Arizona republican., 1893-03-26
RHEUM M.
IBY VIM. W. HIBBARD, M.D.l

As remarked in the opening article on this subject the agency of cold may or may not act as an exciting cause in de- veloping acute rheumatism, and when it does thus act, the individual is usu- ally in such an impaired physical con dition as to invite the disease. This at- lection, though most commonly present in wet and cold months, is found during the dry and hot period and is not un- common in warm weather on account Of trequencyof chills following overhesting. It sometimes suddenly appears after severe strain or some injury to part that afterwards takes on inflammation. A severe attack of dyspepsia, or de- rangement of the liver, if the person be of rheumatic tendency, may serve to
 bring it on. So also overindulgence in stimulants, or rich and indigestible food, especially if one has had an attack previously and of recent date.
 Mental influences of decidedly de- pressing character may, in conjunction with other causes tend to the develop ing of the disease if one be prone to 1t. If a rheumatic joint were opened and looked into, there would be found in most cases an increased effnsion, as the result of inflammation and a somewhat swollen condition of the lining mem- brane would be seen. The increased ef- fusion might be thin, clear and of aka line reaction, or thickened and tLrbid like, with flakes of fibrin, and under the microscope certain cell formations might be discovered-pus cells, how ever, would not commonly be found. Not much blood would be present ex- cept in an individual having a hemor- rhagic tendency. The quantity of pus discovered in most cases is exceedingly small, if any, and is generally due to some other malady connected with rheumatism.
 The cartridges about the joint un- doubtedly share in the inflammation, especially in severe cases, and about them there is more or less inhammatory effusion.
 When acute rheumatism results ia. tally there is usually complication con nected with it, like pneumonia or in- flammation of the Inning membrane of the heart, or some other part of the body that is important in the normal working of the physical system.
 From time to time the blood has un- dergone chemical analysis in this affec- ton. The result of repeated analysis has not been such as to be uniformly positive as to changed chemical condi. tions- The blood has an alkaline reac- ton as in health, and it is generally ad- mitted that the amount of fibrn is in- creased during the disease.
 Different theories have been held as to changes wrought in the blood. Among the most important are the fol- lowing: That rheumatism is due to the presence of tactic acid in the blood, and some writers go 80 far as to give inter- esting theoretical explanations of the successive chemical changes that cer- tain elements of tho food undergo Tn passing through the digestive and as- similative organs to produce, with sub sequent changes pertaining to the res piration, tactic acid. Another theory relates to the formation of germs; that the disease is due to the presence in the blood of vegetable organism of definite character. It is generally admitted, however, that there IS necessity of further investigation in this line before positive declaration can be made. There ia also 6 theory of some weight to the effect that the disease is due to the pres- ence in the system of poison of the na- ture of miasma, entering from without, allied, although distinct from the miasm of malarial fever.
 Acute rheumatism is somewhat vari- able in che history of it's commencement. Tn the majority of cases it is sudden, though not infrequently gradual in it's onset. When the disease commences gradually there is a feeling of general debility, with alternate slight chills and heat, with soreness about the joints of the body, the soreness soon becoming painful the parts involved commence to swell, and there is more or less red ness. Slight motion or pressure makes the patient feel as though he were sui ferer.
 In certain proportion of cases the attack is quite sudden and one may be taken in the night after having been about and passed fairly comfortable day. In such cases fever comes on quickly and to a considerable degree. All the characteristics of inflammation rap idly present themselves. There is pain, tenderness, increased heat in the affected joints, and the slightest motion or light est pressure causes intense suffering to to the part involved. The most notice- able swelling is about those articula- tons which are most superficial and least covered with fat or muscle, as, for instance. the knee, wrist, elbow, ankle and smaller joints of the hands and feet.
 The swelling is due to the effusion