Rheumatism
a term which has been and still is, rather vaguely and extensively used in the nomenclature of disease. But there is one very definite affection to which it is always applied; after this has been discussed the other senses in which it is used will be considered.
Acute rheumatism or rheumatic fever is indicated by general febrile symptoms, with redness, heat, swelling, and usually very intense pain, in and around one or more (generally several, either simultaneously or in succession) of the larger joints, and the disease shows a tendency to shift from joint to joint or to certain internal serous membranes, especially the pericardium and the endocardium; rheumatism being the most common origin of pericarditis, as has been already shown in the article on that disease.
The usual exciting cause of acute rheumatism is exposure to cold, and especially to cold combined with moisture, and hence the greater prevalence of this disease among the poor and ill-clad.
Rheumatism is not, however, a universal sequence of exposure to the cold. It only occurs when there is a special predisposition, or, as it is termed, a rheumatic diathesis or constitution, and the diathesis may be so strongly developed as to occasion an attack of acute rheum matism, independently of exposure to any apparent exciting cause. Men are more subject to the disease than women, but this probably arises from their greater exposure to atmospheric changes on account of the nature of their occupations. The predisposition is certainly affected by age; children under 10 years being comparatively seldom attacked, while the disease is most prevalent between the ages of 15 and 40. Above this age a first attack is rare, and even recurrences are less frequent than earlier in life. Persons once affected become more liable to the complaint than they previously were.
The disease is hereditary in a considerable proportion of cases. The exact nature of the disease poison is unknown.
In the great majority of cases acute rheumatism ends in recovery; and permanent damage to the affected joints is rare. It is, however, extremely apt to recur, either in the early stages of convalescence, or after an interval of months or years. The chief danger RHEUMATISM arises from implication of the heart, which frequently occurs. The younger the patient the greater the liability to these complications, which usually result in more or less permanent impairment of the heart's action. Another condition, much less common, but extremely fatal, is known as rheumatic hyperpyrexia, and is characterized by a very rapid rise of temperature to 108° or 110°, with head symptoms in the form either of drowsiness or of violent delirium.
The patient should be strictly confined to bed between blankets (i. e., without sheets), and be clothed in flannel; he must be carefully protected from draughts, and from undue pressure of the bed clothes, and supplied with light nourishment and diluent drinks. Under such conditions, without other treatment, most cases recover in the course of time.
Till the last quarter of the 19th century there was no general agreement as to what more_should be done. In 1876 Stricker in Berlin and Maclagan in England called attention to a new method of treatment. This method consists in the administration of salicin, or of one of its derivatives (salicylic acid, salicylate of soda, etc.). In rheumatic hyperpyrexia the only treatment that has been found effectual is immersion in a tepid bath as often as the temperature rises to a dangerous point. Convalescence is usually very slow, and it is necessary to keep the patient in bed and on low diet for some time after the fever has disappeared to diminish the tendency to relapse. At this stage tonics, especially quinine and iron, are generally useful.
Chronic Rheumatism. - Chronic painful affections of the joints sometimes follow rheumatic fever and are clearly a consequence of it. The name is often erroneously applied to chronic and insidious forms of gout. There is another form of disease to which most of the cases of so-called "chronic rheumatism" belong, probably distinct from both rheumatism and gout, popularly so called, though it is often called "rheumatic gout," which deserves separate mention.
Osteo-arthritis (chronic rheumatic arthritis and rheumatic arthritis are among its many other names) is characterized in most cases by a very chronic course, by pain and stiffness in one or more of the joints, with creaking on movement, and by destructive changes of the cartilages of the affected joints, with enlargement of the ends of the bones in their neighborhood. It is more common in women than in men; most often begins at or after middle life, though occasionally even in childhood. RHINE Muscular rheumatism is the name usually given to painful affections of the muscles for which no clear cause is discoverable.
RHINE (German, Rhein; Dutch, Rijn), the finest river of Germany, and one of the most important rivers of Europe, its direct course being 460 miles and its indirect course 800 miles (about 250 miles of its course being in Switzerland, 450 in Germany, and 100 in Holland); while the area of its basin is 75,000 square miles. It is formed in the Swiss canton Grisons by two main streams called the Vorder and Hinter Rhein. The Vorder Rhein rises in the Lake of Toma, on the S. E. slope of the St. Gothard, at a height of 7,690 feet above the sea, near the source of the Rhône, and at Reichenau unites with the Hinter Rhein, which issues from the Rheinwald Glacier, 7,270 feet above sealevel. Beyond Reichenau, which is 7 miles W. of Coire, the united streams take the common name of Rhine. From Coire the Rhine flows N. through the Lake of Constance to the town of that name, between which and Basel it flows W., forming the boundary between Switzerland and Germany. At Basel it turns once more to the N. and enters Germany; and, generally speaking, it pursues a N. course till it enters Holland, below Emmerich, when it divides into a number of separate branches, forming a great delta, and falling into the sea by many mouths. The chief of these branches are the Waal and Lek, which unite with the Maas; the Yssel and Vecht, which diverge to the Zuyder Zee; and that which retains the name of Rhine, a small stream that passes Leyden and enters the North Sea. In the German part of its course the chief tributaries it receives on the left are the Ill, Nahe, Moselle (with the Saar), Ahr, and Erft; and on the right the Neckar, Main, Lahn, Sieg, Ruhr, and Lippe. In Switzerland its tributaries are short and unimportant, and this part of its course is marked by the Falls of the Rhine at Schaffhausen, where the river is precipitated in three leaps over a ledge of rocks 48 to 60 feet in height, and by the cataracts of Lauterberg and the rapids of Rheinfelden. The chief towns on its banks are Constance and Basel in Switzerland; Spires, Mannheim, Mainz, Coblentz, Bonn, Cologne, and Düsseldorf, with Worms and Strasburg not far distant, in Germany; Arnheim, Utrecht, and Leyden, in Holland. Its breadth at Basel is 750 feet; between Strasburg and Spires from 1,000 to 1,- 200 feet; at Mainz, 1,500 to 1,700 feet; and at Emmerich, where it enters the RHINELANDER Netherlands, 2,150 feet. Its depth varies from 5 to 28 feet, and at Düsseldorf amounts even to 50 feet. It abounds with fish, especially pike, carp, and other white fish, but the produce of its salmon fisheries has been seriously interfered with since the introduction of steam vessels. It is navigable without interruption from Basel to its mouth, a distance of 550 miles.
The Rhine anciently formed the boundary between the Roman empire and the Teutonic hordes. After the partition of the domains of Charlemagne in 843 it lay within the German empire for nearly 800 years. France long cast covetous eyes on the Rhine, and the Peace of Westphalia in 1648 gave her a footing on the left bank. In 1801 the whole of the left bank of the Rhine was formally ceded to France. The Congress of Vienna in 1815 restored part of the Rhenish valley to Germany, and the cession by France of Alsace and Lorraine after the war of 1870-1871 made the Rhine once more German, until the Peace Treaty of Versailles (1919 ) gave these provinces once more to France. (See WORLD WAR.) The Rhine is dis- WAR.) The Rhine is dis tinguished by the beauty of its scenery , which attracts many tourists. For a large part of its course it has hills on both sides at less or greater distances.
Pleasant towns and villages lie nestled at the foot; above them rise rocky steeps and slopes clothed at one time with vines, with vines , at others with natural wood, and every now and then the castles and fastnesses of feudal times are seen frowning from precipices apparently inaccessible. The finest part for scenery is between Bingen and Bonn; after entering Holland the views are generally tame and uninteresting.