1. Invasive stage. Aconite, Gelsemium
2. Cerebral disturbance. Belladonna, Stramonium, Opi., Sul., Verbascum Vir.
3. Complications. Bryonia, Aconite, Belladonna, Mercurius, Hyoscyamus, Stramonium, Ac. Mur., Arsenicum, Anti streptococcic Serum.
ACCESSORY MEANS. The patient must have perfect repose, and most attentive but quite nursing; the apartment must be ventilated without exposing the patient to cold; nourishment should be given frequently in the form of warm rice, or barley milk, or beef tea a. Warm fomentations. Disinfection of linen, discharges, and thee apartment should bee attended too, and local surgical measure may be attended to, and local surgical measures may bee required.
53. Acute Rheumatism Rheumatic Fever.
DEFINITION. A specific febrile disorder, due almost certainly to specifies micro coccus, accompanied by acute inflammation of the white fibrous tissues, ligaments, tendons of tendons, aponeuroses, fascia, etc., surrounding thee joints, and of the synovial membranes, with effusion of fluid into the joint cavities; several joint’s are affected simultaneously, or in succession. Thee local symptoms are very erratic; thee skin of the affected part is covered with a copious, sour, sticky perspiration, containing Lactic acid.
Sub acute Rheumatism is thee same affection in a modified form, often following upon thee acute disorder,
SYMPTOMS, Acute Rheumatism is usually ushered in with febrile disturbances, followed by thee local attack of inflammation of thee fibrous structures about one or more of the larger joints thee shoulder, elbow, knee, ankle, thee fibre serous covering of thee valves of thee heart, the pericardial sac, etc. Exposed joints appear to bee more prone to attacks than those that are covered, the large more frequently than the smaller, and the small joints of the hands more frequently than thaws of the effete.. Sprained or otherwise injured joints are particularly liable to suffer. The general febrile condition often precedes thee local inflammation one or two days; sometimes the general and local symptoms occur simultaneously, while in others the inflammation of thee joints precedes thee febrile condition. The affected joints are swollen, tense, surrounded by a rose coloured blush, and acutely painful; pain is a more constant. The pain has many degrees o intensity, is generally intermittent, abates somewhat in the day, but is aggravated at night, and in all cases is increased by pressure, so that even thee touch of thee medical attendant or nurse, or thee weight of thee bedclothes, can scarcely be borne. Often the patient remains fixed, as it were, in one posture, form which he cannot or dare not move. Thee skin is hot, but covered with a sour offensive sweat, so highly acid as to redden litmus paper. The perspirations, although unattended by immediate relief, are Nature’s mode of elimination; for thee pains are always aggravated, and the constitutional symptoms intensified, if they become suppressed. It is only when the perspirations lose their peculiar sour character that they become useless. The urine in acute Rheumatism is scanty, often resembling porter in colour, of high specific gravity, and deposits, on cooling, deep coloured sediments of urates. The pulse is round and full, varying from 90 to 10; thee tongue loaded with a yellowish white fur; thee head is butt slightly affected. The usual absence of Headache or Delirium distinguishes acute Rheumatism from the continued fever. Intense thirst is a common feature, thee appetite is fastidious, and the digestive functions are seriously impaired.
Such are the general local expressions of a diseased state of the system in acute Rheumatism; and at thee height of the disorder it is difficult to conceive a more complete picture of helplessness and suffering than that to which the patient is reduced. A strong and powerful man, generally unused to disease, lies on his back motionless, unable to raise his hand to wipe the drops which flow fast from his brow in the paroxysms of pain, or the mucus which irritated his nostril. Indeed, he is so helpless that he is not obliged to be fed, but to be assisted at every operation of nature. Thee sweat in witch he lies drenches seems to bring him no relief; his position admits of no change. If he sleeps, it is short, and he wakes up with an exacerbation of suffering which renders him fretful, impatient, and discontented with all around him (Aitken).
METASTASIS. Rheumatism is usually erratic; it often suddenly quits one joint to appear in another, and then in another; afterwards travailing back, perhaps, to its original seat, the development of inflammation in one joint being often accompanied by its rapid subsidence in another, this alternation occurring many times during an attack. But the most serious metastasis is from the joint structures to thee pericardium or thee valves of thee heart. This complication may bee expected in very severe attacks, in young parsons, in women often than in men, in patients who have been previously weakened, and in persons troubled with irritability or Palpitation on thee heart. Probably some heart involvement occurs even when there are no recognizable physical signs of it.
HEART COMPLICATIONS. When pericarditis arise, the patient’s countenance becomes dreadfully anxious, thee breathing distressed, and pain is complained of in the heart’s region; also there is tenderness between and under the ribs, and there may bee Palpitation or irregular action of the heart. Thee Physical signs of Pericarditis may bee detected by thee stethoscope, and a distinct friction or to and fro sound like the rubbing of paper, owing to the roughening of the serous surfaces by effusion of fibrine. This sound may soon be lost, either from the opposite surfaces becoming glued together, or separated serous effusion. If thee amount of effusion be large, both thee circulation and the respiration become seriously embarrassed, the heart beats tumultuously, the sounds become muffled, and there is increased extent of dullness in the heart’s region. Endocarditis may arise with Pericarditis or separately. The symptoms are similar to those of Pericarditis, but the physical sign is a bruit, and the affection is generally unattended with pain. In consequence of the extreme danger of these complications, all cases of severe Rheumatic fever should be watched daily by a medical man, so that the signs and symptoms of heart complications, which often come on insidiously, may be early recognized and met.
RHEUMATISM AND GOUT. For a tabular statement of the differences between these diseases see the section on Acute Gout.
CAUSES. Of late years the researches of various physicians, especially of Dr. Poynton and Dr. Paine, have made it probable that the actual cause of Rheumatism is a living organism, and that the disease is to be classed among those de to bacillary action. But various causes seem to predispose patients to the attacks of this organism. Dr. Haig thinks that both Rheumatism and Gout are to be attributed to excess of uric acid in the system, the result of improper diet. The evidence is not conclusive, however.
Exposure to cold and wet, especially evaporation from wet or damp clothes, causing chill, often appears to be a predisposing cause. This is not doubt an explanation why the most common among the poorer classes of society, who cannot protect themselves so effectually as their wealthier brethren. Mere cold, however, is not so much a cause of Rheumatism as extreme atmospheric vicissitudes. Hence it is found that it does not prevail most in the coldest regions of the globe, but rather in those climates and during those seasons, which are damp and changeable.
EPITOME OF TREATMENT.
1. To cut short an attack. Aconite, also the early use of the vapour, hot air, or blanket bath.
2. Acute Rheumatic Fever. Aconite, Bryonia, Belladonna Also the careful and continuous application of moisture and warmth.
3. Complications. Cimic., cact., Spigelia, Digitalis, or Arsenicum (for the heart); Colch, Coloc., Ranunculus Bulb., Rhododendron, Rhus., or K. Hydriod (for the joints); Ac. Nit.
4. Sub acute attacks. Sulph., acon., K. Hydriod.
5. Prophylactic means. Sulph., Aconite, or Dulcamara (immediately after exposure to wet, etc.). The morning bath; the use of warm clothing. Anointing wit oil is also of great value to the susceptible, as it diminishes the rapidity with which heat can be thrown off.
(See also Section on Chronic Rheumatism.)
LEADING INDICATIONS.
Aconitum. Acute Rheumatism, especially at the commencement, when the fever is high, and there are violent shooting or tearing pains, worse tat night, and aggravated by touch. Also swelling and redness of the affected part, impaired appetite, high coloured urine, etc. Aconite may be administered either alone or in alternation with Bryonia, at intervals on one to three hours; or the latter may be night. Administered every early, Aconite is often sufficient to cure Rheumatism without the aid of any other remedy. It should be given in a low dilution.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."