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ACUTE RHEUMATISM

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Originally appearing in Volume V23, Page 238 of the 1911 Encyclopedia Britannica.
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ACUTE See also:

RHEUMATISM Or RHEUMATIC See also:FEVER 1S the name given to a disease having for its See also:chief characteristics inflammatory affections of the See also:joints, attended by severe constitutional disturbances and frequently associated with inflammation of the pericardium and valves of the See also:heart. The acute rheumatism of childhood differs materially from that of adults in that the articular manifestations and constitutional disturbance are usually much less severe, whereas the heart and pericardium are especially liable to be attacked. It will be advisable, therefore, in discussing the symptoms, to See also:deal separately with the rheumatism of adults and that of childhood. There are certain points of importance in connexion with its See also:causation which are generally agreed upon. It is essentially a disease of childhood and See also:early adult See also:life, being most commonly met with between the ages of ten and twenty-five and comparatively rarely after See also:forty. See also:Heredity is unquestionably an important predisposing cause. See also:Climate is also a See also:factor of considerable importance, See also:cold and See also:damp with sudden and wide fluctuations of temperature being especially conducive to an attack. While perhaps more See also:common in See also:Great See also:Britain than elsewhere, it is met with in most parts of the globe. Exposure to cold and wet, and especially a chill after See also:free See also:perspiration and fatigue, are among the most common exciting causes of an attack. Of See also:recent years much See also:evidence has accumulated tending to show that rheumatism is a specific infective disease due to a micro-organism, and this is now generally recognized. There is still, however, some difference of See also:opinion as to the nature of the micro-organism by which it is produced. In 1900 F.

J. Poynton and See also:

Paine isolated from eight cases of acute rheumatism in See also:children a See also:minute diplococcus similar to that previously de-scribed by Triboulet and by A. Wasserman, which inoculated into rabbits produced lesions of the joints and of the heart indistinguishable from those met with in acute rheumatism. They have since obtained the same micro-organism from a further large number of cases of acute rheumatism, and their results have been confirmed by See also:Walker, See also:Beattie and others. They therefore claim that this micro-organism, to which they have given the name Diplococcus rheumaticus, is the specific cause of acute rheumatism. The objections which have been raised by other competent observers against this view are: (I) That this diplococcus is not found in all cases of acute rheumatism. (2) That certain other micro-organisms when inoculated into animals will produce See also:joint and heart affections similar to those produced by the aforesaid Diplococcus rheumaticus. It would be out of See also:place here to enter into the merits of this controversy; suffice it to say that the objections raised do not appear to be cogent enough to invalidate the conclusions arrived at by the authors of the germ theory. The See also:matter is, however, still to a certain extent sub judice. In adults the See also:affection of the joints is the most striking feature. The attack is usually ushered in by a feeling of chilliness or malaise, with See also:pain or stiffness in one or more joints, generally those of large or See also:medium See also:size, such as the See also:torus. p~ knees, ankles, wrists or shoulders. At first the pain is confined to one or two joints, but others soon become affected, and there is a tendency to symmetry in the See also:order in which they are attacked, the inflammation in one joint being followed by that of the same joint on the opposite See also:side.

The affected joints are swollen, hot and excessively See also:

tender, and the skin over them is somewhat flushed. The temperature is raised, ranging from about See also:roe to 103° F., the See also:pulse rapid, full and soft; the See also:face is flushed, the See also:tongue coated with a thick See also:white See also:fur, and there is thirst, loss of appetite, and See also:constipation. The See also:body is bathed in a profuse perspiration, which has a characteristic sour, disagreeable odour. The urine is diminished, See also:acid and loaded with urates. The attack is of variable duration, and may pass off in a few days or last for some See also:weeks. Relapses are not uncommon when convalescence appears to have been established. Among the complications which may arise are hyperpyrexia, or rapid and extreme rise of temperature, which may run up as high as rro° F., when See also:death will speedily ensue unless prompt and energetic treatment by cold See also:baths or icepacks is resorted to. Affections of the heart, pericarditis (inflammation of the fibro-serous See also:sac investing the heart) and endocarditis (inflammation of the lining membrane and the valves of the heart), which are so frequently associated with rheumatism, should be regarded as See also:part of the disease, rather than as complications of rheumatism. They are far more common in children than in adults, and it is the damage to the valves of the heart in children by rheumatism which See also:lays the See also:foundation of much chronic heart disease in later life. In childhood the affection of the joints is usually slight, and may be confined to a little pain or stiffness in one or two joints, and is sometimes attributed by parents to " growing pains." The constitutional symptoms are also See also:ill-marked and there are no acid sweats, the temperature is not as a See also:rule very high, the tongue not heavily coated, and the See also:child does not appear to be very ill. The heart and pericardium are, however, especially liable to attack, and this may be so insidious in its onset that See also:attention is not called to it till considerable damage has been done to the heart. It is of importance, therefore, that in children the heart should be frequently examined by a physician, when there is the slightest suspicion of an attack of rheumatism.

Chorea or St See also:

Vitus's See also:dance is a common manifestation of rheumatism in children. Subcutaneous fibrous nodules, attached to tendons or fibrous structures beneath the skin, are a See also:special feature of the rheumatism of childhood. They are painless, and vary in size from one-eighth to See also:half an See also:inch in See also:diameter. They are not very common, but when See also:present indicate that the rheumatism has a See also:firm hold and that cardiac complications are to be apprehended. The patient should be placed in See also:bed between blankets, and should See also:wear a See also:light See also:flannel or woollen See also:shirt. The affected joints should be kept at See also:rest as far as possible, and enveloped Treat- in See also:cotton-See also:wool. Salicylate of soda or See also:salicin, first See also:meat. suggested by Dr Maclagan in 1876, appear to exercise a specific See also:influence in acute rheumatism. They have a powerful effect not only in reducing the temperature, but in relieving the pain and cutting See also:short the attack. Frequent and fairly large doses of salicylate of soda should be administered for the first twenty-four See also:hours: the dose and See also:interval at which it is given should then be gradually reduced till the symptoms subside. In See also:conjunction with this, alkalies such as bicarbonate or citrate of potash should also be administered. The effect of the salicylate should be carefully watched, and the dose reduced if toxic symptoms such as See also:delirium, deafness, and noises in the ears occur. These drugs are of less service in the rheumatism of children than in that of adults, as they do not appear to exercise any specific influence in arresting the cardiac inflammation to which children are specially liable, though they have a marked effect on the joint affections.

Aspirin has recently come into use as a substitute for salicylates, and may succeed when salicylates fail. Subacute rheumatism.—This See also:

term is sometimes applied to attacks of the disease of a less severe type in which the symptoms, though milder in See also:character, are usually of longer duration and more intractable than in the acute See also:form. It is difficult, however, to draw a hard-and-fast See also:line between the two, but the term may perhaps be most appropriately applied to the repeated and protracted attacks of cardiac rheumatism in children.

End of Article: ACUTE RHEUMATISM

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