CHRONIC ARTICULAR RHEUMATISM. 535 



derlich, is an excellent palliative ; but frictions with, ether, which 1 

 used on economical grounds as a substitute for elaylchloriire, answered 

 the same purpose. Local abstractions of blood should be limited to 

 those cases where a single joint has been considerably swollen and 

 painful for a long while. If, after repeated leeching, the pain and 

 swelling do not subside, if they remain fixed in one joint after disap- 

 pearing from the rest, we may cover it with blisters, or paint the skin 

 with tincture of iodine. When ordering the diet of the patient, we 

 must bear in mind the exhaustion threatened by the fever. Hot 

 drinks should be forbidden, as they uselessly increase the perspiration. 

 The room should not be kept too warm, but its temperature should be 

 regular. The complications are to be treated as advised elsewhere. 

 If, during the disease, severe cerebral symptoms come on, we must 

 decide whether they depend on excessive increase of the bodily tem- 

 perature, or on inflammation of the meninges. In the former case it 

 will be well to reduce the temperature by wrapping the body in wet 

 sheets, or by cool baths. Both should be repeated as often as the 

 temperature threatens to increase to a great height. If, when the 

 brain symptoms occur, the temperature be not greatly increased, we 

 should apply leeches to the head, and then cover it with frozen com- 

 presses.* 



CHAPTER II. 



CHRONIC ARTICULAR RHEUMATISM RHEUMATISMUS ARTICULORUM 

 CHRONICUS RHEUMARTHRITIS CHRONICA. 



ETIOLOGY. Chronic articular rheumatism is the name applied to a 

 chronic idiopathic inflammation of the joints, which usually attacks 

 only one or a very few joints, which passes from one joint to another 

 far more rarely than acute articular rheumatism does, and which, in 

 spite of its long duration, induces comparatively little anatomical 

 change. When chronic articular rheumatism leads to suppuration of 

 the joint and caries of the ends of the bones, it is generally customary 

 not to consider it any more as chronic articular rheumatism, but as 

 chronic inflammation of the joint, and to transfer it to surgery just as 

 we do arthrocace and tumor albus. Chronic deforming rheumatism we 

 shall treat of in the next chapter. Chronic articular rheumatism often 

 develops from the acute thus : after the disease has run its course in 

 the other joints, one or more of them do not return to the normal state, 

 out remain the seat of permanent disturbances. In other cases it ap- 

 pears as a chronic disease from the start. Very frequently there is a 

 decided congenital predisposition to chronic articular rheumatism ; on 

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