RHEUMATISM. 



quifitely fevere, or when the mufcles had become contracted 

 and almoft: paralytic, — and indeed in every protracted cafe 

 of the difeafe of the hip-joint, lumbago, or jciatica, the va- 

 pour of hot water, locally and properly applied, afforded 

 (efpecially in conjunction with other topical applications) 

 a fafe and often fuccefsful remedy." It may be neceflary to 

 defcribe the mode of employing this vapour. It confilts in 

 conveying the (team, from a boiler, through tubes of dif- 

 ferent diameter, fo as toapplv it to the different parts of the 

 body. In all obftinate affections of the joints, the author 

 juft quoted obferves, a pipe of nearly half an inch in diameter 

 is to be preferred, and a quarter of an hour is the fhorteit 

 period for its application. In the commencement, however, 

 it is better, as a general rule, to ufe a pipe of fmaller fize, 

 and only to permit the vapour to ftrike upon the affected 

 part at fome diftancefrom its aperture; for by thefe means 

 an inconvenience will be avoided, which has fometimes pre- 

 vented the fteady application of the remedy ; namely, a 

 confiderable irritation of the fkin from an excefs of heat. 

 By degrees the parts become able to bear a large column of 

 vapour, at a very fmall diftance from the extremity of the 

 pipe ; and thus the remedy will be moft likely to produce 

 its full effect. This effect, however, is generally only to be 

 deemed auxiliary, at leaft in obftinate cafes ; for it will fel- 

 dom alone accomplilh the cure. 



Among the epifpaftic applications, hltftermg is eomi 

 reforted to, and often with confiderable benefit, efpecially 

 when the pains appear to be feated only in the falcia and 

 fuperiicial fibres of the mufcles. A repetition of blilters is 

 preferable on the whole, both as productive of lefs diftn 1 

 to the patient, and more benefit to the difeafe, to the prac- 

 tice of keeping the bhfter open by a Itimulating ointment. 

 Some authors have recommended ijjues in preference to blii- 

 ters, where they could be applied without incoi 

 The excitement of an external inflammation, by the appli- 

 cation of the ointment of emetic tartar, has been alfo em- 

 ployed inftead of bliitering ; and in fome cafes its effects 

 have been highly beneficial. 



Rubefacients, or thofe fubftauces which flimulate the cu- 

 taneous vefl'els, and excite a rednefs of the furface by cauf- 

 ing them to be diftended with blood, have been found by 

 the experience of all ages to be capable of removing flight 

 inftances of chronic rheumatifm, and of alleviating the 

 more fevere, efpecially when their operation was aided by 

 friclion, and by warm or itimulant plafters. Where the pains 

 are local and permanent, that is, not liable to fliift about 

 from joint to joint, great advantages refult from Itimulating 

 the Ikin with an active liniment, and fupporting the excite- 

 ment by means of a warm plaller. The liniments may be 

 compofed of any ilimulant, oleaginous, fpirituous, or fapo- 

 naceous liquids : as the common liniment of ammonia and 

 oil, the foap liniment, with camphor, ammonia, tincture of 

 cantharides, or turpentine ; and the plafters may be com- 

 pofed of the gum refins, efpecially ammoniacum, with the 

 acetic acid, or vinegar of fquills, turpentine, plafter of 

 cantharides, &c. Dr. Ferriar's formula, which is borrowed 

 from Dr. Home, and confifted of two drachms of cam- 

 phor, with an ounce of bafilicon, and half an ounce of 

 black foap, is faid by him to have been very efficacious in 

 the relief of lumbago. Thefe liniments (houid be diligently 

 rubbed upon the parts affected, after the fkin has been 

 warmed and irritated by the friction of hot, dry, and coarfe 

 cloths, or the application of the flefh-brufh ; or, efpecially 

 in fciatica and lumbago, during the expofure ot the part to 

 the vapour-pipe. By thefe methods the itimulating effects 

 of the liniments are much increafed, the pain is more effec- 

 tually relieved, and the cure much accelerated ; efpecially 



6 



when a warm plaiter is added to keep up thefe effects. (See 

 Bardfley, loc. cit ; and Ferriar's Med. Hilt, and Reflections, 

 vol. i. p. 186.) The liniment originally employed by Dr. 

 Home was fpread upon leather, and applied over the dif- 

 eafed part ; he fpeaks, not only from his own experience, 

 but from that of others who had adopted it, of the efficacy 

 of the prefcription. ( See Medical Facts and Experiments, 

 part i. feet. 4 ; and again in his Clinical Experiments and 

 Hiftories, feet. 14.) His formula is perhaps more active than 

 that of Dr. Ferriar, containing cumin feed and ammonia in 

 addition to the camphor, oil ot turpentine, and common black 

 foap. But the dilpenfatories abound with formulas for 

 the compofition of itimulating liniments and plafters of 

 fimilar powers. 



Among other Itimulants which have been employed for 

 the cure of chronic rheumatifm, efpecially in thofe cafes 

 which are obftinate and of long duration, or are accompanied 

 by confiderable torpor and rigidity, and a diminution of 

 the vital heat, the influence of the electric and galvanic fluids 

 has been retorted to ; and many teitimonies might be adduced 

 in proof of the beneficial operations of both thefe agent'-. 

 Dr. Bardfley affirms, that the application of electricity by 

 fparks and fhocks, efpecially the former, was manifeftly ad- 

 vantageous ; at the fame time he acknowledges, that it wa« 

 chiefly in conjunction with the local application of vapour, 

 and with tonics and anodynes, adminiitered internally, that the 

 molt marked advantages were produced. For our own part, 

 we have witnefled fo little decided effect from the operation 

 of electricity in any difeafe whatever, that, after a long and 

 frequent ufe of that agent, we have given it up in defpair. 

 W here it produces any effect at all, it is probably by its ope- 

 ration upon the mind of the patient, upon the fame principle 

 as the metallic traclors occafionally alleviated pain, (fee Ima- 

 gination", Influence of, on the Body,) and not from anv 

 fie operation upon the difeafed mufcles. 



The operation of mere friclion affiduoufly employed, 

 either by means of flannel or rough cloths, of the flefh- 

 brufh, or limply ot the hands, or that fort of rubbing or 

 kneading of the body which is called champooing, have been 

 often retorted to with confiderable benefit, efpecially in the 

 cafes connected with a paralytic torpor and rigidity of the 

 parts affected. Perhap3, indeed, it is the ftimulus of the 

 friction, to which much of the benefit of liniments and em- 

 brocations ought to be afcribed ; but as the patient's faith is 

 chiefly fixed upon medicated frictions, lo it is generally necef- 

 fary to pvefcribe them, in order to enfure his perfeverance 

 in the rubbing. 



The preceding oblervations have been applied to rheu- 

 matifm generally, with only occalional references to the 

 particular L inns under which it occurs, fuch as lumbago, 

 fciatica, pleurodyne, rheumatic head-ache, Sec. becaufe the 

 treatment is generally applicable to the different lituations 

 of the body in which the difeafe feats itfelf. The princi- 

 pal attention that is requifite to thefe varieties arifes from the 

 refemblance of the tymptoms to thofe of fome other dif- 

 eafes. Thus the pleurodyne, or rheumatifm affecting the 

 mufcles of the cheft, and the diaphragm, being accompanied 

 with acute pain and difficult r fpiration, might be confounded 

 with pleurily, and erron oufly tr.-ated : but in this rheu- 

 matic affeftion of the cheft there is feldom any cough, and 

 no fever, two fymploms which are neceffarily prefeut in the 

 cafe of pleurify. Again, the lumbago is apt to be miftaken 

 for nephralgia, or pain in the kidnies, connected with in- 

 flammation in thefe organs, or with the prefence of gravel 

 in them or in the ureters : it may be dillinguifhed, however, 

 from the difeaies of the kidnies. by th" circumftances, that 

 the pain does not follow the couile of the ureters, but 



ftretches 



