RHEUMATISM. 



In favour of the treatment of this apparently acute in- 

 flammation by the ftill more oppofite means of a powerful 

 tonic, the cinchona, or Peruvian bark, the recorded tefti- 

 mony is ftill more confiderable. Dr. Cullen affirmed of the 

 bark, that he had " feldom found it ufeful, and in fome 

 cafes hurtful," when employed before the phlogiftic dia- 

 thefis was abated, and fomething like remiffions occurred 

 in the fever. Other practitioners, however, have con- 

 fidered thefe previous changes unneceffary, except in a very 

 partial degree, and contend, that the early ufe of the bark 

 is the molt efficacious mode of curing acute rheumatifm. 

 Dr. Haygarth is one of the mod ftrenuous advocates for 

 this practice ; indeed, a conviction of its advantages is the 

 avowed motive for the publication of his " Clinical Hiftory" 

 of the difeafe, to which we have already referred. He 

 was led to the adoption of the remedy early, on the re- 

 commendation of the celebrated Dr. Fothergill, who re- 

 ceived it from fir Edward Hulfe. Dr. Haygarth has re- 

 corded eighty-four cafes in which the cinchona was ad- 

 miniftered, in general, very early in the difeafe, after a 

 moderate evacuation of the ftomach and bowels, principally 

 by means of antimonial medicines. On fome occalions, 

 however, Dr. Haygarth alfo preceded the ufe of this re- 

 medy by a bleeding, where the fymptoms were very vio- 

 lent. 



On the whole, the inference which we are difpofed to 

 draw from thefe authorities, aided by perfonal obfervation, 

 is, that the moll fuccefsful practice coniitts in a free purga- 

 tive evacuation, and an occafional bleeding in particular 

 habits, in the very onfet of the difeafe, followed imme- 

 diately by the free ufe of opiates, with copious drinks and 

 faline laxatives, and this fucceeded, without delay, when 

 the pains and tumours have fomewhat remitted, by a refort 

 to the decoction of cinchona, or fome gentle tonic. 



All external applications to the parts which are fwelled 

 and painful, in acute rheumatifm, are of little or no fervice. 

 The warm bath and fomentations, efpecially in the begin- 

 ning of the difeafe, rather aggravate than relieve the pains. 

 Bliflering, or the minor degree of fuperiicial inflammation 

 produced by rubefacients, if they diminifii the pain in one 

 part, generally only occafion it to (hift to another, and do 

 little towards the cure of the general affection. The fame 

 obfervation is applicable to refrigerant remedies, fuch as to 

 wafhing with cold water or other lotions the tumid joints ; 

 the difeafe but changes its itation, without any tendency 

 to ceafe altogether ; and the change of fituation, though it 

 is commonly from joint to joint, may neverthelefs occa- 

 fionally take place from the joints to a more important 

 organ. 



Rheumatism, Chronic. In many inftances, this form 

 of rheumatifm is the direct confequence of an attack of 

 the acute form of the difeafe. The febrile fymptoms, the 

 fwelling, and particularly the rednefs of the joints, have 

 difappeared, and the general functions have refumed their 

 healthy condition ; t)ut ftill certain joints continue to be 

 affected with pains and ftiffnefs, which are particularly felt 

 on motion, and are often accompanied by a fpontaneous 

 coldnefs, and a torpor, fometimes almoft amounting to 

 paralytic. Thefe affections are much influenced by the 

 changes in the temperature and humidity of the atmofphere, 

 and are diftinCtly aggravated by external cold, and relieved 

 by external warmth. The parts affected are not eafily 

 made to perfpire, and when the other parts of the body are 

 brought into a ftate of free and warm perfpiration, that on 

 the pained joints is only cold and clammy. The pains are 

 alfo, like thofe of acute rheumatifm, moft fevere in the 

 night. 



This chronic affection of the joints, however, is verv 

 often altogether independent of any previous inflammation 

 and fwelling, and occurs in many perfons who have never 

 been fubjedl to an attack of acute rheumatifm. It occurs, 

 indeed, very frequently in perfons fomewhat advanced in 

 life, and beyond the period when the acute form of the 

 malady is ufually feen. In thefe cafes it is commonly 

 afcribed to the action of cold ; very often to partial ex- 

 pofures of the particular parts of the body in which it 

 takes its feat ; and it is apt to be produced again and again 

 in thofe parts which have once fuffered from expofure of 

 other parts of the body to cold. Thus, getting the feet 

 wet will induce an attack of lumbago, fciatica, ^or a crick 

 in the neck, according to the predifpofition induced in 

 thefe refpective regions by former attacks. Many cafes of 

 chronic rheumatifm are afcribed, however, to violent ilrains 

 of the mufcles of particular parts, occurring on fudden and 

 fomewhat violent exertions, and even to fatigue from long 

 continued exertions of particular mufcles. 



As the exact nature of the affection called chronic 

 rheumatifm is not very clearly underltood, fc the method 

 of cure, which is ufually purfued, is fomewhat empirical ; 

 i. e. the mere refult of 'the obfervation of the effects of 

 different medicines which have been tried. Dr. Cullen, 

 indeed, attempted to explain the nature of the difeafe, by 

 faying, that it coniiftcd in " an ator.y both of the blood- 

 veflels and of the mulcular fibres of the part affected, to- 

 gether with a degree of rigidity and contraction in the 

 latter, fuch as frequently attend them in a ftate of atony ;" 

 and therefore concluded, that fuch remedies were required, 

 as were fuited " to reftore the activity and vigour of the 

 vital principle in the part." The explanation of Dr. 

 Bardfley, however, though not very different, is perhaps 

 more confonant to the general opinion upon this fubject. 

 He confiders the principle of cure as fimple and uniform ; 

 namely, that " it coniitts in removing paffive inflammation, 

 and rettoring the debilitated veffels and mufeular fibres to 

 their due tone and aftion." (See Dr. Bardfley's Medical 

 Reports, p. 4.) The remedies by which thefe objefts 

 are attained, may be included under two heads, internal and 

 external. 



The internal remedies which have been recommended 

 for the cure of chronic rheumatifm, though very numerous, 

 have, on the whole, been found to poflefs a very uncertain 

 power over the fymptoms of that difeafe ; and many which 

 have been highly extolled, have been given up in total dif- 

 appointment. Neverthelefs, in many inftances, thefe re- 

 medies are effentially beneficial, fometimes curing the dif- 

 eafe alone, and generally aiding the operation of external 

 applications. They may be defcribed under the denomina- 

 tion of fudorifics and ftimulants, or (timulant-diaphoretics, 

 to which may be added mercurials, and fome individual ar- 

 ticles of peculiar operation. 



Thefe fudorifics appear to poflefs very little remedial 

 power over the chronic rheumatifm, and the lefs in propor- 

 tion as the difeafe partakes lefs of the fwelling and inflam- 

 mation of the acute fpecies, or as it is of longer (landing. 

 In the majority of cafes they are even worfe than ufelefs. 

 Dr. Bardfley fays, " in fhort, I can fpeak decidedly of the 

 injurious effects of fudorifics, when pufhed to any great ex- 

 tent, in every inftance of fevere local affection of the joints ; 

 and alfo in moft other cafes, where the difeafe has been long 

 continued, and the patient's conftitution much debilitated. 

 In chronic lumbago and fciatica, I have never experienced 

 any kiting benefit to refult from this mode of practice." 

 Dr. Bardfley, indeed, fpeaks very lightly of the effects of 

 all the internal remedies, not only of this, but of the itimu- 



lant 



