Among the causes which give rise to the affection, chilling of the body is of unquestioned importance. It is evident that individuals whose occu pations expose them to rapid changes of temperature (drivers, farmers, sailors, etc.) are most liable to contract the disease. Over-exertion and injuries to the joints also seem to prepare the soil for articular rheumatism. Acute articular infections may take place after certain infectious diseases, such as scarlet fever, blood-poisoning, pneumonia, cerebral meningitis, and gonorrhea. In these cases they are caused by the same bacteria which gave rise to the original disease.
Various modes of treatment have been employed in acute articular rheuma tism, but all of these have been displaced by the salicylic-acid treatment introduced in the. " seventies " of the nineteenth century. Salicylic acid is a remedy which, if administered in fresh cases, and at the beginning of the attack, produces excellent results. It is true that the drug occasionally causes disagreeable by-effects, such as nausea, ringing of the ears, etc. ; but it has little harmful action on the heart, notwithstanding the assertion of " natural healers." Rheumatic affections of the heart are not a con sequence of the salicylic-acid treatment ; but, as already stated, they result from the same poison which causes the inflammation in the joints. It is to be borne in mind that the salicylates are not specific remedies. They are among the most useful drugs known, but they are not infallible ; and, when used injudiciously by the uninformed, they have been known to cause dangerous, even fatal, results. The weak heart of a rheumatic does not stand too much depression. Salicylic-acid combinations, therefore, can not be taken with impunity. They are dangerous unless taken under the strict directions of a physician. Applications of warm water are usually not well tolerated at the beginning of the disease, but act aggravatingly. In cases of cerebral rheumatism, accompanied with high fever, cold baths and cold packs are indicated.
If the joints are exceedingly painful, auxiliary measures may be neces sary. These include packing the affected joints in wadding, and securing correct and restful position of the affected limbs by means of pasteboard bandages or splints. The temperature of the patient's room should be equable, not varying more than between 63° and 63° F. In the presence of fever, the diet should preferably consist of milk, mineral water, tea, bland soups, and eggs. It is an essential condition that the patient, even in mild
cases, should remain in bed as long as possible, and not get up until a week after the pains have disappeared.
Prevention of many rheumatic conditions could doubtless be effected if individuals who follow the more dangerous callings would observe certain precautionary measures. These may be summed up as follows : Anyone who becomes heated, whether by physical exertions or by staying in a hot room, should avoid resting in cold or damp air or in draughts. He should keep moving until he is able to change his clothing, to dry himself, and to remain in a warm room. The opening of windows and doors, as practised by persons who work in front of a hot furnace, is to be condemned, as is also resting in cold or windy places after dancing.
Persons who have recovered from an attack of rheumatism should wear proper woollen or flannel under-garments, practise a sensible method of hard ening themselves under a physician's directions (see HARDENING), avoid damp dwellings, and, if necessary, give up an injurious profession.
Chronic articular rheumatism may develop from one or several attacks of the acute affection, or it may occur gradually and insidiously in conse quence of the repeated action of cold and dampness. Laundresses, charwomen, and servant-girls are particularly exposed to this affection, which generally occurs after the thirty-fifth or fortieth year of life. The principal manifestations are limited almost exclusively to the affected joints, and con sist of pain and stiffness. The pains may be so moderate that they inter fere little, or not at all, with the patient's occupation ; or they may be so severe that they render impossible the use of the affected limbs and favour the development of permanent rigidity.
The course of the disease is always a protracted one. Improvements alternate with aggravations. The less severe the changes in the joints, the greater is the possibility of recovery. It is highly probable that what is known as chronic articular rheumatism is, in reality, a combination of several different affections. Little is to be expected from internal remedies. The celebrated lemon-cure does not accomplish any permanent results, and is frequently the cause of serious disorders of the stomach.