240 RHEUMATISM. 



regarded as being tlie result or external manifestation of tlie 

 action of some miasmatic influences, it seems now very generally 

 accepted as originating from intrinsic causes : that altliougli 

 tliere lias not yet been detected any peculiar or hurtful material 

 circulating in the blood, it is yet highly probable that the 

 general and local diseased manifestations owe their origin to 

 some constitutional and inbred morbific agent, the result of 

 some imperfectly executed chemical or vital process connected 

 with the exercise of animal function ; or at least, that for its 

 existence this inducing agent, or specific factor, is not depen- 

 dent on anything, or is itself received into the body, from with- 

 out. It has been spoken of by some as a blood disease, and 

 evidence of the poisoned state of the blood has been pointed 

 out as exhibited in the coincident occurrence of fever and 

 certain regularly appearing local phenomena and internal 

 structural changes, by the symmetrical development of local 

 symptoms, and the often exhibited metastatic character of 

 these. However, the only abnormal condition as yet well 

 established, and proved to have a constant existence in the 

 blood in rheumatism, is the large increase in the fibrinogenous 

 materials, and the relative disproportion which exists between 

 these and the saline ingredients as compared with the usual 

 proportionate relations in health. Probably from the loiow- 

 ledge that certain secretions and excretions of the body, in 

 acute rheumatism, are distinctly acrid and acid, the idea may 

 have originated that the true rheumatic poison was some 

 special and distinctive organic acid produced in excess during 

 the exercise of natural function, or if not manufactured in 

 excess, at least unnaturally retained in the system from some 

 defect in convertive or eliminative function. The idea first 

 suggested by Dr. Prout, that all the phenomena, systemic and 

 local, exhibited in rheumatism might be referred to the reten- 

 tion in the S3^stem of an extra amount of lactic acid, has been 

 extensively adopted, enforced, and expounded by many succeed- 

 ing pathologists. The source of this lactic acid is believed to 

 be the ordinary one of the transformation of the starch of the 

 food into this agent, which, in the further steps in the heat- 

 production, is converted at the lungs by combining Avitli 

 oxygen into carbonic acid and water ; and that the extra 

 amount of the acid is to be accounted for by the occurrence of 



