RHEUMATISM 221 



backward, movement of the contaminated cerebro-spinal 

 fluid contents of the motor nerve tubes, and, concurrently, 

 by aiding the neutralisation and elimination of any toxic 

 matter which may have secured an entrance into or been 

 evolved in the sarcolemmar sheaths and substance of the 

 affected muscles. 



Bearing the indications naturally suggested by these 

 views in mind, diaphoretics, properly so-called, aided by 

 the use of every external and internal measure, general 

 and local, which the individual case may require, in order 

 to initiate, sustain, and prolong the process of excretion 

 necessary until the materies morbi of the disease is dis- 

 lodged, must be promptly, continuously, and, of course, 

 rationally and guardedly used ; the after-treatment being 

 regulated, necessarily, by the condition of general health 

 and local disablement in which the process has left the 

 patient. 



These observations refer to acute rheumatism, or rheu- 

 matic fever, only ; let us, therefore, continue on the same 

 lines to attempt to elucidate the subject of sub-acute or 

 articular rheumatism. This latter affection is frequently 

 a sequel of the former, as well as an apparently indepen- 

 dent affection, but when produced by the subsidence of 

 an acute attack, it may be regarded as a continuation of 

 the toxic invasion of the textures continuous with the 

 involved muscles ; i.e. by the infiltration of the tendons 

 attached to or continuous with the affected muscles, or 

 rather the agglomerated sheaths of the muscles, with their 

 attachments to the bones, periosteum, and ligaments sur- 

 rounding the joints, and the cartilages covering the ends 

 or extremities of the bones and their contained synovial 

 fluids. 



All this results from the histological continuity and 

 contiguity of the parts enumerated, and may often be 

 traced in regular sequence. The appropriate treatment in 

 individual cases may, therefore, now be directed on some- 

 what more clear and definite lines than has too often been 

 the case in times gone by, or when mere empiricism was 

 only possible. 



The chronic form of the disease may also, we think, 

 have its pathology to some extent cleared up by a patient 



