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the other symptoms of pyrexia, and particularly by a frequent, full, and hard pulse. Sometimes the pyrexia is formed before any pains are perceived ; but more commonly pains are felt in par. ticular parts, before any symptoms of pyrexia appear.
· 442. When no pyrexia is present, the pain is sometimes confined to one joint only; but, when any considerable pyrexia is present, although the pain may be chiefly in one joint, yet it seldom happens but that the pains affect several joints often at the very same time, but for the most part shift. ing their place, and, having abated in one joint, become more violent in another. They do not commonly remain long in the same joint, but frequently shift from one to another, and some. times return to joints formerly affected ; and in this manner the disease often continues for a long
443. The pyrexia attending this disease has an exacerbation every evening, and is most considerable during the night, when the pains also become more violent; and it is at the same time that the pains shift their place from one joint to another. The pains seem to be also increased during the night, by the body being covered more closely, and kept warmer.
444. A joint, after having been for sometime
affected with pain, commonly becomes affected als so with some redness and swelling, which is pain. ful to the touch. It seldom happens, that a swelling coming on does not alleviate the pain of the joint; but the swelling does not always take off the pain entirely, nor secure the joint against a return of it. .
445. This disease is commonly attended with some sweating, which occurs early in the course of the disease; but it is seldom free or copious, and seldom either relieves the pains or proves cri. tical.
446. In the course of this disease, the urine is high-coloured, and in the beginning without sediment; but as the disease advances, and the pyrexia has more considerable remissions, the urine deposites a lateritious sediment. This, however, does not prove entirely critical ; for the disease often continues long after such a sediment has appeared in the urine. acers. bit:
447. When blood is drawn in this disease, it always exhibits the appearance mentioned in 237.
448. The acute rheumatism, though it has so much of the nature of the other phlegmasiæ, differs from all those hitherto mentioned, in this, that it is not apt to terminate in suppuration. This als most never happens in rheumatism; but the dis. ease sometimes produces effusions of a transparent gelatinous fluid into the sheaths of the tendons. If we may be allowed to suppose that such effusions are frequent, it must also happen, that the effused huid is commonly reabsorbed ; for it has seldom happened, and never indeed to my observation, that considerable or permanent tumours have been produced, or such as required to be opened, and to have the contained fluid evacuated. Such toe mours, however, have occurred to others, and the opening made in them has produced ulcers difficult to heal. Vide Storck. Ann. Med. II.
449. With the circumstances mentioned from 439 to 448, the disease often continues for several weeks. It seldom, however, proves fatal; and it rarely happens that the pyrexia continues to be considerable for more than two or three weeks. While the pyrexia abates in its violence, if the pains of the joints continue, they are less violent, more limited in their place, being confined commonly to one or a few joints only, and are less ready to change their place.
450. When the pyrexia attending rheumatism has entirely ceased; when the swelling, and particularly the redness of the joints, are entirely gone; but when pains still continue to affect cer. tain joints, which remain stiff, which feel uneasy
upon motion, or upon changes of weather, the disease is named the Chronic Rheumatism, as it very often continues for a long time. As the chronic is commonly the sequel of the acute rheu. matism, I think it proper to treat of the former · also in this place.
451. The limits between the acute and chronic rheumatism are not always exactly marked.
When the pains are still ready to shift their place; when they are especially severe in the nighttime; when, at the same time, they are attended with some degree of pyrexia, and with some swell. ing, and especially with some redness of the joints; the disease is to be considered as still partaking the nature of the acute rheumatism
But, when there is no degree of pyrexia remaining; when the painted joints are without redness ; when they are cold and stiff; when they cannot easily be made to sweat ; or when, while a free and warm sweat is brought out on the body, it is only clammy and cold on the pained joints; and when, especially, the pains of these joints are in. creased by cold, and relieved by heat applied to them; the case is to be considered as that of a purely chronic rheumatism.
452. The chronic rheumatism may affect different joints ; but is especially ready to affect those
joints which are surrounded with many muscles, and those of which the muscles are employed in the most constant and vigorous exertions. Such is the case of the vertebræ of the loins, the affection of which is named Lumbago; or that of the hip-joint, when the disease is named Ischias, or Sciatica,
453. Violent strains and spasms occurring on sudden and somewhat violent exertions, bring on rheumatic affections, which at first partake of the acute, but very soon change into the nature of the chronic, rheumatism.
454. I have thus delivered the history of rheu. matism; and suppose, that, from what has been said, the remote causes, the diagnosis and prognosis of the disease, may be understood. The distinction of the rheumatic pains from those resembling them, which occur in the syphilis and scurvy, will be obvious, either from the seat of those pains, or from the concomitant symptoms peculjar to these diseases. The distinction of rheumatism from gout will be more fully understood, from what is to be delivered in the following chapter.
455. With respect to the proximate cause of rheumatism, there have been various opinions. It has been imputed to a peculiar acrimony; of which,