CHRONIC RHEUMATISM. 251 



cantharides liniment. In many instances where tlie local 

 action is settled in connection with individual joints, smart 

 vesication with some cantharidine application I have almost 

 invariably found followed by relief from pain, a great point to 

 be gained even while freedom of movement is still much 

 impeded. 



II. Chronic Eheumatism. 



Although this form may follow as a sequel of acute rheum- 

 atism, it is also met with as an independent and idiopathic 

 affection. In either case the symptoms of its existence may 

 be regarded as merely modifications of the more pronounced 

 form, minus the pyrexial features. Chronic rheumatism is 

 also less liable to exhibit metastatic features, less disposed to 

 seize upon the cardiac structures, and probably also less in- 

 clined to yield to curative measures. 



The only recognisable symptoms consist in inflammation of 

 the aponeurotic expansions over the articulations, which 

 gradually extends to the periosteum and the component 

 elements of the joints, resulting in such textural changes as 

 alteration of synovial membrane and cartilage, while a porcelain- 

 like material takes the place of the latter, which, although 

 admitting of movement, does so only in a modified manner, 

 and together with the general thickening of ligament and 

 other structures, tends to stiffen and impede the natural free- 

 dom of the joint. In many cases, although pain and lameness 

 exist, and are largely influenced by atmospheric and other 

 extrinsic conditions, swelling is not always a constant feature. 



Treatment. — In the manifestations of rheumatism the sequel 

 of the acute type, and where the articular structures are 

 evidently undergoing change, the preferable treatment is the 

 application of the actual cautery. When, however, the disease 

 is decidedly of a chronic type from the first, where the consti- 

 tutional fever is little if at all marked, or of a truly intermittent 

 character, such severe means are rarely called for. 



Regarding the local manifestations, which are certainly the 

 most prominent feature, as merely the development, or at least 

 owing their existence to the specific constitutional diathesis, it 

 is found that much mitigation of pain and restoration of func- 

 tion may be obtained through the use of constitutional 



