Rheumatic fever

“ In fact, they probably cause more than any other, because they are at least ten times as common and frequent. For instance, many cases of rheumatism, or rheumatic fever, come after attacks in the nose and throat, which cannot be distinguished from a common cold or ordinary tonsilitis. Indeed, it is more than probable that one of the ten or a dozen different germs that may get into your nose or throat and give you a cold, is the germ that causes rheumatism. At all events, it would be fairly safe to say, "No colds, no rheumatism." ”

“ Yet nature is not wanting in similar phenomena, which have appeared in ancient and modern times; and if we take into the account the great frequency of cognate rheumatic maladies, it is possible that isolated cases may have sometimes occurred, in which repletion of impure fluids, and violently inflammatory treatment have augmented a rheumatic fever, even to the destruction of nervous vitality, by means of profuse perspiration—only, perhaps, that they ran a longer course, (which does not constitute an essential difference,) and under totally different names, whereby attention is misled. ”

“ This day, our guest, Marmaduke Falmer, joined us downstairs in the sitting-room for the first time since his illness.
He is sadly deteriorated, in a bodily sense, by the wasting rheumatic fever that brought him nigh to death; but he is still young, and the doctor (humanly speaking) has no doubt of his speedy and complete recovery. My sister takes the opposite view. She remarked, in his hearing, that nobody ever thoroughly got over a rheumatic fever. Oh, Judith! Judith! it’s well for humanity that you’re a single person! ”

“ Rheumatic Fever.—This disease begins with restlessness and fever; there is a white or creamy condition of tongue, and the bowels are deranged. Presently the joints begin to ache, the pain increases till there is great swelling and tenderness over one or more of the large joints of the body; the temperature rises, and, in some cases, becomes excessively high; the urine deposits a thick brickdust sediment on cooling. As there is a great risk of the heart becoming affected in this disease, it must always be regarded with apprehension, and medical advice procured at once. ”

“ I have already stated that nine out of ten of all cases of heart disease in early life, not due to original malformation, are of rheumatic origin, and further that heart disease comes on in the course of four out of five cases of rheumatic fever in the child, slight as well as severe. It seldom occurs before the third or fourth day of the illness, so that if parents take the alarm at the very outset, it is usually though not invariably possible for the doctor by judicious treatment to anticipate and to prevent its occurrence, or at any rate greatly to control its progress. ”

“ Other local inflammations occasionally arise in the course of acute rheumatism: pneumonia is one of the most frequent; left pleuritis is not infrequent, and is doubtless often caused by the extension of a pericarditis; but both pneumonia and pleurisy are occasionally double in rheumatic fever. ”

“ Rheumatic fever is one of the common diseases of London, which attacks young adults, and very often cripples them for life. It is a disease of great importance, and appears from the last report of the Registrar-General to have been on the increase since 1858.
Besides the greater liability to premature death which is caused by overcrowding, there are other drawbacks which are scarcely less important. One of these, with which we are well acquainted in London, is an increase in the dirtiness and smokiness of the air, which is mainly due to private fireplaces. ”

“ The arthritic or gouty state of fever differs from the rheumatic, in affecting, with the joints and muscles, all the nervous and lymphatic systems, the viscera, and the skin. Its predisposing, exciting, and proximate causes are the same as the rheumatic and other states of fever. It bears the same ratio to rheumatism, which the yellow fever bears to the common bilious fever. It is a fever of more force than rheumatism. ”

“ It occurs in temperate climates during the fall, winter, and spring—less often in summer. Persons more frequently suffer between the ages of ten and forty years. It is rare in infants; their pain and swelling of the limbs can be attributed more often to scurvy (p. 180) , or to surgical disease with abscess of joint or bone. Exposure to cold and damp, in persons insufficiently fed, fatigued, or overworked, is the most common exciting cause.
Symptoms.—Rheumatic fever may begin with tonsilitis, or other sore throat, with fever and pains in the joints. ”

“ Continued Fevers are generally of a Bilious character, except in winter, when they are more or less connected with irritation of the lungs, or with Rheumatic affections, when they are termed Catarrhal or Rheumatic Fevers. If the bilious symptoms prevail, give Aconite and Baptisia during the chills and high febrile stage, at intervals of an hour, and during the declining stage of the fever, give Podophyllin and Mercurius until a perfect intermission is produced, when the same treatment should be adopted as in intermittents. ”

“ In 1824 he wrote ‘An Essay on the Blood,’ in 1825 one ‘On Colchicum,’ in 1826 ‘Observations on Laennec's Diagnosis,’ and in 1827 ‘A Treatise on Rheumatism,’ which is an interesting picture of the period when rheumatic fever was beginning to be separated in medical writings from chronic rheumatism, and when the relation of heart-disease to rheumatic fever, though known from the clinical teaching of David Pitcairn [q. v.] , was but imperfectly observed. Scudamore treated rheumatic fever by bleeding, purgatives, colchicum, tartar emetic, opium, and quinine. ”

“ Bronchitis and pneumonia are not so common as in measles. Sometimes convalescence is retarded by abscesses forming in various parts of the body; at other times there is a painful affection of the joints which much resembles rheumatic fever. ”

“ It occurs more rarely after scarlet fever, and even after some of the milder children's diseases. In rheumatism, especially where a heart complication has occurred, this rule with regard to sudden movements is extremely important Rheumatism is itself not a fatal disease, yet there are certain cases in which very high temperature sets in, causes delirium, and death ensues at times before the patient recovers consciousness. Where rheumatic patients show a tendency to run high temperatures, that is, 104° or higher, it is well to be prepared for this emergency. ”

“ The cynanche trachealis is a febrile disease. The membrane which produces suffocation and death in the wind-pipe is the effect of inflammation. It is said to be formed, like other membranes which succeed inflammation, from the coagulable lymph of the blood.
20. The rheumatic state of fever is confined chiefly to the labouring part of mankind. The topical affection is seated most commonly in the joints and muscles, which, from being exercised [56] more than other parts of the body, become more debilitated, and are, in consequence thereof, excited into morbid and inflammatory action. ”

“ FEBRIS UNDULANS, MALTA FEVER, MEDITERRANEAN FEVER
Definition.— Undulant fever— a disease of low mortality, indefinite duration, and irregular course —is the result of infection by a specific germ, the Micrococcus melitensis. In its more typical form it is made up of a series of febrile attacks, each individual attack, after lasting one or more weeks, gradually subsiding into a period of absolute or relative apyrexia, also of uncertain duration. Common and characteristic complications are rheumatic-like affection of joints, profuse diaphoresis, anaemia, liability to orchitis and neuralgia. ”

“ Much of this is found on investigation to be due to the well-known historic confusion between "cold," in the sense of exposure to cold air, and "cold," in the sense of a catarrh or influenza, with running at the nose, coughing, sore throat, and fever, a group of symptoms now clearly recognized to be due to an infection. In short, the vast majority of common colds are unmistakably infections, and spread from one victim to another, and this is the type of "cold" which causes the majority of rheumatic attacks. ”

“ This affection usually runs a brief course, although a repeated onset of fever and rheumatic pains, followed by cutaneous hemorrhages, may protract it for months. It commonly attacks those who have a rheumatic tendency but are otherwise apparently well. ”

“ It will usually be avoided readily by observing that in relapsing fever there are great nausea, repeated vomiting, insomnia, peculiar formication of the extremities, jaundice, early enlargement of the liver and spleen, with abdominal pain and soreness, and a tendency to epistaxis; and, further, that despite the high temperature, cerebral symptoms such as result from rheumatic hyperpyrexia are not threatened, except in grave typhoid cases or just preceding the crisis. ”

“ It is employed principally in typhoid fever, on the theory that a condition of high fever is in itself a source of danger quite distinct from the other injurious effects of a febrile disease. On the other hand, the employment of high degrees of heat has of late been shown to be a potent agency in the treatment of certain forms of disease, notably in various affections classed as rheumatic. ”

“ There is no difficulty in finding germs of all sorts, principally micrococci, in the blood, in the tissues about the joints, and on the heart-valves of patients with rheumatism, and these germs, when injected into animals, will not infrequently produce fever and inflammatory changes in the joints, roughly resembling rheumatism. ”

“ Without any apparent reason the poison of rheumatism habitually attacks one joint on one day, and another joint on another day, and with as little apparent reason it occasionally falls of a sudden upon the inhibitory heat-centre, and actually paralyzes it. In a few minutes intense fever is developed, and the bodily temperature rapidly approaches nearer and nearer that line on the other side of which is death. ”

“ Rheumatism occurs, though it is rarely violent either in a chronic or acute form; dropsical affections are rather common, often due to debility after fever; enlargement of the liver and spleen are common, the latter being most frequent in whites and mulattoes, and usually following upon fevers; the most common eruptive diseases are measles and erysipelas—both mild; varioloid, though common, is rarely fatal; flatulent colics are common; slight scratches and abrasions give rise readily to ulcers, more common in whites and mulattoes than in blacks. ”

“ I have seen it accompany, as well as succeed, the small-pox, measles, scarlet-fever, and apthous sore throat. In the late Dr. Foulke it succeeded acute rheumatism. The late Dr. Sayre informed me, he had seen it occur in a case of yellow fever, in the year 1798.
It sometimes comes on suddenly, but it more frequently creeps on in the form of a common cold. Its symptoms are sometimes constant, but they more generally remit, particularly during the day. It attacks children of all ages, from three months to five years old. But it occasionally attacks adults. ”

“ The contagion, -like that of typhus, appears to be most active in the immediate vicinity of the patient and to be greatly lessened by the access of fresh air. It is capable of being conveyed by clothing. The incubation of the disease is about one week. The symptoms of the fever then show themselves with great abruptness and violence by a rigor, accompanied with pains in the limbs and severe headache. ”

“ As a rule the disease begins with headache, stiffness of the neck and chilly sensations. There may be vomiting, and the temperature is raised. The mind is often confused, and the patient may be delirious. The skin eruption, which occurs especially on the back and about the joints, and which is responsible for the name “spotted fever,” is not very frequently seen, and can hardly ever be detected on a dark skin. In very bad cases there is violent delirium, laboured breathing, and a purulent discharge from the nostrils. ”

“ Profuse sweats are common during remissions at all stages of the fever; rigor is rare. Pains in the limbs often suggest rheumatism. When the disease is thoroughly established emaciation and anaemia become noticeable, and, together with the enlargement of the liver and spleen, cause the patient to present a typical appearance. Œdema of the legs, sometimes circumscribed œdemas, or even ascites may now be present. In many the skin acquires an extraordinary earthy-grey colour; the hair is apt to become dull, dry, and brittle, and may fall out ”

“ In some cases it is plain that local injuries will bring on most violent diseases of the whole system. Thus a local inflammation of the end of one of the fingers, by physicians called a paronychia, has been known to induce a most violent fever, nay, even to occasion death. These violent symptoms end as soon as the suppuration is completed; so that, were it not for the excessive pain of the inflammation, we might be apt to suppose that the fever terminated in the suppuration, whereas it evidently was occasioned by the local disease, or the tendency of the part to suppurate ”

“ INFLUENZA (La Grippe) .—La Grippe is an acute infectious disease caused by a germ. It may be epidemic, attacking a large number of persons at one time, or it may continue in the same region for some time and is then called endemic. It is caused by a germ, discovered by a man named Pfeiffer.
The Onset.—The onset may be from one to four days and is usually sudden with a chill and all the symptoms of an active fever due to a general infection, varying according to the location. If in the organs of respiration it begins like a severe cold ”