INFLAMMATIONS. 



85 



to another, and are always much increased by the action of the 

 muscles belonging to the joint or joints affected. 



CCCCXL. The larger joints are most frequently affected, 

 such as the hip-joint and knees of the lower, and the shoulders 

 and elbows of the upper extremities. The ankles and wrists 

 are also frequently affected, but the smaller joints, such as those 

 of the toes or fingers, seldom suffer. 



CCCCXLI. This disease, although sometimes confined to 

 one part of the body only, yet very often affects many parts of 

 it ; and then it comes on with a cold stage, which is immediate- 

 ly succeeded by the other symptoms of pyrexia, and particularly 

 by a frequent, full, and hard pulse. Sometimes the pyrexia is 

 formed before any pains are perceived, but more commonly 

 pains are felt in particular parts before any symptoms of pyrexia 

 appear. 



" In cases of rheumatic pains, it is a question that often oc- 

 curs to be determined, whether we are to consider the primary 

 disease as fever or as rheumatism, for it makes some difference 

 in our conduct ; and it is to be determined in this manner : When 

 the febrile symptoms, the headach, anxiety, debility, anorexia, 

 nausea, are present in a great degree, and when the pains are 

 more general, and not so much in particular joints, as shifting 

 from one joint to another, and not attended with swelling, we 

 judge that an idiopathic fever is present. On the contrary, we 

 judge the disease to be more purely rheumatic when these feb- 

 rile symptoms are in a great measure absent ; when the pains 

 are more fixed on particular joints at one time, though they may 

 shift their place ; and when in these joints it is attended with 

 swelling." 



CCCCXLII. When no pyrexia is present, the pain is some- 

 times confined to one joint only ; but when any considerable py- 

 rexia is present, although the pain may be chiefly in one joint, yet 

 it seldom happens but that the pains affect several joints often at 

 the very same time, but for the most part shifting their place, 

 and, having abated in one joint, become more violent in an- 

 other. They do not commonly remain long in the same joint, 

 but frequently shift from one to another, and sometimes return 

 to joints formerly affected ; and in this manner the disease of- 

 ten continues for a long time. 



