INFLAMMATIONS. 89 



to a peculiar acrimony ; of which, however, in ordinary cases, 

 I can find no evidence ; and, from the consideration of the re- 

 mote causes, the symptoms, and cure of the disease, I think 

 the supposition very improbable. 



The cause of an Ischias Nervosa assigned by Coturmius, ap- 

 pears to me hypothetical, and is not supported by either the 

 phenomena or method of cure. That, however, a disease of a 

 rheumatic nature may be occasioned by an acrid matter applied 

 to the nerves, is evident from the toothach, a rheumatic affec- 

 tion generally arising from a carious tooth. 



That pains resembling those of rheumatism may arise from 

 deep-seated suppurations, we know from some cases depending 

 on such a cause, and which, in their symptoms, resemble the 

 lumbago or ischias. I believe, however, that, by a proper at- 

 tention, these cases depending on suppuration, may be com- 

 monly distinguished from the genuine cases of lumbago and 

 ischias ; and from what is said in CCCCXLVIII. I judge it to 

 be at least improbable, that a genuine lumbago or ischias does 

 ever end in suppuration. 



CCCCLVI. The proximate cause of rheumatism has been 

 by many supposed to be a lentor of the fluids obstructing the 

 vessels of the part ; but the same consideration as in CCXLI. 

 1. 2. 3. 4 and 5. will apply equally here for rejecting the sup- 

 position of a lentor. 



CCCCLVII. While I cannot, therefore, find either evidence 

 or reason for supposing that the rheumatism depends upon any 

 change in the state of the fluids, I must conclude, that the 

 proximate cause of acute rheumatism is commonly the same 

 with that of other inflammations not depending upon a direct 

 stimulus. 



CCCCLVIII. In the case of rheumatism, I suppose that the 

 most common remote cause of it, that is cold applied, operates 

 especially on the vessels of the joints, from these being less 

 covered by a cellular texture than those of the intermediate 

 parts of the limbs. I suppose further, that the application of 

 cold produces a constriction of the extreme vessels on the sur- 

 face, and at the same time an increase of tone or phlogistic dia- 

 thesis in the course of them, from which arises an increased impe- 

 tus of the blood, and, at the same time, a resistance to the free 



