Symptoms
Sometimes the onset of rheumatic fever is sudden. IN most cases, the child first develops a sore throat. About two weeks later, he may have a fever and stiffness which may be preceded or accompanied by joint swelling. The patient may also suffer from lack of appetite, profuse sweating and perhaps even a rash. The joints involved are usually the ankles, knees and wrists. Nodules can be felt under the skin over the elbows and wrists. The affected joints are swollen and they are painful, tender and warm during the active stages of the disease. The pulse becomes rapid and there are heart murmurs. The electrical activity of the heart, recorded by the electrocardiograph, changes.
If the disease affects the nervous system, the patient becomes irritable and excitable, and his movements are clumsy. Spontaneous movements develop mostly in the face and arms. The disease may also involve the valves and various layers of the heart and produce breathlessness. \

Causes
Certain streptococcus germs present in the throat are apparently responsible for the onset of rheumatic fever. The organism provokes the formation of antibodies which react not only with the streptococci but with normal constituents of human heart muscle and joint membranes.
Heredity is an important factor and the disease seems to run in families. If both parents have had the disease during childhood, their children are more likely to have rheumatic fever. Overcrowding is another important cause for the outbreak of this disease. There is always the likelihood of rheumatic fever wherever large numbers of children and young people assemble. Other causes of the disease are malnutrition and dampness.

Treatment
The child-patient should be kept in bed until the swelling of the joints subsides and fever settles. He should be nursed carefully and not allowed to exert himself. He may be given plenty of fruit juices in the begining of the treatment. Orange juice will be especially beneficial. It can be given diluted with water on 50 : 50 basis. If possible, the bowels should be cleansed daily with warm- water anema.
Hot and cold compresses should be applied several times daily to relieve swelling and pain in the joints. Cold packs should also be applied to the trunk. A cold pack to the throat will also be beneficial. The procedure for these packs have been explained in the Appendix.
The patient may adopt an all-fruit diet when the temperature has come down to normal and the tngue has cleared. In this regimen,he should take fresh juicy fruits such as apple, pineapple, peach, pear, grapes, orange and papaya or any other juicy fruit in season. Thereafter , he may gradually embark upon a well-balanced diet according to his age. The emphasis should be on whole grain cereals, fresh fruits and raw vegetables and their juices.
A useful remedy for rheumatic fever is the use of asparagus (halyan) seeds, black cumin (kala jeera), fenugreek (methi) and ajwain. All the four herbs should be taken in equal quantity and ground into powder. Three grams of this powder should be swallowed with water every morning. This will control the swelling of rheumatism.
Another useful remedy to relieve the pain of rheumatic fever is to grind finely 1.25 decigrams of white arsenic, one dried grape and four decigrams of pepper and make into 24 pills. One pill should be taken daily after breakfast.
As for local application, one kilo of root of castor tree should be boiled in eight litres of water. The mixture should be expressed and strained when one-fourth of the liquid is left. It should be boiled in half kg. of castor oil till all the water has evaporated. This oil should be rubbed over the affected parts and they should be bandaged with cottonwool.

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