The diagnosis of acute articular rheumatism is, to my mind, as frequently misapplied in acute arthritis as that of influenza in pulmonary affections and that of malaria in obscure febrile conditions. Under acute articular rheumatism should be included, of course, only those cases of acute arthritis in which there is a rapid invasion, similar to that in an infectious disease, with high temperature, hot, swollen, tender joint or joints, acid sweats, marked leukocytosis with polynuclear increase, and a marked tendency to endocarditis, and in which the administration of salicylates proves them to be a specific remedy. It is unfortunate that the term "rheumatism" has ever been used to designate other joint affections.
Some of the most noted authorities in tropical medicine declare that acute articular rheumatism and scarlatina are both practically non-existent among natives in the tropics. No one will deny that scarlatina occurs in Panama in imported cases only,