The Good Old Days - Acute rheumatism

This unhappy disease starts with shivering and feverishness, followed by fever, then pain and stiffness in the joints. The patient may become helpless, and dread any form of movement because of the pain so engendered.

The joints are found to be swollen from oedematous infiltration of the tissues around them rather than effusion into the joint. Sudamina, an eruption caused by sweat, is consequent upon the sustained high temperature.

The pulse is rapid and full, the tongue covered with a white, creamy looking fur. There is much thirst and the appetite is deficient. The urine is scanty and high coloured, and deposits on cooling a large quantity of red sediment.

In the worst form of this malady the temperature may rise to 109defF, and if this occurs, the case is often fatal.

The patient must be put in an ice-cold bath, which is regularly replenished.

There is a great tendency to complicating affections in acute rheumatism. It is common practice to examine the region of the heart regularly to detect any mischief with this vital organ.

Endocardial mischief may affect either the aortic or the mitral valves, and the heart may be tumultuous in its beating. There is a theory abroad that acute rheumatism is caused by the presence of lactic acid in the blood, but of this there is not the slightest proof.

Whatever may be the part or joint first affected in a case of acute rheumatism, it rarely becomes the fixed seat of the disease, which, before long, almost invariably transfers the site of its manifestation to some other joint, leaving the one previously affected entirely free, or nearly so. Treatment with chlorate of potash, lemon juice and two ounces of salt every 24 hours are all beneficial.

Of the direct causes of acute rheumatism, there can be no question that cold and damp combined are the most usual.

Consequently the poor and ill-clad are those who suffer most frequently from the disease, although any person exposed to such influence is liable to be similarly affected.

Adapted from Practical Medicine by Alexander Silver MA MD, published in 1874 by Henry Renshaw of London.

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