiescent for months or years, until lowered vitality and a sore throat af fords a suitable chance for It to do its specific work, in the joints, heart, kidneys, nerves, brain and the various fascia of the body. It is believed that any focal point of suppuration within the body may afford a starting point for infection—if the specific organism is present— as in pyorrhea — middle ear and post nasal dis charge gonorrhea, abscesses, fissures — chronic appendicitis, etc.
The morbid anatomy of rheumatic joints show synovial membrane swollen and hyperae mic; serous infiltration of ligaments and other tissues; joint fluid turbid with albumen, fibrin and leucocytes (pus and blood rarely present) ; sometimes ecchymoses on cutaneous and serous surfaces. In the blood the red corpuscles are reduced more than one-half ; the haemogloblin is much less than normal, but fibrin and hum cytes are largely increased. There are various complications of acute rheumatism, chorea, con junctivitis, nephritis, pleurisy; etc, but the most serious are endocarditis and pericarditis. The heart is affected in very many cases, most frequently the left side (rheumatism of the heart), the edges of contact of the•initral valves being swollen and covered with fibrinous masses; less frequently, the aortic valve rarely, the pulmonary or tricuspid. Contraction and distortion of the affected valves, may result. Ulceration is rare. Simple fibrinous .or sera fibrinous pericarditis is .common; myocarditis seldom occurs, The attack may begin with headache, indigestion, aching, chilliness, slight tonsilitis or pharyngitis, but usually comes with a chill, followed soon by' high fever (may be or F.), swelling, tenderness, heat and shiny appearance of one or more joints (knees most often, the% wrists and fingers, ankles, etc.), a coated tongue, foul breath, a soft pulse of to 110°, thirst, constipation and by profuse sour sweat. There is always a tendency to re• currence, c.omplics,tions and migration from one joint to another. The mind is clear, except when .the fever is very high.' Coma, which is ,rare, is due either to high fever or nephritis.