RHEUMATISM, CHRONIC. 479 



among the labouring poor, and those who are exposed to changes of season and 

 weather, and to cold and wet. It is not, however, by any means confined to the 

 poorer classes, for it frequently attacks those whose lot absolves tla-m from the 

 necessity of earning their daily bread. In many cases it is associated with, if not 

 dependent on, derangement of the digestive organs. It is frequently of syphilitic 

 origin, the pains of secondary syphilis being not uncommonly confounded with those 

 of chronic rheumatism. 



We must now consider the different methods of treating chronic rheun 

 It is desirable, in the first place, to pay attention to the condition of the general 

 health, and should this be below par, steps should be taken to improve it. Care 

 should be taken to see that the organs of digestion are in proper working order, and 

 that digestion is performed naturally and easily. Such evils as indigestion and 

 constipation should be removed with as little delay as possible. The patient must 

 be protected against atmospheric vicissitudes by warm clothing, and should be cased 

 in flannel from the neck downwards. 



Chronic rheumatism, as everybody knows, is a very obstinate complaint, and 

 many different remedies have been used or suggested for its cure. The medicine 

 may be given internally, or the treatment may be purely local, or both methods may 

 be combined. We will speak first of the internal remedies. 



Iodide of potassium is a most valuable medicine for this complaint. It is 

 especially indicated when the pain is worse at night. As we have already said, the 

 pains -of secondary syphilis cannot, as a rule, be distinguished from chronic rheuma- 

 tism, but the nocturnal increase of suffering is to be regarded as an indication for 

 the employment of iodide of potassium, whether the pain is referable to rheumatism 

 or to some other cause. The fact of a patient suffering from a syphilitic taint would 

 increase the chances of this remedy proving successful. Two table-spoonfuls of the 

 iodide of potassium mixture (Pr. 32) should be taken three times a day. 



Salicine, which succeeds so admirably in acute rheumatism, often does good 

 in the more chronic forms. Pr. 12 may be employed. 



Rhus toxicodendron, the poison-oak, is useful in rheumatic lameness of the 

 lower extremities. It is indicated in all cases of rheumatism in which the pain is worse 

 when at rest, but is relieved by motion. It also does good where on first moving 

 after rest the pain is increased, and relief is not experienced until gentle and con- 

 stant motion has been continued for some time. Drop doses of the tincture of rhus 

 may be given in a tea-spoonful of water every two hours. This drug is often some- 

 what tardy in its action. 



Acteea racemosa is useful in many forms of chronic rheumatism of the joints, 

 and is more likely to do good when the pains are worse at night or in wet or windy 

 weather. It has been found by an eminent writer on treatment to be of signal 

 benefit in the following class of cases : The patient is at first troubled with pains, 

 apparently rheumatic, in most of the joints, unaccompanied by fever or swelling. 

 The disease soon seats itself in one part, as the wrist and hand ; the tissues here 

 become much thickened and the bones enlarged, till after a time all movement is 

 lost and the member becomes useless. Warmth allays the pain, and it almost ceases 

 at night. The attack presents many of the characters of gonorrhceal rheumatism, 



