GENERAL DISEASES. 103 



acetatis are also useful remedies. Locally, hot fomenta- 

 tions to the joints, and anodyne lotions of opium, aconite 

 or belladonna afford much relief. In the later stages, if the 

 joint affections show little improvement, stimulating lini- 

 ments may be applied. In some cases, where these are in- 

 effectual, vesication with some preparation of cantharides is 

 of service in subduing the inflammation and the consequent 

 pain and tenderness. 



CHRONIC RHEUMATISM may follow acute rheu- 

 matism, or may occur as an independent affection. 



This form may exhibit no pyrexial symptoms whatever. 

 There is less tendency to metastasis of inflammation or to 

 implication of the cardiac structures than in acute rheu- 

 matism. 



The inflammation of the joints is of a more persistent 

 character, and more frequently leads to ulceration of the 

 cartilages, eburnation of the bones and the formation of 

 osteophytes than is the case in the acute form. In chronic 

 rheumatism the bones in various parts are subject to various 

 pathological changes. Bony excrescences may form on the 

 spinal column, on the bones of the pelvis, and on the syno\dal 

 membranes of the joints. The joints may, or may not, be 

 enlarged. Anchylosis of the joints, ulceration of the 

 articular cartilages, and eburnation of the extremities of 

 the bones, may often be met with, and various distortions in 

 different parts may result. 



Treatment. — When the disease is chronic from the first, 

 occasional laxatives, bicarbonate of potassium and iodide of 

 potassium, may be administered ; tonics also may be given 

 in addition. Locally, stimulating liniments are useful. 

 When the disease occurs as a sequel to the acute form, 

 iodide and bicarbonate of potassium, and quinine and other 

 remedies may be tried. Locally it is sometimes advisable 

 to apply the actual cautery. 



