158 THE BLOOD IN RHEUMATISM, &C. [BOOK I. 



Articular Rheumatism and Rheumatoid Arthritis. 



In acute rheumatism there occurs a specific inflammation of the 

 serous membrane of the joints, usually accompanied by considerable 

 effusion, but scarcely ever ending in suppuration. There is at the 

 same time a very great tendency to inflammatory changes of the 

 pericardium and endocardium. 



Clearly separated from gout by the absence of an excess of uric acid 

 in the blood, and in the large majority of cases by that of lesions of the 

 kidney, acute articular rheumatism is a type of a disease in which 

 local inflammatory changes are accompanied by a high temperature. 



As in all other diseases in which a high temperature accompanies 

 local inflammatory changes, the most marked modification in the 

 chemical composition of the blood consists in an augmentation of the 

 fibrin which separates on coagulation. 



The blood is usually buffed and cupped ; the amount of fibrin 

 is said to bear some relation to the intensity of the febrile disturbance. 



At first the increase of fibrin is the only change which chemical 

 analysis reveals ; in the course of the disease, however, anaemia 

 supervenes, and is evidenced by the aspect of the patient, no less 

 than by a diminution in the number of the corpuscles. The changes, 

 if any, which occur in the anatomical characters of the corpuscles 

 or in the proportion of haemoglobin which they contain, have not 

 yet been made out. 



According to Becquerel and Rodier, in acute rheumatism, as 

 well as in all other acute inflammations, there occur (1) an increase in 

 the amount of fibrin ; (2) a diminution in the amount of blood- 

 corpuscles ; (3) a diminution in the serum-albumin ; (4) an increase 

 in the fatty matters; (5) a diminution in the soluble salts of the 

 blood. With the exception of the increase in the amount of fibrin, 

 the other changes are in all probability chiefly to be referred to the 

 disturbance between the balance of income and expenditure which 

 occurs in all acute diseases, and which leads to rapid loss of weight 

 and anaemia; these are, however, like the changes revealed by 

 analysis, but the effects of a morbid process of which the exact starting 

 point, no less indeed than the exact seat, is hidden from us. 



In subacute rheumatism and in rheumatoid arthritis there are no 

 constant changes in the composition of the blood. It is, however, 

 of great importance, as constituting the widest difference between 

 .the so-called rheumatic gout (rheumatoid arthritis) and true gout, 

 whether acute or chronic, that in the first-named disease there is no 

 tendency whatever to accumulation of uric acid in the blood, and to 

 its subsequent deposition in the tissues of the body. 



Rickets and Osteomalacia. 



In these two diseases, in which grave disorders of nutrition exist, 

 which must necessarily affect the composition of the blood, no systematic 

 investigation, so far as we know, has been attempted. 



