RHEUMATISM AND GOUT.
Rheumatism and Gout are allied condi tions affecting the body as a whole, and all the tissues of the body, though their worst and more marked effects may be shown at par ticular parts, in the joints, for instance, in rheumatism, and in the heart and in the great toe hi gout.
In the introduction some idea has been given of the changes which take place in muscle, by which highly complex chemical changes occur in the muscle, some substances in or of the muscle breaking down in the process by which the work of the muscle is done. Waste sub stances are thus produced which require to be removed from the body. At the same time another process keeps pace with the breaking down, by which fresh complex substances are built up to replace those broken down. The breaking-down process is of the type called by chemists oxidation-processes, processes of com bustion or union with oxygen. Now similar processes occur in all the tissues of the body, each tissue, muscular, nervous, and so on, having its own special kind of building-up and breaking-down processes, characteristic of the healthy activity of the tissue.
Now in rheumatism and in gout, for some reason not yet properly understood, these pro cesses do not go on in a healthy way. It may be that the defect is due to some inherited tendency of the tissue, or it may be due to unhealthy conditions of living perverting the normal processes of the body, to improper diet or excesses of one kind or another. One result at least of the perverted action of the tissues is the production of unusual waste substances, or exceptional quantities of waste substances usu ally present in very small amount, which the organs whose business it is to remove the waste products find it difficult to deal with, and in at tempting todeal with which they may ultimately suffer. The continued presence in excess of these waste substances in the tissues and in the blood act as irritants to them, and thus sooner or later diseased conditions arise. In one person it may be one tissue or organ that first begins to suffer, in another person another tissue or organ, dependent to some extent upon tem perament or idiosyncrasy, in sonic cases doubt less dependent on occupation, for if, by the nature of his daily work, in one person one tissue or organ is subject to special strain, it is likely to be that tissue or organ that will first feel the effects of the disordered general tissue change.
This explains how it is that rheumatism and goat may manifest themselves in so many dif ferent ways in different individuals, or even in the same person, the kidneys being at one time disturbed, the joints at another, the akin at another, and so on.
The typical mode in which rheumatism at tacks is in the form of an affection of the joints, attended by high fever and severe joint pain, called acute articular rheumatism or rheumatic fever, and this we shall therefore consider first.
Rheumatic Fever (Acute Rheumatism, Acute Articular Rheumatism). —Acute rheumatism is a disease accompanied by very high fever, and attended by characteristic joint pains. The tendency to the disease runs markedly in families; 'and previous attacks increase the liability of a return. It affects mostly per sons under the age of thirty. Exposure to colds, chills after overheating, &c., are fre quent causes.
Symptoms. — The disease usually appears with signs of an ordinary attack of cold, such as a general feeling of illness, loss of appetite, sore throat, disturbed sleep, pains in the bones, feverishness, Sze., the signs of what is commonly called an influenza cold, symptoms described under catarrh (p. 214). The chief signs of the fully formed disease are high fever, pains in the joints, and severe sweats. The joints attacked are usually the larger ones, ankles, knees, wrists, shoulders, and elbows. The joints are not attacked all at once, but one after another as a rule, one joint getting well when another is becoming more painful. The pain is often excessive, so that the person lies straight and motionless in bed, afraid even of the slightest shake to the bed. The affected joints are hot, tinged with redness, tender to touch, and swollen. When the swelling has fallen, and the pain nearly gone, a feeling of stiffness remains. The muscles are also affected, and liable to painful twitchings. After the pain has begun in a joint, it increases till it is very severe, and then gradually dies away, the swelling disappearing with it. However much the joint may be swollen, matter is practically never formed in it. During the illness the whole body is bathed in sweat, which has a peculiar sour smell, easily perceived by everyone who comes near the patient. The sweats continue throughout the disease, and gradually pass off with recovery. The fever is often so high as itself to threaten life. In addition to these symptoms the tongue is white, appetite bad, bowels irregular, and pulse fast (120 per minute).