470 THE TREATMENT OF DISEASES. 



Rheumatism, both in the acute and chronic forms, is probably an hereditary 

 disease, but this influence is far less marked than in the case of gout. 



Rheumatic fever is principally a disease of youth, and in this respect again it 

 differs essentially from gout. It is found to occur most commonly between the ages 

 of sixteen and twenty. 



It is rather more common in men than in women. 



Its development is favoured by anything which lowers the general state of 

 health. It is partly from this cause, and partly from the fact that they are more 

 constantly exposed to wet and cold, that rheumatic fever occurs most frequently in 

 those who are poor and ill-fed, and whose lot it is to toil. 



Rheumatic fever is always most prevalent in climates remarkable for damp and 

 variable weather, and it is consequently not to be wondered at that it is a very 

 common disease in many parts of this country. 



We must now proceed to consider the course of an ordinary attack of rheumatic 

 fever. We have already supposed the case of a young man suffering from acute 

 rheumatism as the result of exposure to wet and cold. What happens to him ? At 

 the time he probably experiences some kind of chill or rigor, although it need not of 

 necessity be very severe. Two or three days after he feels feverish, and finds that 

 some of his joints are affected. His temperature is high, his pulse rapid, and the 

 whole surface of the body hot and bathed in perspiration, having a peculiar acrid or 

 acid odour. His tongue is coated with a thick creamy fir, there is loss of appetite 

 and usually increased thirst, with constipation of the bowels. The urine is scanty 

 and high-coloured, and gives rise to a copious red deposit on cooling. The ankles, or 

 perhaps the knees, are painful and powerless to bear the weight of the body ; on 

 examination they are found to be hot, tender, swollen, and somewhat flushed on the 

 surface. 



When the disorder is at its height it is difficult to conceive a more complete 

 picture of helplessness and suffering than that to which the patient is reduced. A 

 strong and powerful man generally unused to illness lies on his back motionless, un- 

 able to raise his hand to wipe away the drops of sweat which flow fast from his brow 

 in the paroxysms of pain, or the mucus which irritates his nostrils. Indeed, he 

 is so helpless that he has not only to be fed, but to be assisted at every operation of 

 nature. The sweat in which he is drenched brings him no relief ; his position admits 

 of no change ; if he sleeps, his sleep is short, and he awakes with an exacerbation 

 of pain which renders him fretful, impatient, and discontented with his lot and 

 all around him. 



The duration of an attack of acute rheumatism is very variable, but it lasts, as 

 a rule, for about twenty-one days. There is probably no disease which is more 

 variable in its duration than rheumatic fever. Some people get over an attack in 

 five or six days, whilst others take as many weeks before they can succeed in com- 

 pletely throwing it off. The pain, redness, and swelling of the joints gradually sub' 

 side, the temperature falls, the sweating diminishes, the tongue becomes clean, and 

 after a time the patient is pronounced convalescent. 



So far we have considered only a simple case of rheumatic fever, in which the 

 inflammation has been limited to the joints. In a large number of cases the disease 



