What are the dangers from acute rheu­matism and what can be done?

Acute Rheumatism

Q. What are the dangers from acute rheu­matism and what can be done?

A. Acute rheumatism is rarely immediately fatal, but sometimes leaves the victim with difficulties which, sooner or later, terminate his life. This occurs whenever the heart becomes affected by the disease, which not infrequently happens. It does not result from a change of the seat of the malady from the joints to the heart, as is sometimes thought, but by an extension of the disease to the lining membrane of the heart.

In consequence of inflammation, the valves of the heart become thickened and contracted so that valvular organic disease of the heart results; rheumatism, indeed, is the most common cause of this form of heart disease. The extension of the disease to the heart is indicated by the occurrence of acute pain in the left side, disturb­ance of the pulse, increase of fever, and increased frequency of respiration. Either one or all the joints in the body may participate in the inflammation. The joints are generally af­fected symmetrically; that is, the ankles, wrist, knees, elbows, or shoulders will be affected on both sides at the same time. When this is not the case, analogous joints upon the same side are likely to be affected, as the ankle and wrist, the knee and elbow, the hip and shoulder, etc. Some­times _ the disease appears to be very fickle, changing constantly from one joint to another without any apparent cause, the change taking place within a few hours.

Anything which lowers vital resistance will, of course, predispose to rheumatism. Meat-eating, beer-drinking, the use of tea and coffee, exces­sive eating, exposure of the body to prolonged chilling when perspiring or in a state of fatigue, and neglect of the bowels, are among the most potent predisposing and active causes of the disease.

Eminent authorities agree that medicines have little or no effect in shortening the course of this disease. It has been shown that a person suffering from rheumatism with rest and proper care usually recovers without any treatment. But there can be no doubt that many things can be done for the patient that will tend greatly to shorten the course of the disease and give very great relief from the suffering incident to the painful malady.

A rheumatism patient should first of all be provided with a suitable bed. This should con­sist of a soft, smooth mattress, preferably cot­ton or hair, or better still an air mattress. He should be provided with a woolen gown and with perhaps a woolen cape to protect the shoulders in addition. Linen or cotton sheets should be replaced by woolen sheets so that the patient will be less likely to chill after perspir­ing. It has been noted that in this disease there is apparently an over-production of lactic acid, much of which is excreted by the skin, causing the perspiration to become acid. The tendency to perspiration should be encouraged by fre­quent sweating baths. The affected joints should be kept as quiet as possible. In case the knee or elbow joints are affected, it is a good plan to place the limb upon a splint and so avoid mo­tion of the painful joint.

As soon as possible after an attack begins, the patient should be placed in a hot blanket pack, in which he should be kept for several hours. As a general rule the longer the pack is continued, the better the effect. The pack should be continued two to four hours at least, and may be repeated two or three times within the twenty-four hours with advantage. Hot fomentations applied over the affected joints also give great relief. The joints should be kept constantly enveloped in warm applications. Moist heat may sometimes be exchanged for dry heat, in the form of bags filled with salt, sand, or cornmeal, or some similar substance as hot as can be borne. Hot-water bags constitute the best method of applying dry heat in these cases. The patient should be allowed an abundance of water. Lemonade, with a very little sugar, is one of the best drinks, as the juice of the lemon seems to have some influence upon the disease, in some cases. The sour perspiration should be frequently removed from the skin by rubbing with dry flannels. Warm sponge baths often add to the patient's comfort. When the fever rises very high, it is, in some cases, neces­sary to administer a prolonged cool bath. The patient should be put into a bath about the tem­perature of the body, the temperature of the water being gradually lowered to 75° or 70° F. The bath should not be prolonged sufficiently to produce marked chilliness on the part of the pa­tient. Tepid sponge baths, repeated every hour or two, or more frequently, if necessary,. may be employed in these cases. When hot fomentations seem to increase the pain in the joinb, cool or cold applications may be employed.

The diet of the patient during the attack should consist wholly of simple preparations of fruits and grains. Meat of all kinds, as well as beef-tea, should be wholly avoided. The use of meat after convalescence is begun is a fre­quent cause of relapse, hence flesh should be wholly discarded.

If symptoms of inflammation of the heart arise, the patient should be kept upon a very low diet, or should take little or no food for a day or two. Hot fomentations and poultices should be constantly applied to the chest, covering the whole left side. The patient should have an abundance of fresh air, but should not be ex­ posed to drafts.