RHEUMATISM, ACUTE, or RHEUMATIC FEVER.–This is a disease of the blood due to excessive acidity, producing pains and swelling of joints, muscles, and internal organs and membranes, accompanied with heavy, sour perspiration and fever. It is brought on by chills, and also by an cause which lowers the vitality.
An infective element has been isolated, but the conditions of damp and chill are all-important in favouring its development. Very often the symptoms show themselves first in the throat, causing inflammatory sore throat, or quinsy.
Symptoms and Diagnosis.–It is hardly possible to mistake an attack of rheumatism for anything else. The pains in the joints and muscles, and the swelling, excessive sour perspiration which gives no relief, are found in no other disease. In pyaemia, or blood-poisoning, there is frequently affection of the joints, which become the seat of abscesses, but there is always the history to guide in these cases, and the fever is of the hectic type. Rheumatism may accompany scarlet fever. Like scarlet fever and the other eruptive fevers, it has a great tendency to attack the heart, causing inflammation of its lining membrane (endocarditis), and leaving the valves defective, or else inflammation of the outer covering (pericarditis). These are detected by pain, faintness, and by hearing the rubbing sounds of pericarditis, or the blowing sounds, instead of the sharp “lupp-dupp” when the endocardium is affected. In rheumatic fever the temperature is sometimes very high and dangerous to life; sometimes it is but little raised above the normal.
General Treatment.–This may be fitly summarised in two words– flannels and gruel. It is necessary that the patient should be clothed in a flannel night-dress, and put to bed in blankets, or Jaeger sheets. The heavy perspiration will soon saturate linen or cotton night-dresses and chill the patient, whilst flannel or woollen garments retain the heat and let the perspiration escape. The food should be such as does not favour the formation of lactic acid, the presence of which in the system gives rise to most of the symptoms.
The ultimate cause is the lowered and perverted vitality, the consequence of which is that the digestive faculties are not equal to transforming the food and the tissues perfectly. Waste products (especially lactic acid) increase, and the rheumatic fever is the effort the system makes to get rid of them. If follows that only the most easily digestible foods are admissible, and of these gruel or gruel-kinds of food are the best. Milk has so many advantages that it must in many cases be resorted to, but its tendency to turn acid in the stomach is against its use when it can be avoided. Chicken-tea, mutton- broth, beef-tea, with barley, may be given, and as drink, barley water as much as is desired. During convalescence weak tea may be given as soon as the patient can relish it, and a little bread and butter, gradually returning to ordinary diet as the strength increases. Those who have a tendency to rheumatism should not eat much meat, and should take milk but sparingly. Sweets also should be avoided, and watery fruits and vegetables. Grain foods are the best–oatmeal, barley, wheat-meal and whole meal bread.
Medicines.–(Every two or three hours until improvement sets in, the intervals between the doses being lengthened as the symptoms abate.)
–High fever, dry, hot skin, thirst, redness of the cheeks; shooting or tearing pains, worse at night; redness of shining swelling of the parts affected; pain aggravated by touch; extreme irritability of temper; disposition to uncover the parts, and relief from doing it.
-Shooting, tearing, or tensive pains; shifting pains, which affect the muscles rather than the bones; red and shining swelling and rigidity of the parts affected;parts worse at night, and on the least movement; profuse perspiration, or coldness and shivering; much heat, with headache and derangement of the stomach; peevish or passionate temper.
–Shooting, burning, or tearing pains, aggravated at night, especially towards morning, and in the warm bed, or by exposure to damp or cold air; puffy swelling of the affected parts; the pains seem to be seated in the bones or joints; profuse perspiration without relief. Moist white tongue. (Mercurius covers a very large percentage of cases and often suffices alone to clear up a case).
–After Merc, if insufficient.
–Tearing, burning, or wrenching pains; sensation of weakness and crawling in the affected limb; red, shining swelling of the joints, with rigidity or shootings when touched; pains worse during rest, or in cold, damp weather. After Aconite or Bryonia
–Pains aggravated in the evening, or at night in bed, in a warm room, or on changing the position; pains which pass quickly from one joint to another; numbness in affected parts; pains relieved by cool air; present with pale face, disposed to shivers and to chills.
–Pains aggravated by the slightest touch; profuse perspiration; great debility, especially from loss of blood or other fluids.
–Pain, swelling, stiffness, and weakness of joints when the acute stage has passed.