While these are the usual signs of a regular attack, the disease may occur in a much milder form, with slight fever lasting only a day or two, only one or two joints being affected. In many such cases the disease frequently returns.
The length of the illness is never very de finite, varying from two to six weeks or longer, but when the patient is properly attended to the severe symptoms should not last much beyond nine days. Recovery of strength is, however, slow. Death from the rheumatism itself is not common. But in the train of rheumatism are a great many other diseases, especially heart disease—namely, valve disease of the heart (p. 319), and inflammation of the pericardium (p, 318),—inflammation of the lungs and air tubes, and various others. In. deed the great risk is that of affection of the heart.
Treatment.—The patient should be in an open bed, lying between blankets. The affected joints should be kept at rest. An aid to this is obtained by wrapping them in cotton-wool, secured by a flannel bandage. The principal medicine now given is salicine or salicylate of soda. It is administered in 20-grain doses in water every two hours for twelve hours or so, when the pains are generally relieved and the fever falls. Thereafter the powders are re peated every three or four hours or at longer intervals. The evil of the remedy is that frequently produces deafness and unpleasant noises in the ears, and sometimes sickness and faintness. In spite of the noises in the ears, &c., the powders should be persisted in if necessary, as the unpleasant symptoms attend ing their use will pass away in a few days. But if sickness or faintness arise, a more sparing use of them must be made. It is marvellous how quickly in many cases this treatment relieves. When it does so, the dose should be continued twice or thrice daily for several after the fever has passed away. Then a quinine-and-iron tonic should be given, and great care must be taken for some time to prevent a relapse. Sometimes this treatment fails. In such a case the old treatment with potash must be resorted to. Thirty grains of acetate of potash are to be given every 3 or 4 hours. At bed-time 10
grains (to an admit) of Dover's powder will relieve pain and help sleep. Quinine-and-iron tonics are also necessary after the fever has passed. Throughout the illness nourishing, easily-digested foods are to be given in small quantities frequently repeated. Milk and milk puddings, thin mutton broth, &c., are best, but no butcher meat should be allowed till recovery has taken place. Soda-water and milk is a grateful drink to the patient. The bowels also require attention, an ordinary purgative medi cine being given as required.
Though the treatment has thus been men tioned in some detail, it is needful to say that no case ought to be without medical super vision, unless that is absolutely unavoidable. A physician will often detect commencing affection of the heart, and take steps to prevent it if possible. Neglected cases too often end fatally in time, because this evil has not been guarded against.
Chronic Rheumatism, as it affects the joints, is discussed on p.
Irregular Forms of Rheumatism. muscles frequently suffer from the rheumatic taint, the chief symptom being pain, specially at night, and of an aching or stabbing character.
Rheumatic nerve affections are also frequent. They are usually of a neuralgic character. Thus sciatica may be of rheumatic origin, so also may headache. Inflammation of the tonsils and throat, inflammations of the eyelids and eye, and inflammations of the skin have also frequently their cause in rheumatic conditions of the tissues. The kinds of skin affection that are frequently rheumatic are such as nettle rash and the superficial inflammatory blush.
It is difficult to decide when the rheumatic poison is at the root of these disturbances. But there is never any harm done by trying anti rheumatic medicine in small frequently-repeated doses, such as salicylate of soda (5 grains), or iodide of potassium (3 grains), or salol (5 grains), repeated four or five times daily for a time. In the muscular and nerve affections, massage, rubbing, warm salt-baths, hot and cold douch ing will be found useful.