24G RHEUMATI,S3I. 



indicated by the thermometer, being particularly well marked, 

 with a rather frequent, full, and unyielding pulse. 



In all, at this stage, the bowels are rather confined ; there is 

 thirst, while the secretion from the kidneys is of the true 

 febrile type, small in amount, and of high specific gravity. 



Besides these features of general disturbance common to 

 many febrile affections, there is to be noticed the special car- 

 diac disturbance. When the involvement of the heart is 

 trifling, the inconvenience may be so sHght and the S}anptoms 

 so little attractive that this complication may escape observa- 

 tion. There seems good ground for believing that all cases of 

 acute rheumatism show specific inflammation of some part of 

 the structures of the heart ; but from the fact that the serous 

 fluid eftused is rapidly taken up, and any fibrinous adhesions 

 are very early effected, the disturbance of function has not 

 been sufficient to attract attention. 



When, however, there is much effusion in the heart-sac, 

 pressing upon and confining its movements, complicated with 

 inflammation of the muscular tissue, the inner lining mem- 

 brane or valvular structures, both general and local symptoms 

 become distressing and distinctive. 



Pain is exhibited on exercising percussion over the region of 

 the heart, intensified by j)ressure in the intercostal spaces of 

 the left side. There is some restlessness, anxious expression 

 of countenance, slight cough, difficulty in breathing, and palpi- 

 tation when rapidly moved or sharply turned round. These 

 conditions may attract us to make a more careful examination 

 by auscultation, which will reveal a somcAvhat altered condi- 

 tion of the natural sounds of the organ. Very often all that 

 we can be certain of is that there is some irregular contraction 

 about the orifices, or that the natural impulse of its move- 

 ments is deadened by the presence of fluid in the pericar- 

 dial sac. 



Of the local symptoms lameness is the most attractive ; it is 

 severe as well as sudden. The animal, when last seen, may 

 have had perfect freedom of locomotion ; it may now be totally 

 incapable of movement, or only able to accomplish this with 

 the greatest difficulty. Manipulation of the affected limb or 

 limbs — for lameness is often symmetrical — will at once satisfy 

 us of the nature of the affection ; one or more joints will bo 



