RHEUMATISM (from Gr. , flux), a general term for various forms of disease, now subdivided more accurately under separate names.
or is the name given to a disease having for its chief characteristics inflammatory affections of the joints, attended by severe constitutional disturbances and frequently associated with inflammation of the pericardium and valves of the heart. The acute rheumatism of childhood differs materially from that of adults in that the articular manifestations and constitutional disturbance are usually much less severe, whereas the heart and pericardium are especially liable to be attacked. It will be advisable, therefore, in discussing the symptoms, to deal separately with the rheumatism of adults and that of childhood. There are certain points of importance in connexion with its causation which are generally agreed upon. It is essentially a disease of childhood and early adult life, being most commonly met with between the ages of ten and twenty-five and comparatively rarely after forty. Heredity is unquestionably an important predisposing cause. Climate is also a factor of considerable importance, cold and damp with sudden and wide fluctuations of temperature being especially conducive to an attack. While perhaps more common in Great Britain than elsewhere, it is met with in most parts of the globe. Exposure to cold and wet, and especially a chill after free perspiration and fatigue, are among the most common exciting causes of an attack.
Of recent years much evidence has accumulated tending to show that rheumatism is a specific infective disease due to a micro-organism, and this is now generally recognized. There is still, however, some difference of opinion as to the nature of the micro-organism by which it is produced. In 1900 F. J. Poynton and Paine isolated from eight cases of acute rheumatism in children a minute diplococcus similar to that previously described by Triboulet and by A. Wasserman, which inoculated into rabbits produced lesions of the joints and of the heart indistinguishable from those met with in acute rheumatism. They have since obtained the same micro-organism from a further large number of cases of acute rheumatism, and their results have been confirmed by Walker, Beattie and others. They therefore claim that this micro-organism, to which they have given the name Diplococcus rheumaticus, is the specific cause of acute rheumatism. The objections which have been raised by other competent observers against this view are: (1) That this diplococcus is not found in all cases of acute rheumatism. (2) That certain other micro-organisms when inoculated into animals will produce joint and heart affections similar to those produced by the aforesaid Diplococcus rheumaticus. It would be out of place here to enter into the merits of this controversy; suffice it to say that the objections raised do not appear to be cogent enough to invalidate the conclusions arrived at by the authors of the germ theory. The matter is, however, still to a certain extent sub judice.