Licence: Public Domain Mark
Credit: A manual of medical diagnosis / by A.W. Barclay. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
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![its immobility is due to pain or to stiffness of the joint, as well as when it is caused by paralysis. Handling the limb is the most effectual mode of discriminating these three conditions, The history of the case may be also available for distinguishing between the various affections embraced under the head of iheumatism, as it points out the severity of the sufferings and the duration of the attack, its limitation to one limb, or its transference to others. We should never omit to inquire whether there have been any previous attack of a similar cha- racter ; both because of the bearing this has on disease' of the heart, and also because the characters of the affection are apt to be less pronounced in proportion to the frequency of their repetition. § 1. Acute Rheumatism.—The general symptoms indicate the pre,sence of a febrile or inflammatory dis- order : the sensations of the patient refer especially to the existence of pain. Our next step is to ascertain its locality,—whether felt in the limbs, and spoken of as “pains in the bones,” so common in fever; or in some defined situation, as the effect of simple inflam- mation ; or whether confined to the joints themselves. If the patient, in his description, follow it from one joint to another,—the ankles, the knees, the hips, the wrists, elbows, and shoulders,—we may be sure that the dis- ease is acute rheumatism. In this form, the pain is severe,—not coming in twinges, nor acconq)anied by startings (muscidar I spasm),—but continuous, aggravated by motion, and j intolerant of pressure; sometimes so intense, that the ; weight of the bed-clothes cannot be borne ; every pos- j ture alike uneasy, the ])atient would fain alter it, but that the dread of increased suffering in the attempt | commonly restrains him. Flying from one limb to another, or affecting all nearly alike, the wrists and ankles are more es])eeially jmone to suffer in acute rheumatism ; and these joints are commonly tumid](https://iiif.wellcomecollection.org/image/b24989812_0100.jp2/full/800%2C/0/default.jpg)
