408 
SOCIETY MEETINGS. 
the hippurates of soda and ammonia and hippurie acid. The 
specific gravity is high, owing to an increase of urea and decrease 
of water. 
If the blood be drawn, the coagulum is firm and large, with a 
great increase of fibrin. In general, the strength is well pre¬ 
served. It may attack the heart, but rarely, as endocarditis, with 
valvular lesions. Pericarditis is less frequent. .When it attacks 
the heart, the pulse is quick, irregular, or intermittent, with a 
sighing or hissing murmur. 
The duration of acute rheumatism varies. A peculiarity of 
it is it may not pursue a steady, continuous march, from beginning 
to end. Its course is often marked by fluctuations, as regards 
the general and local symptoms, especially the latter. Often 
after a few days the affected joints are free, or nearly so, from 
pain, soreness, etc., and convalescence seems to be at hand, when 
suddenly the symptoms are renewed. This may occur repeatedly 
during the career of the disease. 
Acute synovitis might be confounded with acute rheumatism, 
but in acute synovitis from injury or cold, like articular rheuma¬ 
tism, there is pain and heat in a joint, with distention. But it 
does not, except in a rheumatic constitution, affect more than one 
joint, and there is scarcely any or no effusion into the surround¬ 
ing tissues. The outline of the joint can be distinctly discerned, 
and fluctuation is readily detected. Often, too, the accumulation 
of fluid reaches an extent far greater than in rheumatic inflamma¬ 
tion, and the febrile and constitutional derangement is not so 
severe as in active rheumatism, and the affection has no tendency 
to change its seat. Chronic rheumatism is a mere modification 
of the former, except that the fever may be absent. It is more 
persistent and less metastatic; it leads to alteration of structure, 
as ulceration of articular cartilage, and fibrous and bony enlarge¬ 
ments, and in cattle, sometimes to suppuration. It may cause 
ossification of the walls of the heart. The acute often degenerates 
into the chronic, and an animal subject to chronic is often attacked 
by the acute form. 
Pathology .—Pathologists disagree as to the poison. It is 
generally thought to be lactic acid. In man, uric acid is found 
