Rheumatism

“ It is, however, upon signs which are of a more general character that we ought chiefly to rely for diagnosis. The fact that the patient has previously experienced a genuine attack of [226] acute rheumatism, though of some value, is by no means to be taken as a conclusive argument that the present attack is of a rheumatic nature. The really important matter is, that whether the patient has or has not suffered acute rheumatism before the occurrence of the subacute or chronic form, the latter will always be attended by more or less of the specific constitutional disturbance of rheumatism. ”

“ A man has inflammatory rheumatism—his homœopathic doctor gives him forty pellets of the thirtieth attenuation of aconite, and directs him to take two at a time twice a day, which would last ten days. His child gets them, and finding they are sweet, swallows them all at a dose. Now if there were any truth in Homœopathy, this child must have rheumatism, or a similar affection, severely, so that there would in that event be two cases of rheumatism instead of one in the same family. ”

“ That form of rheumatism known as visceral is as a general rule secondary in comparison with articular rheumatism. Several joints and tendon sheaths may be attacked at the same time. Under such circumstances rheumatism may be defined as a febrile disease, probably of an infectious nature, revealing itself by simple or multiple inflammation of joints and the tissues surrounding them, and capable of becoming complicated with inflammation of the pleura, pericardium, endocardium, meninges of the brain, etc. ”

“ Among the acute diseases which by their derangement of nutritive processes especially render those who have suffered from them liable to this painful affection of the muscles during convalescence, is acute articular rheumatism or rheumatic fever. It is this fact, taken together with the use of a misnomer, that has given rise to the view that the muscles share with the serous and fibrous structures in the lesions of that disease, and that myalgia is rheumatism of the muscles. ”

“ RHEUMATISM.—This is an inflammation of the tissues that form the locomotory apparatus. The effect of cold on the muscles and tendons is an important factor in its production. It differs from other inflammations by shifting from one part to another. It is termed muscular rheumatism when it affects the muscles, tendons and fascia, and articular rheumatism when it involves the articulations. A second classification, acute and chronic, depends on the character of the inflammation. The muscular form is common in horses, dogs and hogs, while the articular form more commonly affects cattle. ”

“ I have had several women with me this afternoon more or less disabled by chronic rheumatism. Certainly, either their labour or the exposure it entails must be very severe, for this climate is the last that ought to engender rheumatism. This evening I had a visit from a bright young woman, calling herself Minda, who came to beg for a little rice or sugar. I enquired from which of the settlements she had come down, and found that she has to walk three miles every day to and from her work. ”

“ The rheumatic patient lives on, and talks on of [Pg 113] “Doc’s” failure to stop his rheumatic pains. All doctors know that rheumatism is the universal disease of our fickle climate. If it were not for rheumatic pains, and neuralgic pains that often come from nerves irritated by contracted muscles, the Osteopath in the average country town would get more lonesome than he does. People who are otherwise skeptical concerning the merits of Osteopathy will admit that it seems rational treatment for rheumatism. ”

“ When the inflammation is seated in the ligament and tendons, rheumatism is established. Both these affections are very harassing to the patient; the pains are severest at night, and wholly prevent sleep, the countenance becomes sallow, appetite, strength, and flesh fail, and hectic fever completes the list of troubles consequent upon these forms of the disease. Nodes and rheumatic pains may exist independently of, or in connexion with, other syphilitic symptoms. ”

“ I believe it to be a true specific for certain kinds of rheumatism. Its first trial was given a patient suffering as follows: She had had rheumatism for about ten years—never became serious. Sometimes she was nearly relieved from it; again lost much rest and sleep from it. Her wrist would become painful and very weak from ordinary labor. She always suffered very much in the morning upon any motion, and complained of being stiff. Had to have assistance in dressing. Upon sudden motion, sensation in the muscles as of tearing and being bruised—even painful upon pressure. ”

“ There are a certain number of cases of so-called rheumatoid arthritis which produce very serious changes in joints with inevitable crippling and quite beyond all possibility of repair. These cases are often spoken of as chronic rheumatism and it is the solicitude produced by the dread of them that makes the worst part of the discomfort in many a so-called chronic rheumatic case. If their affection is to be progressive, then the patients foresee a prolonged confinement to bed in the midst of severe pain, hopeless of ultimate cure. ”

“ That true rheumatic processes may extend from serous or fibrous structures to contiguous muscular masses has, in the absence of demonstration, been assumed by many writers of authority, but that acute or subacute rheumatism, with its recognized characters, ever manifests itself primarily or exclusively as an inflammation of muscle-substance is an assumption wholly without clinical or pathological support. ”

“ Acute rheumatism—a fruitful cause of cardiac disease in the earlier periods of life—is seldom seen beyond the age of fifty. I have, however, attended a case of acute articular rheumatism at the age of seventy-five ”

“ The pathogenesis of rheumatoid arthritis is the subject of differences of opinion very like those existing in regard to acute articular rheumatism. The weight of evidence is in favor of its diathetic relationship to rheumatism; and the doctrine of an arthritic diathesis and of the operation of the causes of the disease through the nervous system appears to be specially applicable to it, with less difficulty than to acute rheumatism, and the probability of a specific germ being its true cause is very remote. ”

“ The laboring man who keeps his stomach and liver in a constant state of irritation, with spirituous drinks—who uses his voluntary muscles hard and long every day, and is exposed to all kinds of weather, is the most eligible, and the most frequent victim of rheumatism; for in him the condition of the stomach, the limbs, and the exciting cause, meet in all their strength. Hence, in places where perry and cider abound, the peasantry are especially subject to rheumatism. ”

“ As soon as the bodily heat approached its normal intensity consciousness returned, and in a few moments the animal, which had just before been at the point of death, was running about the grass.
Some months since I had an opportunity of repeating this experiment upon a human being.
In acute inflammatory rheumatism it sometimes happens that the swelling and pain of the joints suddenly disappear, and the patient becomes comatose or wildly delirious. It has been customary to explain these symptoms as the result of the rheumatism leaving the joints and attacking the brain. ”

“ In acute muscular rheumatism, there is at first a dull pain in the muscles, which gradually increases. When the affected muscles are not used the pain is slight, and certain positions may be assumed without inducing it constantly; but in movements which involve contraction of the muscles the pain is very violent. In some cases, the disease is movable, changing from one muscle to another, but usually it remains fixed in the muscle first attacked. The appetite and digestion are not often impaired, and there is no fever. ”

“ From these indiscretions and their consequences may be dated all his bodily sufferings in future life—in short, rheumatism sadly afflicting him, while the remedies only slightly alleviated his sufferings, without hope of a permanent cure. Medical men are too often called upon to witness the effects of acute rheumatism in the young subject. In some the attack is on the heart, and its consequences are immediate; in others it leaves behind bodily suffering, which may indeed be palliated, but terminates only in a lingering dissolution. ”

“ So much for acute rheumatism. Vague and unsatisfactory as is our knowledge of it, it is, unfortunately, clearness and precision itself when contrasted with the welter of confusion and fog which covers our ideas about the chronic variety. The catholicity of the term is something incredible. Every chronic pain and twinge, from corns to locomotor ataxia, and from stone-in-the-kidney to tic-douloureux, has been put down as "rheumatism." ”

“ How much the treatment of these so-called chronic rheumatisms depends on suggestion, in spite of the apparent improbability of anything so materially discomforting being under the influence of the mind, is best appreciated from a consideration of the many inert materials that have been used for the cure of rheumatism. There is, of course, no more virtue in red flannel than in any other colored flannel, but many people suffer from rheumatism or rheumatic discomfort whenever they do not wear red flannel and are sure that it means much for them. ”

“ It is little better than a diagnostic garbage-dump or dust-heap, where can be shot down all kinds of vague and wandering pains in joints, bones, muscles, and nerves, which have no visible or readily ascertainable cause. Probably at least half of all the discomforts which are put down as "rheumatism" of the ankle, the elbow, the shoulder, are not rheumatism at all, in any true or reasonable sense of the term, but merely painful symptoms due to other perfectly definite disease conditions of every imaginable sort. ”

“ Sudden changes of the weather, and all quick transitions from heat to cold, are very apt to occasion the rheumatism. The most extraordinary case of a rheumatism that I ever saw, where almost every joint of the body was distorted, was a man who used to work one part of the day by the fire, and the other part of it in the water. Very obstinate rheumatisms have likewise been brought on by persons not accustomed to it, allowing their feet to continue long wet. ”

“ I took the trouble to analyze in more than a dozen cases the rheumatism that was supposed to exist in the preceding generation, and found that it consisted of everything from pains due to old injuries and especially dislocations or fractures, through the various deformities connected with flatfoot, up to and including the worst manifestations of arthritis deformans. The condition in the parents supposed to be hereditary is never genuinely rheumatic. ”

“ Dag Daughtry questioned impatiently. "Besides, my rheumatism don't count. It's the nigger-boy's swelling."
"You need a course of treatment," Doctor Emory assured him. "Rheumatism is a tough proposition. It should never be let grow chronic. ”

“ It has already been mentioned that rheumatism of the bones and joints, and in fact of various parts of the body, is unfortunately but too frequently an accompaniment or a consequence of syphilitic disease: and an observer will discover that nodes rarely exist without rheumatic inflammation (of which by-the-by they are a species) being more or less present. ”

“ CHRONIC RHEUMATISM.—Chronic rheumatism is a disease attacking persons of middle age, or after, and is seen more commonly in poor, hard-work [Pg 176] ing individuals who have been exposed to cold and damp, as laborers and washerwomen. Several of the larger joints, as the knees, shoulders, and hips, are usually affected, but occasionally only one joint is attacked. ”

“ The manifestations of acute articular rheumatism other than the articular are various, and some of them, more especially those observed in the heart, may be regarded as integral elements of the disease, for they occur in a large proportion of the cases, often coincidentally with the articular affection, and may even precede it, and probably may be the sole local manifestation of acute rheumatism, although under the last-mentioned circumstances it is difficult to prove the rheumatic nature of the ailment. ”

“ In this heated, half-fevered condition of system, if a person be exposed to cold wind or to damp, can she wonder that illness is the result? And this illness will take the form of rheumatism in the joints in one, muscular pains and stiffness in another, chest complaint in a third, and so on through every scale of trouble. ”

“ It may be that chronic articular rheumatism is induced by the prolonged operation of damp cold, and that the prolonged rheumatic irritation, aggravated by constant use of the joint and by occasional violence, ultimately superinduces the profounder alterations characteristic of arthritis deformans. ”

“ We know that rheumatism, which appears very probably to affect this system, is rarely the attendant of children of the first age; that in a hundred patients affected with it, there are ninety at least above the age of fifteen or sixteen years. ”

“ But if cold water falls upon them, or if they have to put their legs in water, they become subject to lumbago, sciatica, to indefinite pains in their limbs, and often to a real rheumatism. The rheumatism is generally subacute, sometimes chronic, and most often localized in a single joint—generally that of the left knee, on which the pick-men and heavers rest in working. ”