ACUTE ARTICULAR RHEUMATISM. 527 



cur primarily and idiopathically, and are not of traumatic origin, are 

 termed rheumatic, no matter whether the disease can be referred to 

 catching cold or not. Another characteristic of rheumatic affections 

 is the frequent disproportion between the severe subjective symptoms 

 and the insignificant anatomical changes, as well as the tendency of 

 the disease to pass from the part first affected to others of analogous 

 structure and function. But the proportionately severe pain in rheu- 

 matism is less due to the variety than to the location of the disease ; 

 at least traumatic, gouty, and other inflammations of moderate degree, 

 are very painful, when they attack fibrous tissues. Nor is the fugacity 

 of rheumatic affections, their tendency to shift position, entirely char- 

 acteristic, for no one would object to terming rheumatic an idiopathic, 

 painful affection of a joint, which did not show this fugacity, but *e- 

 mained limited to the same joint for years. 



CHAPTER I. 



ACUTE ARTICULAR RHEUMATISM RHEUMATISMUS ARTICULORUM 



ACUTA RHEUMARTHRITIS ACUTA FLYING GOUT. 1 



IN acute articular rheumatism the synovial capsule of a greater or 

 less number of joints is the seat of an inflammatory disturbance of nu- 

 trition. The simple name of polyarthritis acuta would be enough for 

 this disease, if there were not a secondary polyarthritis acuta occurring 

 in the course of infectious diseases from which acute articular rheuma- 

 tism is to be distinguished as polyarthritis acuta rheumatica seu idio- 

 pathica. In most cases of acute articular rheumatism, the inflamma- 

 tion of the synovial capsule does not attain a very high grade. The 

 exudation into the joint is usually neither copious nor fibrinous, nor 

 does it contain many pus-cells. The swelling visible about the affected 

 part depends mostly on inflammatory oedema of the connective tissue 

 around the joint. But this slight degree of inflammation and the 

 quality of the exudation are by no means constant peculiarities of the 

 disease ; on the contrary, there are some cases where the inflammation 

 has attained a far higher grade, and where a fibrinous or purulent ex- 

 udation is deposited. 



The predisposition to acute articular rheumatism is very unequal in 

 different persons, without our knowing the reasons for this dissimilarity. 

 Some persons seem to inherit a predisposition to the disease. Those 

 who have had one or more attacks are very liable to it. The disease 

 is rare in early childhood and in old age ; it occurs most frequently be- 

 tween the ages of fifteen and forty years. Men are attacked as often 

 as women, or perhaps more frequently. The predisposition appears to 



