tensity of the pain and acute edge of the discomfort usually
subside in from five to fifteen days, especially under competent care.
When the temperature falls, the drenching sweats cease, the joints
become less exquisitely painful, and the patient gradually begins to
pull himself together and to feel as if life were once more worth
living. He is not yet out of the woods, however, for while the pain is
subsiding in the joints which have been first attacked, another joint
may suddenly flare up within ten or twelve hours, and the whole
distressing process be repeated, though usually on a somewhat milder and
shorter scale. This uncertainty as to how many joints in the body may be
attacked, is, in fact, one of the chief elements in making the duration
of the disease so irregular and incalculable.

Even when the frank and open progress of the disease through the joints
of the body has come to an end, the enemy is still lying in wait and
reserving his most deadly assault. Distressing and crippling as are the
effects of rheumatism upon the joints and tendons, its most deadly and
permanent damage is wrought upon the heart. Fortunately, this vital
organ is not attacked in more than about half the cases of acute
rheumatism, and in probably not more than one-third of these are the
changes produced either serious or permanent, especially if the case be
carefully watched and managed. But it is not too much to say that, of
all cases of serious or "organic" heart disease, rheumatism is probably
responsible for from fifty to seventy per cent. The same germ or toxin
which produces the striking inflammatory changes in the joints may be
carried in the blood to the heart, and there attack either the lining
and valves of the heart (endocardium), which is commonest, or the
covering of the heart (pericardium), or the heart-muscle. So intense is
the inflammation, that parts of the valves may be literally eaten away
by ulceration, and when these ulcers heal with formation of scar-tissue
as everywhere else in the body, the flaps of the valves may be either
tied together or pulled out of shape, so that they can no longer
properly close the openings of the heart-pump. This condition, or some
modification of it, is what we usually mean when we speak of "heart
disease," or "organic heart disease." The effect upon the heart-pump is
similar to that which would be produced by cutting or twisting the valve
in the "bucket" of a pump or in a bulb syringe.