Rheumatism. 541 



muscular tissue and its product into lactic acid (CjHjO (OH) J, 

 instead of carbonic acid ( C O ( O H ) J . But in spite of the per- 

 fect theory, there is the fact that as a rule no special increase of 

 lactic acid can be found in blood or urine in acute rheumatism 

 and the improbability that an excess of this acid caused by sud- 

 den excessive muscular waste could be kept up during a long 

 attack of acute much less of chronic rheumatism. Again the 

 comparative immunity of sucklings in which there is the greatest 

 opportunity for the production of lactic acid, would imply that 

 that alone cannot be accepted, as the one essential cause of the 

 affection. That its excess in the system will aggravate rheuma- 

 tism, or even produce it under favorable circumstances must be 

 freely acknowledged ; also that acidity of the saliva is a marked 

 feature of rheumatism. 



The acid phosphate of soda may be assigned a somewhat sim- 

 ilar role. In strongly predisposed subjects the ingestion of citric 

 or other organic acid will sometimes precipitate rheumatic articu- 

 lar pains. 



Still other products, the result of imperfect oxidation or meta- 

 bolism must be allowed a place as probable factors in rheumatism. 

 The occurrence of gout in connection with the excess of uric acid 

 in the system is strongly suggestive of this, and the frequency of 

 muscular rheumatism in pampered, overfed dogs with diseased 

 livers and abnormal hepatic products, seems to give further sup- 

 port. Even in man, the~ subject of acute rheumatism, often leads a 

 luxurious life and suffers from inactive or disordered liver, while 

 in man and animals alike, a low grade of health and imperfect 

 functional activity of important organs, are often precursors and 

 accompaniments of acute rheumatism. 



Neuropathic theory. The doctrine of a neurotic cause originat- 

 ed by Dr. Mitchell, of Philadelphia, has considerable basis in 

 theory. The primary chill tends to nervous derangement, 

 which may readily affect the overworked or already diseased and 

 debilitated joints. Similar peripheric disturbance of nutrition oc- 

 curs in locomotor ataxia in which the central nervous lesion is 

 very evident. There is a strong disposition in rheumatism to 

 show a bilateral symmetry, which points directly to a central ner- 

 vous control. The frequent violence of the pain, disproportionate 

 to the moderate structural changes, points in the same direction, 



