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RHEUMATISM, ARTICULAR.—This affection, which is known also as joint-rheumatism and as rheumatic fever, is greatly dreaded owing to its painfulness and its tendency to recur. Distinction is made between two forms of the disease—the acute and the chronic.

Acute articular rheumatism, according to its principal symptoms, must be designated as an acute febrile affection, most probably caused by the action of bacteria, and in which the inflammation of various joints and the involvement of the heart are the most prominent features. The disease usually begins suddenly with a rise in temperature, and it may, in severe cases, lead to a stiffness of the entire body, rendering the patient as helpless as an infant. As a rule only a few joints are affected at one time. Not until later in an attack may the disease progress to other, previously healthy, joints. In this manner most of the joints of the body may become successively attacked, some of them even repeatedly. It rarely happens that an attack of rheumatism is lodged in one joint only. When this occurs, as is sometimes the case when the disease is due to gonorrhoea, the symp toms recede very slowly. The joints most frequently involved are those of the knees, hands and feet. They swell very suddenly, and become extremely painful. The slightest movement or pressure, even a shaking of the bed, intensifies the peculiar tearing and boring pains. At the same time some headache is present, together with profuse perspiration which smells remarkably sour. The urine is red in colour and scanty in amount. After repeated fluctuations between improvement and aggravation the febrile symptoms recede, then the pains, and finally the swelling and stiff ness of the joints. The duration of the disease varies. Sometimes it passes off in a week or two ; in other cases it lasts from four to six weeks or more. The average duration may be said to be about a month.

An especially severe form—which, however, is rare,—is the so-called cere bral rheumatism, in which the febrile symptoms become prominent. The temperature may mount to 109° F., accompanied with delirium and convul sions, soon to be followed by unconsciousness. This disease terminates fatally in most cases.

The course of acute articular rheumatism, apart from the severe form mentioned in the foregoing, is usually a favourable one. It is, however, often complicated by a number of affections which aggravate the condition of the patient. The most important of these complications (which are due to the same poison which causes the affection of the joints) is infection of the heart, causing inflammation either of the pericardium or of the heart valves. This results from the bacterial poison being carried from the joints to the heart by the blood-stream. Frequently no symptoms of this complication are present, and only an experienced physician is able to determine that the heart is implicated. The younger the patient, the greater is, as a rule, the danger of heart involvement, such danger being slight after the thirtieth year. Although some of these heart-affections are cured, there remains in many instances a permanent defect which may give rise to subsequent disorders. An inflammation of the pleura is also to be considered as a possible complication.

Various other complications of articular rheumatism may occur. In addition to prickly heat, which is caused by the profuse perspiration, there may be other eruptive affections of the skin (such as nettle-rash), or hem orrhages from the skin may take place. In rare cases coarse nodules, varying in size from that of a millet-seed to that of a cherry-stone, may appear under the skin. These occur almost exclusively in children, giving rise to the condition known as nodular rheumalivn.

The outbreak of articular rheumatism is very often preceded by inflam mation of the tonsils ; and it is even probable that tonsillitis is the primary affection. In children between ten and fifteen years of age, the disease is very frequently followed by ST. VITUS'S DANCE (which see). Acute articular rheumatism attacks principally persons between fifteen and thirty-five years of age. It occurs mostly in temperate zones, and is most frequent during the cold season and in months which are distinguished by changeable weather. In children the joint-symptoms are less marked than in adults, but affections of the heart are more frequent.

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