472 THE TREATMENT OF DISEASES. 



between chronic rheumatism and rheumatic fever. In these attacks there is usually 

 slight swelling, heat, and tenderness of the joints, but there is very little, if any, 

 fever. Even in patients who have suffered long and severely from repeated attacks 

 of acute or sub-acute rheumatism it is unusual to find that any deformity or alteration 

 in the shape of the joints has been produced. 



We have already had occasion to refer incidentally to some of the chief points 

 in which gout and rheumatic fever differ. It is, however, a matter of convenience 

 to have these facts arranged in a tabular form. It is of the greatest importance to 

 be able to distinguish the two diseases, for gout is readily amenable to the influence of 

 colchicum, whilst acute rheumatism is but little influenced by its administration. 



DIFFERENCES BETWEEN GOUT AND ACUTE RHEUMATISM. 



Gout. Acute Rheumatism. 



Age. Occurs most commonly in people over Occurs most commonly in young people, 

 thirty. 



Sex. Occurs much more frequently in men Occurs with almost equal frequency in the 

 than in women. two sexes. 



Hereditary. Is decidedly hereditary. Is hereditary, but not very decidedly. 



Social Condition. Occurs most commonly in Is the lot of the poor and ill- fed. 

 those who live luxuriously. 



Joint. In earlier attacks usually affects only Usually attacks the larger joints of the body, 

 one joint at a time, and most commonly the and frequently several at once, 

 great toe. 



Chalk-stones. Often associated with the for- Never leads to the formation of chalk-stonea, 

 mation of chalk-stones. 



Perspiration. Profuse perspiration not com- Profuse acid perspiration a prominent 



mon. symptom. 



Heart. No tendency to inflammation of the Heart frequently affected, 

 membranes of the heart. 



We must now consider the course of treatment to be adopted in cases of rheu- 

 matic fever. As this is not a contagious disease, there is of course no necessity for 

 isolating the patient. The u?ual precautions should be taken for ensuring cleanliness 

 and thorough ventilation of the room and all that it contains. The chief points to 

 which attention should be directed have been referred to whilst speaking of the 

 general treatment of fever. The patient must, of course, be confined to bed, and 

 should be kept as quiet as possible both physically and mentally. As profuse perspi- 

 ration is a prominent symptom of the complaint, the sufferer should lie between the 

 blankets, and not in the sheets. Linen which is wet or damp is apt to strike cold, 

 and is not only unpleasant, but very likely to prove dangerous to the patient. A 

 sudden check to the perspiration cannot fail to be injurious, and may even lead to 

 a rapid transference of the inflammation from the joints to the heart. It should 

 always be remembered that rheumatic fever is a very painful complaint, and that 

 the touch of the physician, the handling of the nurse, or even the shaking of the bed 

 by the footstep of an approaching friend, may cause the sufferer the most exquisite 

 pain. 



Respecting the diet there is little to be said. When the fever runs high, food 



