42 PRACTICE OF MEDICINE. 



VACCINATION. 



The real nature of this excellent means of preventing the small- 

 pox seems to be, that it is a kind of small-pox, modified and ren- 

 dered milder by passing through the constitution of some of the 

 domestic animals. It appears that if the cow be inoculated with 

 small-pox matter, the disease, which the animal exhibits in conse- 

 quence, is the same which is familiarly known as the cow-pox, and 

 which, if communicated to the human subject, gives the same amount 

 of protection, against a subsequent attack of small-pox, as an attack 

 of that disease would. 



As a general rule, the exanthemata occur only once during life. 

 But late experience shows that this rule is liable to many exceptions, 

 since there is no kind of exanthema, which has not been known to 

 occur twice in the same subject, and this is especially the case with 

 small-pox. The protecting influence, therefore, of vaccination (if it 

 can wear out, as is asserted by some authorities), should be renewed 

 at intervals, at and after puberty. 



RHEUMATISM. 



Rheumatism is an inflammation of a peculiar character, affecting 

 the fibrous structures primarily, but liable to implicate also the serous 

 or synovial membranes in their vicinity. It causes intense pain, and 

 effusion of serum or lymph, but very seldom, if ever, causes suppu- 

 ration or gangrene. 



Its 'proximate cause or real nature seems to be an accumulation 

 in the blood of certain acid and other excrementitious matters, that 

 ought to be eliminated by the skin and kidneys. 



It generally attacks the fibrous tissue around the large joints ; and 

 a distinction is to be made between ^5row5 and 5?/?2o?;2(2/ rheumatism. 

 The former attacks the fibrous, ligamentous, and muscular structures 

 in the neighbourhood of the joints, without affecting the synovial 

 membranes much ; the latter (or rheumatic gout, as it is sometimes 

 called) implicates the synovial membrane, causing effusion and con- 

 siderable swelling of the joints. 



Rheumatism may be acute or chronic. 



Acute rheumatism is a disease of early life, often affecting children. 

 Its usual exciting cause is exposure to wet and cold, combined with 

 muscular fatigue. 



The most severe form of acute rheumatism is called rheumatic 

 fever. There is a very high degree of fever ; full jerking pulse ; 

 thickly furred tongue ; profuse sour perspiration ; scanty and high- 

 coloured urine, depositing a copious lateritious sediment. Together 

 with thes^onstitutional symptoms, there is great pain in several of 

 the larger joints, increased excruciatingly by pressure or motion ; and 

 slight redness and swelling. This inflammation is very apt to shift 



