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.
102/642 (page 78)
![paratively r.arc instances, tlie external signs of the disease only follow after the subsidence of some internal inflammation. Those occurrences are most particularly associated with pericarditis; but endocarditis and pleurisy may also become causes of obscurity in febrile conditions connected with rheumatism. There is really little practic.al difficulty in recogni.sing a case of acute rheumatism; we have only to distingui.sh it from gout, and from the inflammation of the joints attending on secondary deposit: and their diagno.sis must be more fully considered in subsequent sections. A first attack is generally the best defined: the patient is probably under thirty ; the redness of the skin con- fined to the part immediately over the joint, the pain and tender- ness out of all proportion to the aspect of inflammation, and various joints suffering simultaneously. In any other than a first attack, the history of the former seizure may prove that to have been gout, and wll naturally lead us to suspect that this, though less defined, is probably gout too. The previous occurrence of either renders it probable that the present disease is not connected with purulent contamination of the blood. The history, again, of its commence- ment and progress, in gout or rheumatism, differs from that usually obtained in a case of pyremia: in the latter, there is some existing suppuration or inflammation of veins or absorbents, which was perhaps recognised long before inflammation attacked the joints ; and we are thus prepared to look for its occurrence: somefimes, however, the process is a very rapid one, and the at- tack exceedingly like acute rheumatism to the inexperienced. One or two points aid very much in the discrimination, as they are con- nected with the essential nature of the disease. The inflammation round the joint is more erysipelatous in appearance, and is com- bined with oedema, and the pain is less severe ; other parts, at a distance from any joint, are similarly affected; or there maybe inflammation about the eye-lids, soreness of throat, &c.: the fever is adynamic, and the patient depressed; the inflammation con- stantly passes on to suppuration—which never hajipens in acute rheumatism. Delirium is occasionally associated with acute rheumati.sm, and we may .satisfy ourselves, m the majority of cases, that it is not due to inflammation of the brain, but merely an evidence of deterioration of blood, or of laboured circulation, consequent upon inflammation of the heart. It can only cause anxiety wlien the disease has sud- denly recedeil from the joints, and has not affected the heart; be- cause, as will be shown when speaking of delirium, we may then possibly have metastasis to the brain. In the chest are to bo found the most constant complications of acute rheumatism. By far the larger number of ca.ses of ]iericarditis which have been recognised during life occur in the progress of this disease, and a considenible prnjiortion of the pi'rmanent valvular lesions may be observed to take their rise in rheumatic endocarditis, or may be](https://iiif.wellcomecollection.org/image/b24989812_0102.jp2/full/800%2C/0/default.jpg)
