So-called cerebral rheumatism is due to a toxic congestion.. Sometimes urticaria and spots of ecchymosis appear upon the skin and in children small nodules, firm but movable, are attached to tendons and fascia., and are found over the spine, scapula and inflamed joints. Acute rheumatism is to be distinguished from arthritis following scarlet fever and found in the course of other diseases — due also to spe cific germs — and from acute osteomyelitis, scurvy (in children), gout and gonorrheal rheu matism.
There is a sub-acute rheumatism, very com mon, with mild symptoms and slow recovery. It may follow an acute attack or be sub-acute from the outset and may pass into the chronic form. Temperature is seldom above 102° F. The so-called acute rheumatism of children is sub-acute; the joint-symptoms may be so slight as to be readily overlooked, but there is more liability to cardiac inflammation than in adults. Children perspire less, but are liable to have chorea, tonsilitis and cutaneous manifes tations. If not treated acute rheumatism lasts from two to three weeks or more.
Severe cases may recover under treatment within a week; and mild cases last several weeks, so obstinate sometimes is the disease. The joints are not left with fibrinous adhesions unless chronic rheumatism supervenes. Death is rare, and when it occurs it results from high fever, pneumonia, pleurisy or myocarditis. Re lapses are quite common. Treatment requires many details. Among preventive measures are care a• t exposure to cold and damp, e when overheated ; freedom from mus cular strain; the wearing of woolen undercloth ing in winter, and of linen-mesh in summer; abstinence from sweets and malt liquors; very moderate eating of animal food; sponging with cool water, followqd by friction; outdoor exer cise; and the keeping of the bowels open with Carlsbad water or Rochelle salt. During the attack place the patient between blankets on a comfortable mattress; have him use a bed-pan; carefully dispose the inflamed part in a com fortable position. While the disease is severe give light food, no meat, sweets or malt liquors; allay fever with cool spongings and tincture of aconite; quiet the patient with Dover's powder or codeine; locally apply methyl salicylate, oil of wintergreen, or equal parts of guiacol and glycerin; and keep the part warm with cotton batting, oil-silk, etc. Medic inally, salicin, salol, or salicylate of soda and bicarbonate of potassa or soda, or the citrate of ppoottaassa seem to be of most avail.
•Ohronie rheumatism is a form of chronic joint-inflammation, attended by moderate pain, and by changes in the joints resulting in their defortnfty. It begins insidiously, or follows at
tacks of acute or sub-acute rheumatism, and is rare before the 40th year. The predisposing causes are poor hygienic conditions, debility, malnutrition, cold and damp, and occupations which involve the repeated and long-continued use of certain joints, as in the cases of seam stresses and tailors. A moderate thickening and some distortion appear in affected joints (fingers mid knees especially) ' which may be bilateral The changes are mainly in the fibrous tissues, though sometimes there is synovial injection and effusion. Erosion of cartilages is seen only in prolonged cases. Endocarditis, pericarditis and pleurisy are rare.
The symptoms slowly develope; general health may be good; pain occurs when joints are red and swollen, and may be severe at night. Joints swell from time to time, and some per sons readily predict an attack. The muscles about the joints after a time atrophy and the affected joints are deformed by deflection due to adhesions. Slight fever may accompany at tacks. The diagnosis excludes gout and ar thritis deformans (qq.v.).
In treatment medicine is of uncertain value. Iron, Vichy water, iodide ofpotassium and Carlsbad salts or phosphate soda may be used More relief is to be obtained from douch ing and sweating of the joints, massage, protec tion against cold and damp and injuries to the joints, an ample diet (no sweets, and no ako holic stimulant except whisky), a dry equable climate and residence at one of the spas. Bee stings have proved valuable.
Rheumatoid arthritis, a better term than arthritis defornsans, may follow acute or chronic rheumatism or apparently may start de novo. It freqtiently is associated with neu ritis. It usually does not come to persons under 50 and is an obstinate disease, seldom fully recovered from. It is marked by varying at tacks of severe localized or shooting (neuritic) pains, by tenderness and soreness of joints, by contraction and sometimes severe jerks of muscles about the joints and leading to them, by atrophy of muscles, bony nodes about joints and fibrous bands within joints, numbness of heels, constriction about chest and neck, some times marked deformity of one or more of the limbs rendering person unable to move the affected limbs. Yet with it all, the afflicted per son may live for years, and at times have spells of good general health. Treatment usually unsatisfactory — static electricity, bacterius, local heat, soothing applications, internal medi cines (for the physician to advise)—proper food, keeping the bowels clean and living as much as possible in out-door air.