22. ROSENTHAL'S METHOD OF WASHING OUT THE STOMACH . . . . . . . 606 23. ANTERIOR VIEW OF A STRANGLUATED INTESTINE AND STRICTURE . . 842 24. POSTERIOR VIEW OF A STRANGULATED INTESTINE AND STRICTURE . . 842 25. APPEARANCE OF THE NATURAL RELATIONS OF THE DIVERTICULUM TO THE INTESTINE . . . . . . . . . . . . . . . . . . . . . . . 843 26. SIMPLE INVAGINATION OF THE ILEUM . . . . . . . . . . . . . . 844 27. SIMPLE INVAGINATION, WITH OCCLUSION OF BOWEL, FROM INFLAMMATORY CHANGES . . . . . . . . . . . . . . . . . . . . 844 {17} GENERAL DISEASES (_CONTINUED_). FROM DERANGEMENTS OF THE NORMAL PROCESSES OF NUTRITION. RHEUMATISM. | PURPURA. | GOUT. | DIABETES MELLITUS. | RACHITIS. | SCROFULA. | SCURVY. | HEREDITARY SYPHILIS. {19} RHEUMATISM. BY R. P. HOWARD, M.D. Acute Articular Rheumatism. SYNONYMS AND DEFINITION.--Acute Rheumatism, Acute Rheumatic Polyarthritis, Rheumarthritis, Rheumatic Fever, Polyarthritis Synovialis Acuta (Heuter). Acute articular rheumatism is a general non-contagious, febrile affection, attended with multiple inflammations, pre-eminently of the large joints and very frequently of the heart, but also of many other organs; these inflammations observing no order in their invasion, succession, or localization, but when affecting the articulations tending to be temporary, erratic, and non-suppurating; when involving the internal organs proving more abiding, and often producing suppuration in serous membranes. It is probably connected with a diathesis--the arthritic--which may be inherited or acquired. It may present such modifications of its ordinary characters as to justify being called (2d) subacute articular rheumatism, and it may sometimes pass into the (3d) chronic form. ETIOLOGY.--There is a general consensus of opinion that acute articular rheumatism belongs especially to temperate climates, and that it is exceedingly rare in polar regions; but respecting its prevalence in the tropics contradictory statements are made. Saint-Vel declares that it is not a disease of hot climates; Rufz de Levison saw only four cases of acute articular rheumatism, and not one of chorea, in Martinique during twenty years' practice; while Pruner Bey says it is common in Egypt, and Webb remarks the same for the East Indies. Even in temperate climates, like those of the Isle of Wight, Guernsey, Cornwall, some parts of Belgium (Hirsch), the disease is very rare--a circumstance not to be satisfactorily explained at present.