KIIKl'MATISM. 



RHEUMATISM. 



cold water, to which carbonate of sod* is added, answers well. 

 Compound rhubarb pill, a very commonly-used aperient, is hurtful to 

 penon* prone to suffer froui pile*. But an unobjectionable and very 

 mildly acting aperient pill can be made with equal parts of extract of 

 rhubarb, extract of jalap, and extract of taraxacum, with a very little 

 jalapiua, and some drops of any volatile oil, such as dill, carraway, or 

 , : MI 



Several species of rheum, and garden varieties of them, are cultivated 

 for the sake of the petioles of the leaves, which are much used to 

 make tarts in spring. The cooling and gently aperient properties of 

 these render them grateful ami beneficial to most persons ; but indi- 

 viduals prone to calculous complaint* should carefully avoid them, and 

 all vegetables which owe their acidity to oxalic acid, as the formation 

 of the oxalate of lime, or mulberry calculus, may be the consequence 

 if indulgence. This observation applies equally to the species of 

 Rumex which are used as sorrel. [CiCKii AHIKTI.NI-M.] (Percira's 

 MatMed.') 



ItHEUMATISM (from ^uparur/i&t, "a dcfluxion"). It is probable 

 that this term was originally adopted during the prevalence of the 

 doctrines of the humoral pathology, when every disease attended with 

 swelling was attributed to the flow |of some morbid humour to the 

 part affected. Before the year 1C42, rheumatism and gout were 

 usually described as one disease, under the name of arthritis ; the dis- 

 tinction between the two is said to have been first accurately made by 

 Bellonius, a physician who suffered much from rheumatism. 



Acute rheumatism, called also rheumatic fever, has been so well 

 described by Sydenham, that we make use of his own words : " This 

 disease," he observes, " happens at any time, but especially in autumn, 

 and chiefly affects such as are in the prime of life. It is generally 

 occasioned by exposing the body to the cold air immediately after 

 having heated it by violent exercise or some other way. It 

 begins with chilliness and shivering, which are soon succeeded by 

 heat, restlessness, thirst, and the other concomitants of fever. In a 

 day or two, and sometimes sooner, there arises an acute pain in some 

 or other of the limbs, especially in the wrists, shoulders, knees ; which 

 shifting between whiles, affects these parts alternately, leaving a mi- 

 ness and swelling in the part last affected. In the beginning of the 

 illness the fever and the above-mentioned symptoms do sometimes 

 come together, but the fever goes off gradually, while the pain con- 

 tinues and sometimes increases.' Acute rheumatism varies considerably 

 in intensity tod duration; the patient may have great fever, and 

 severe pain in nearly every joint, so as to render him perfectly 

 helpless; or the fever may be slight, and the local inflammation 

 limited to one or two joints. There is not always a relation between 

 the severity of the local symptoms and the constitutional disturbance. 

 The duration of this disease is much the same under any mode of treat- 

 ment ; it may be terminated in a few days, or may endure as many 

 months ; in nearly every case the general symptoms cease before the 

 local inflammation is stopped. Acute rheumatism simply, is seldom if 

 ever a fatal disease, but complicated with pericarditis, endocarditis, or 

 pleurisy, it is highly dangerous. It behoves us therefore in every case 

 of rheumatism to be on our guard against these complications ; they 

 are so frequent and come on so insidiously, that a recourse to the aid 

 of the stethoscope should never be neglected. [HEART, DISEASES OF 

 THE.] 



With respect to what is called chronic rheumatism, it may be either 

 a continuance of acute rheumatism in a milder form, or may originate 

 in this chronic, or, more properly speaking, subacute character. In 

 either case all the characters of acute rheumatism are present, but in 

 a less violent degree ; thus, there is a quickened pulse, some increased 

 heat of skin, a furred tongue, and loss of appetite and sleep, the feb- 

 rile action undermines the general health, while the local inflammation, 

 although indolent, disorganises fhe joints. This state of things may 

 endure for an indefinite period, or the febrile symptoms may after a 

 time disappear and the morbid action in the joints cease, not however 

 without leaving behind them such ravages as require a special local 

 treatment. Dr. Elliotson has distinguished chronic rheumatism into 

 hot and cold : in the former, the joints affected are above the natural 

 temperature of the other parts of the body, and are relieved by the 

 application of cold ; in the latter, the contrary is the case. Whether 

 the pain of the joints is relieved most by hot or by cold applications, 

 it is generally aggravated in cold moist weather, and diminished dur- 

 ing an opposite condition of the atmosphere. The only diseases with 

 which rheumatism can be confounded are gout and periostitis ; for its 

 distinction from the former of which see GOUT> 



The term rheumatic, whether properly or not, has been applied to 

 various affections which have very little resemblance to one another, 

 except in being attended with pain. Thus a class of cases lias been 

 called rheumatic gout. This is a disease partaking of the characters 

 both of gout and rheumatism. It may be rheumatism attacking the 

 small joints, or it may be gout extending to the large; in either 

 case the distinction is not of much importance, as the treatment is the 



When rheumatism is seated in the back, it is called lumbago, 

 from lumliut, the loin; when in the back of the neck, the patient is 

 said to have a stiff neck, or a " crick in the neck ; " when in the head, 

 one half only is usually attacked, and it is called hemicrania. When 

 the pain occupies the moru fleshy parts of the limbs, as the muscles or 



their aponeuroses, the term rheumatalgia is sometimes'made use of. In 

 this last-named affection there is neither redness nor swelling, and pain 

 is experienced only when the muscles of the part affected are called 

 into action. Many persons believe that the nerves themselves may be 

 affected with rheumatism, and refer to sciatica and hemicrania as 

 examples. In these cases the j>ain is generally of an intermittent 

 character. This intermittnco of pain is not peculiar to nervous 

 rheumatism, but is met with also when the aponeuroses of muscles are 

 the seat of the disease, as in hemicrania. " It usually attacks one half 

 of the organ (the head), and the pain generally comes on in the evening 

 about six o'clock, and continues very violently for a few hours. Occa- 

 Kunully when it is intermittent in this way, the parts are hot, swollen, 

 and throb, and the eyes water ; but in other cases this is not felt." 

 (Elliotson.) Many physicians of eminence deny that the above-named 

 affections are rheumatic, and consider them to be of nervous origin ; 

 henik-rania and lumbago they call neuralgia, and rheumatalgia they 

 designate by the term myositia. From this contrariety of opinion we 

 may conclude that little is known respecting the structures actually 

 affected in these varieties of rheumatism; of the morbid changes whirh 

 they undergo we are likewise in equal ignorance. In the true or articular 

 rheumatism it is the synovia! membrane lining the cavity of the joints 

 and the fibrous tissues external to them that principally suffer. The 

 respective degree in which each of these structures is implicated is not 

 the same in every case. Thus, in one case, we shall find the joints dis- 

 tended with fluid, the fluctuation of which is very perceptible to the 

 hand ; while in another there shall be swelling, but it will be more 

 diffused and without fluctuation, showing that little or no effusion has 

 taken place into the joint, but that the swelling results from the 

 inflammation of parts external to it. This difference has led some 

 persons to speak of rheumatism as fibrous and synovial ; but in;; 

 as it is not always easy to determine to which variety the case under 

 examination may belong, and is besides of no practical importance, the 

 distinction is not usually regarded. The fluid which is found in the 

 joints may be either gelatinous or purulent, according to the severity 

 of the inflammation. The synoviol membranes which line them are 

 red and thickened ; the ligaments external to the joints are thickened 

 and rigid, the limbs frequently contracted, and the muscles wasted. 

 In rheumatic gout there is often found a deposit of lithate of soda in 

 the joints affected, a proof that, in many cases at least, this disease 

 partakes more of the character of gout than of rheumatism. The 

 appearances presented in the heart and its coverings, where this organ 

 has been attacked, have already been described in the article HEART, 

 DISEASES OF THE. 



Catties of Rheumatism. Among the causes which predispose to 

 rheumatism must be placed an hereditary tendency and the age and 

 temperament of the individual. The period of life most subject to 

 acute rheumatism is from puberty to 35 years of age, and persons of 

 full plethoric habit are said to be more liable to its attacks than 

 those of an opposite temperament. It is supposed by many, 

 among whom may be cited the names of M. Andral ('Anatomie 

 Pathologique '), M. C. Roche (' Dictiounoire de Me'de'cine et de Chirur- 

 gie), and Dr. Barlow (' Cyclopaedia of Practical Medicine), that an 

 absolute or relative condition of plethora is essential to the develop- 

 ment of rheumatism; and the blood, according to these authorities, 

 may be either excessive in quantity or altered in quality. " There are 

 some individuals," observes M. Andral, " who naturally make a greater 

 quantity of blood than others. When the bloodvessels contain a 

 greater proportion of the nutritive fluid than is necessary to supply 

 the demands of the different organs, the superabundant quantity 

 becomes a permanent source of excitation to the solids, and at the 

 same time the blood has a remarkable tendency to accumulate in 

 different organs ; so that in such a case the whole system in in a general 

 state of excitation, and some of the organs may become the seat of 

 local congestion of various degrees of duration and intensity." In 

 applying these doctrines to the disease we are considering, he observes, 

 "If we mark the symptoms and progress of acute rheumatism . we 

 find that very often a well-marked febrile action, with a strong reaction, 

 but without any symptom whatever of local affection, precedes the 

 pain. In a word, there is first an inflammatory fever, and then 

 rheumatism. Next observe the extreme mobility of the rheumatic 

 pains. They run along, in a manner, wherever the blood is distributed ; 

 the application of leeches often removes the pain from one part, Imt it 

 soon shifts to another, and not unfrequeutly it quits the articulating 

 tissues and fixes on different internal organs, producing, by the 

 derangement of their functions, symptoms more or less severe. It 

 often happens that bleeding from a large orifice puts an end tn the 

 disease, as if, by diminishing the mass of blood, it proportionally 

 diminished the stimulus that promoted all these shifting irritations." 

 It is then, when the body is in this predisposed condition, from any of 

 the before-mentioned causes, that exposure to a continued draught of 

 cold air or a shower of rain becomes the immediate exciting cause of 

 an attack of rheumatism. 



Whatever may be the general condition of plethora, which has been 

 1 1 in certain coses, there can be no doubt that rheumatism will 

 only come on in certain conditions of the blood. It has been observed 

 that during rheumatism considerable quantities of lithic acid and 

 lithate <if ammonia occur in the urine, and thore seems to be little 

 doubt that in all cases of rheumatism there in au accumulation in the 



