88 PRACTICE OF PHYSIC. 



joint, and there also the most violent and obstinate. The 

 reason seems to be, that it is a joint exercised most frequent- 

 ly and with most force. This is not always the case, but 

 most commonly so ; and if another joint is more frequently 

 exercised, it becomes more liable to rheumatism. The disease 

 is more violent also in the hip-joint from the number of mus- 

 cles, as it is communicated from one to another. Next to the 

 hip, the shoulder is most frequently affected, which confirms all 

 this/' 



CCCCLIII. Violent strains and spasms occurring on sud- 

 den and somewhat violent exertions, bring on rheumatic affec- 

 tion, which at first partake of the acute, but very soon change 

 into the nature of the chronic rheumatism. 



CCCCLIV. I have thus delivered the history of rheuma- 

 tism ; and suppose, that, from what has been said, the remote 

 causes, the diagnosis, and prognosis of the disease, may be un- 

 derstood. The distinction of the rheumatic pains from those 

 resembling them, which occur in the syphilis and scurvy, will 

 be obvious, either from the seat of those pains, or from the con- 

 comitant symptoms peculiar to these diseases. The distinction 

 of rheumatism from gout will be more fully understood, from 

 what is to be delivered in the following chapter. 



" The scorbutic pains may be distinguished by the marks of 

 a scorbutic acrimony in the body at the same time, as lassitude, 

 fetid breath, bleeding gums, livid blotches, vibices, &c. or the 

 patients having been long exposed to the causes known to in- 

 duce scurvy, as animal food ill-cured, want of vegetables : or 

 even if the pains have come on after scurvy has been cured, 

 without any cause, which commonly occasions rheumatism, we 

 may attribute it to the remains of that first-mentioned cause. 



" In order to distinguish venereal pains from rheumatism, we 

 may take notice, that in the former the bones are chiefly affected 

 in the middle, and not painful on handling. And though some- 

 times it may be found that joints and muscles are affected with 

 pain from this cause ; yet, as in the case of scurvy, if venereal 

 symptoms have preceded or attended, we may be sure of the 

 pox being the cause of these pains. " 



CCCCLV. With respect to the proximate cause of rheuma- 

 tism, there have been various opinions. It has been imputed 



