RHEUMATISM. 



time ; but the pain is conltantly fhifting its place, leaving the ceflation of acute rheumatifm. Tin,-, fad wasfirfl I 

 fome joint and going to another, and frequently returning 

 again to each of them feveral times during the courfe of the 

 difeafe ; and in this manner the difeafe is often protracted 

 for a confiderable length of time. Soon after, and fome- 

 times at the fame moment wil the commencement of the 

 pain, the joint feized becomes fwelled and fomewhat red ; 

 and this fwelling is extremely painful to the touch. The 



pain is fometime's relieved by the occurrence of fwelling, but 

 not always ; neither is the joint thus rendered more fecure 

 from a return of the attack. The patient, thus unable to 

 move the joints affected, which are irritated and acutely 

 pained by external fometimes even by the weight 



of the bed-clothes, and in a flate of fevere internal pain, un- 



tioned by Dr. Baillie, on the authority of the late Dr. Pit. 

 cairn, and has fince been more fully eltablifhed bv the re- 

 cords of feveral cafes. See efpecially a paper by Mr. fer- 

 jeant-furgeon Dundas, in the firft volume of the Medieo- 

 Chirurgical Tranfaftions ; alfo Dr. Baillie's Morbid Ana- 

 tomy. 



It has been remarked by Dr. Cullen, as indicative of the 

 peculiar nature of rheumatic inflammation, that "the acute 

 rheumatifm, though it has fo much of the nature of the 

 other phlegmafix, differs from all thofe hitherto m 

 in this, that /'/ it not apt to terminate in fippuration. 

 mofl never happens in rheumatifm ; but the difeafe fome- 

 times produces effuiions of a trail/parent gelatinous f.uid 'into 



able to find any poiition of eafe, lies fleeplefs and reftlefs for the fheaths of the tendons. If we may be allowed to fup 



feveral days and hights together. The fever accompanying 

 the difeafe is moil coniiderable during the night, at which 

 time the pains alfo are molt violent. The pulfe is com- 

 monlv from ninety to a hundred in a minute, and occafion- 

 allv more frequent ; often full, and fometimes hard and 

 iharp, but moit frequently foft. The heat of the fkin is 

 confiderable, and the difeafe is commonly attended with 

 {Wearing, even from an early period, which is often profufe 

 and conftant, but never either relieves the pains permanently, 

 or proves a crifis to the fever. The urine, in acute rheu- 

 matifm, is remarkably high-coloured from the beginning, 

 and afterwards depoiits moit copioufiy a browniih-red fedi- 

 ment, like brick-duit. This fediment, however, is pro- 

 bably the refult rather of the profufe fweating, than of any 

 peculiarity belonging to the difeafe ; fince it is commonly 

 feen after a dofe of fudorific medicine, or any other variety 

 of perfpiration. Like the fweating, it does not occafion or 

 betoken any favourable change in the fever. When blood 

 is drawn in this difeafe, it always exhibits, and generally in 

 a high degree, the buffy coat, as it is called, or a coriaceous 

 covering of coagulable lymph, on its furface. 



With the fymptoms above detailed, the rheumatic fever 

 often continues for feveral weeks : it feldom, however, 



pofe that fuch effufions are frequent, it mult alfo happe 

 that the eftufed fluid is commonly re-abforbed ; for it h; 

 feldom happened, and never indeed \o my obfervation, that 

 confiderable or permanent tumours have been produced, or 

 fuch as required to be opened, and to have the contained 

 fluid evacuated. Such tumours, however, have occurred 

 to others, and the opening made in them has produced 

 ulcers difficult to heal." (See Cullen, Firil Lines, par. 448.) 

 The non-occurrence of fuppuration in thefe violent rheu- 

 matic inflammations is of itfelf a itriking charadteriitic of the 

 difeafe ; and the circumftance, that it is not productive, on 

 the other hand, of what are called chalkfiones, or of that 

 cretaceous-like fecretion which is the refult of the inflamma- 

 tion of gout, diitinguifhes it from the latter maladv. In 

 addition to this circumttance, however, there are other 

 points of diftinftion between the gouty and rheumatic inflam- 

 mation ; namely, that the latter ufually attacks the large 

 joints ; that it is not preceded by fymptoms of indigeftion ; 

 that it does not recur in regular paroxyims ; and that it at- 

 tacks younger people, and thofe not liable to gout from 

 their modes of life ; and, as we (hall fee immediately, is 

 ufually the eftect of a fpecific caufe, cold. 



Caufes of Acute Rheumatifm. — The circumllances which 



proves fatal, and perhaps never, while the joints alone are conllitute a predifpoiition to the attacks of acute rheumatifm 



the feat of the difeafe ; the fever, indeed, ufually becomes 

 lefs violent after two or three weeks, and the pains lefs fe- 

 vere, and lefs difpofed to change their place. But occa- 

 fionally the inflammation of the joints has difappeared, and 

 fome vital organ, as the brain, lungs, or ltomach, has been 

 feized with inflammation, by which the patient has been 

 carried off; or thefe organs have become limultaneoufly af- 

 fedted, and the fame fatal event has enfued. We have had 

 occafion to witnefs two inftances of this kind, out of feveral 

 hundreds of cafes, in which a tranfition of the difeafe from 

 the joints to the lungs took place, or, at leaft, in which, on 

 the fpeedy ceflation of rheumatifm in the joints, a violent in- 

 flammation of the lungs fupervened, and terminated fatally. 

 We have alfo feen fuch a metaftafis to the lungs, which was 

 removed by vigorous treatment. The venerable Dr. Hay- 

 garth, however, has given a more unfavourable ilatement of 

 this matter from his experience ; for " out of 170 cafes," 

 (fpeaking of acute rheumatifm,) he fays, " I have found 

 twelve which had a fatal termination, either by a tranflation 

 of the inflammation to the brain, lungs, kidnies, ftomach, 

 or fome other vital part, or as being found in combination 

 with other difeafes." ( See Clinical Hilt, of Acute Rheu- 

 matifm, p. 61.) Dr. Cullen has not mentioned any fuch 

 refult of the difeafe. From the obfervations of our con- 

 temporaries, it ha- been found that the heart is peculiarly 

 liable to be affedted by a metaftafis of rheumatic inflamma- 

 tion, or to be attacked with a flow difeafe, by which its 



are various. Perfons of an irritable, plethoric, or fan- 

 guineous habit, are moit liable to be affected, when expofed 

 to the adtion of the exciting caufes ; and a certain period of 

 life, in which there is a confiderable vigour in the fangui- 

 ferous fyftem, alfo predifpofes to it. It affects, indeed, per- 

 fons of all ages, from five to above fixty vears ; but is much 

 the moit frequent between the time of puberty and the 

 thirtieth year. Dr. Haygarth confiders it as molt common 

 between fifteen and twenty. Some difference has been fup- 

 pofed to exiit with refpedt to fer ; fince it is certain that 

 males are much more fubjedt to the difeafe, in this country, 

 than females ; Dr. Haygarth fays, in the proportion of 

 nearly four to three. But it is probable, as the fame writer 

 fuggeits, that this arifes from the more conftant expofure of 

 men to cold and rain, by the nature of their occupations, 

 than women ; whence, he was informed, that, in Holland, 

 the rheumatifm is feldom found in women, though the air is 

 very humid, becaufe they are more domeilicated thaii in this 

 country, and their drefs is warmer. Preceding attacks of 

 the difeafe feem to afford a ftrong predifpoiition to future 

 recurrences of it. 



When thefe predifpofitions exiit, the acute rheumatifm is 

 readily excited by the fudden application of cold or damp, 

 when the body has been already much heated, and is per- 

 fpiring after fatigue ; or when one part of the body is ex- 

 pofed to cold, while the other parts are kept warm ; or, 

 laitly, by any long continued application of cold and moif- 



bulk becomes increafed, and its fuudtions dilturbed, after ture, under any circumftances, as by wearing wet or damp 



3 clothes. 



