530 DISEASES OF THE ORGANS OF LOCOMOTION. 



comes on late ; it usually corresponds to the severity and extent of the 

 local symptoms, and has all the characters of a sthenic inflammatory 

 lever. The bodily temperature does not usually attain the high grade 

 observed in infectious diseases ; in most cases it does not rise more 

 than two or three degrees above normal, but exceptionally it becomes 

 104 105.5, or even higher. The pulse is more frequent, usually 

 from 90 100 beats in the minute, and is generally full and soft. Only 

 in those cases where the temperature becomes very high does the 

 pulse reach 120 130 beats in the minute. In many cases, even where 

 there is no complication with endocarditis, we hear blowing murmurs, 

 so-called blood-murmurs. The respiration is hastened, the skin is al- 

 most always covered with very profuse perspiration of acid odor, which 

 has no critical significance, but is usually just as abundant during the 

 advancing stage, and at the height of the disease, as in the declining 

 stage. The skin is often covered with an eruption of miliaria rubra. 

 We have previously shown that this exanthema belongs to the eczemas, 

 and results from irritation of the skin at the orifices of the perspiratory 

 glands from excessive sweating. Besides vesicles filled with a milky 

 fluid, we often see efflorescences in the shape of red papules, where 

 there has not been sufficient exudation to raise the epidermis into a 

 vesicle. More rarely sudamina, or miliaria alba, occur. The great 

 loss of water, due partly to increased evaporation caused by the high 

 temperature, partly to the profuse sweating, is shown not only by the 

 thirst, but by the scantiness of the urine. Frequently only twelve to 

 fourteen ounces of urine are evacuated in twenty-four hours. As the 

 amount of urea is increased on account of the accelerated change of 

 tissue, the concentrated urine has a very high specific gravity ; and, as 

 the amount of water it contains is insufficient to retain the urates in 

 solution at low temperature, copious sediments of these salts form as 

 soon as the urine cools. These appear darker red than common, on 

 account of the quantity of coloring matter which is deposited with the 

 salts. A very copious sediment of urates does not always allow us to 

 conclude that the amount of urea excreted in twenty-four hours is in- 

 creased ; at least, in two cases of acute articular rheumatism, treated 

 at the Greifswalder clinic, where Hoppe-Seyler had the kindness to 

 examine the very thick urine which deposited a large sediment, the 

 amount of uric acid was only normal. It is, to some extent, justifiable 

 to term such urine almost pathognomonic of acute articular rheuma- 

 tism ; for in scarcely any disease is the loss of water so great from 

 profuse sweating as well as from increased evaporation, caused by the 

 high temperature. 



Among the complications of acute articular rheumatism, pericar- 

 ditis, endocarditis, and myocarditis, deserve especial mention. When 



