102 MANUAL OF EQUINE MEDICINE. 



mation be slight, the symptoms of cardiac mischief may- 

 pass unobserved. If, however, there be much pericardial 

 eflfusion, and inflammation of the heart-muscle itself, of the 

 endocardium and valvular structures, very severe sym- 

 ptoms show themselves. There will be great tenderness 

 over the region of the heart, and the sounds will be altered 

 in character (vide ' Cardiac Diseases '). The pain and swell- 

 ings of the joints frequently subside in one extremity quite 

 suddenly, and then reappear in another ; this ' metastasis,' 

 or changing of the seat of inflammation, is a marked feature 

 of rheumatism. 



Sometimes the inflammation of the joints does not abate 

 and suppuration ensues. In these cases the febrile symptoms 

 become more severe and the joint is destroyed. 



Complications. — Inflammation of the pericardium and 

 endocardium ought, perhaps, to be regarded as part of the 

 acute rheumatic inflammation as much as the inflammation 

 of the joints themselves. 



Morbid Anatomy. — Death in acute rheumatism is mostly 

 due to cardiac disease, and corresponding lesions are found 

 accordingly. The joints and the structures around them 

 will be found in diff'erent conditions of pathological change, 

 varying with the intensity of the inflammation and its 

 duration. 



Treatment. — A mild aperient should be given in all 

 cases. A small dose of aloes or a saline purgative may be 

 selected, and the bowels should be kept open by regulation 

 of diet or appropriate remedies. The abstraction of blood 

 is not to be recommended. Bicarbonate of potassium should 

 be given in full doses three or four times daily with the 

 spirit of nitric ether. If the temperature be high, salicylate 

 of sodium given three times daily for a day or two in full 

 doses proves very efi'ectual in reducing it. Colchicum, in 

 the form of a tincture or the wine, and liquor ammonise 



