RHEUMATISM. 



clothes. Whence the dil Imoft exclufively obferved 



in cold and changeable climates; and is moll frequent in 

 the molt variable feafons, as in the tyring and autumn, very 

 feldom oc( urring during the fteady heat of fummer. 



Cure of ! R —With refpeS to the treat- 



ment, which is molt fuccefsful in the removal of this dif- 

 treffing and painful malady, confiderable dilTerence of 

 opinion, and form (liquations of opinion, have taken place 

 : i nen. The acute pain, the great heat, 

 ofthepulfe, and the bufiy or in- 

 flammatory apj oi the blood, when drawn, have led 

 the majority to look upon it as a highly inflammatory 

 ( ured almolt exclusively (like the other 

 organic inflammations i by copious blood-letting. Boerhaave 

 maintained thi doftrine; and Cullen followed him to the 

 full extent. " The blood ought to be drawn in large quan- 

 tity," fays the latter, " and the bleeding is to be reputed in 

 proportion to the frequency, fulnefs, and hardnefs of the 

 pulfe, and to the violence of the pain. For the molt part, 

 large and repeated bleedings, during the firft days of the dif- 

 , feemtobe neceflary, and accordingly have been very 

 much employed ; but to this fome bounds are to be fet: for 



n a flow recovery, and, if not 

 abfolu tual, are ready to produce a chronic rhcu- 



matifm." (Firft Lines, parag. 463. See Boerhaave, 

 app. 1493-) The Cullenian doctrine is, we believe, even 

 now taught in the fchool of Edinburgh, with fcarcely any 

 of the cautionary bounds mentioned by that fugacious prac- 

 titioner. Sir John Pringle trufted much to the fame prac- 

 Sydenham b :gan his career by ordering four bleedings 

 for the cure of rheumatifm; but he appears to have gra- 

 dually declined in his attachment to that practice, and lays, 

 that he found it better to purge after the fecond bleeding. 

 And again, in the hit piece which he ever wrote, lie lays, 

 " If we obftinately perf.lt in thefe evacuations, till the 

 fymptpms entirely ^o off, the difeafe will often terminate 

 fatally." (Sched. Monitor.) He alfo fays, in Ins Pro- 

 Ii he compofed for the ufe of his ion, 

 tns, who live temperately, " the 1 

 [m f be as fuccefsfully cured by a very cooling and 

 ifhi d -t, as by repeated hi which 



-." Van Swieten, who has I 

 out this pn - m's experie ice, ; 



acute rheumatifm without bb 1 , 

 re mild in the beginning. 

 Now tl lias b the progrefs of th ■ gi neral exp 



rent, few Englifli phyfii 

 ■j eem ; in dy for acute rheuma- 



itrary, the molt experienced have Lilly 



ority of cafes, iracui 

 , ; and that, if it i; frequently rep 

 iali ry, by Gnkin ient into .1 I 



. bronic difeafe, as Dr. Cullen Hated, Ei 1 

 : mil alwaysoccaii 



a lingerie conva ps the- onl : . 



i, ,. inflam- 



, ' '' tbat 



L in 1 



pi . vVh re I 

 , vital organ 



. . irtedto, as 



the moll I pleu itis. 



! ' proved 

 lybei 







liferent ] >ners 1 



r, fudorifics, opiates, and 



the Peruvian bark, of each of which it will be neceflary to 

 take fome notice ; for they are all ufeful under certain con- 

 ditions of the patient and the difeafe, and conflitute the 

 principal means ot cure. 



Purgatives, as they contribute, if proper!;. I, to 



reduce every fpecies of febrile excitement, though they arc- 

 alone incapable of effectually relieving this difeale, are yet 

 elleutially beneficial as a part of the plan *of cure. The fa- 

 line purgatives, fuch as the fulphate of magnefia, are the 

 belt adapted to relieve the bowels and the fyftem at large; 

 or they maybe affiled by moderate dofes of calomel, which 

 perhaps more effectually empties the upper bowels. They 

 become alfo more particularly neceflary, when the narcotic 

 medicines, to be mentioned prefently, are adminiftered, with 

 , to obviate the conflipation which the latter produce. 

 But no practitioner would confide in cathartics alone for the 

 cure of acute rheumatifm. 



With refpeft to fudorifics, there is a more general ten- 

 dency to trull the cure to them ; partly becaufe the pains 

 are often faid to be eafier, while perfpiration is prefent ; and 

 partly with the view of afiiiting the apparent efforts of the 

 conltitution. It maybe remarked, however, that altho 

 the molt profiife fweats very frequently break out fpon- 

 taneoully, they feldom afford any eflential relief; and they 

 will continue day after day, without any apparent influe 

 upon the difeafe. Accordingly, much direct benefit could 

 not in reality be expected to arife from augmenting a dif- 

 charge, already very profufe, and of confiderable duration; 

 and, in truth, we believe mere fweating is productive of no 

 benefit. But the medicines given as fudorifics, efpecially 

 antimonials and Dover's powder, operate beneficially per- 

 haps by their other qualities. Thus the antimonials, and 

 the ipecacuanha, and fait of this powder, are kindly and 

 gentle laxatives, and thus produce an antiphlogift.it 

 evacuants; but the principal operation ot the powdei 

 Dr. Dover is probably the refult of the opium which it 

 contains. 



For opiates alone, that is, uncombined with antimony or 

 ipecacuanha, have been relied upi n by fome practiti 01 

 and with the molt marked fuccefs. As opium, and other 

 fubltanccs, poflefling a iimilar nai c pi 

 known from ancient times to be highly ftimulant, that is, 

 to caufe an ine ur in the circul 



and nervous fyftem, and there! e highly injurious in 



is; fo all thofe phyfii .. , I 1 I . ■■ 1 ated 

 feftion, fhunned the vi'^ of opiates religion 

 e. :i thofe, who found by experience that blood-1 

 not required, queftioned ni s ; the impunity with 



red. Experience, 

 bas now fully 1 I this point alfo - 



be adminifl only with 



he inoft fevei te 1 heu- 



matifm. As fi r own ti 



(and i, occafion to treat fome hui I Is ol per- 



ted with this malady, 1 tl 



ha duly falin - laxative, wi 

 thin dilu e;i drink , and a, light diet, i 



luccel'sful 1 



the di 



introi I into St. G» 



the pi ■ I : • 



lay be 



. . tl ■■ . the coml 



1 [reat, 



nee, or a 



, like the violei Hera. 



In 



