MEDICINE. 
inflammation, and from its attacking two 
similar parts at the same time, as both 
ankles and both wrists, and these attacks 
being in succession to each other : and he 
further remarks, that this accounts for rheu- 
matic inflammation so very rarely termi- 
nating in suppuration, as the original cause 
is not in the inflamed part ; but, instead of 
suppuration, a quantity of mucus or coagii- 
lable lymph is formed on the inflamed 
membrane, which is either re-absorbed, or 
lies on it, producing pains on motion long 
after the termination of the inflammation. 
The remote causes of this disease are, 
frequent vicissitudes of the weather ; cold 
suddenly applied to the body when under 
perspiration; the long continued applica- 
tion of cold, particularly when combined 
with moisture, as when damp or wet clothes 
are applied to the body or extremities for 
any considerable length of time ; plethora ; 
cold caught when the system is under the 
influence of the hydrargyrns ; certain sea- 
sons of the year, as spring and autumn. 
The proximate cause is supposed to be an 
inflammation of the membranes, and tendi- 
nous aponeuroses of the muscles. 
The cure of this species of the disease 
will be effected by removing the morbid 
excitement, by a strict adherence to the 
antiphlogistic regimen, by blood-letting, 
which must be repeated in proportion to 
the degree of strength and hardness of the 
pulse, and violence of the symptoms : we 
mrSt not, however, push general evacua- 
tions too far, as they not only retard the re- 
covery of the patient, but fi cquently induce 
an obstinate chronic state of the disease : 
topical evacuations, by means of leeches or 
cupping, may, after general blood-letting, be 
advantageously employed when the pain 
becomes fixed in the joints, attended with 
some degree of redness and swelling : gentle 
saline or mercurial cathartics, or laxative 
clysters, should be frequently administered : 
a gentle diaphoresis should be excited by 
means of the neutral salts, or of saline 
draughts combined with nauseating doses 
of tartarised antimony and the sulphuric, or 
nitrous spirit of mther, or camphor may be 
employed in combination with volatile salt 
of hartshorn : cooling mucilaginous diluents 
are to be taken freely : the diet should con- 
sist of food of little stimulus, and the cure 
will be further promoted by the warm bath. 
When the excitement has been subdued, 
bark, combined with chalybeates, and 
jnyrrh or opiates, combined with ipeca- 
'|;uanha, may be administered with great 
advantage : rubefacients are of service, and 
blistering should be employed when the 
excitement is considerably reduced, and 
the pain is much confined to one part. Bark 
has of late been recommended to be admi- 
nistered in every stage of the disease, and 
there is no doubt that it may be employed, 
not only with great propriety, but with 
safety, if the pain be attended with distinct 
remissions, and assumes more or less the 
form of an intermittent: when the excite- 
ment, however, is considerable, it will be 
advisable to premise some general evacua- 
tions. 
The remote causes of Chronic Rheumatism 
are preceding acute rheumatism, cold ap- 
plied partially to the body when heated, 
and most of the causes producing the other 
species. The proximate cause is supposed 
to be atony of the blood-vessels and muscu- 
lar fibres of the part aflFected, together with 
some degree of rigidity and contraction in 
those fibres : and the removal of this com- 
plaint must be attempted by restoring the 
activity and vigour of the part affected, and 
also that of the system in general, by the 
usual remedies for this purpose ; and espe- 
cially by the use of guaiacum and other 
warm resins, mustard-seed, and horse-rad- 
dish ; with a local application of volatile 
liniments and the flesh-brush. The warm 
bath, or Buxton waters, may also be em- 
ployed with advantage. 
Podagra. — Gout. Of this disease there 
are four species or varieties, the regular, 
atonic, misplaced', and retrocedent: it is 
not necessary, however, to dilate upon each 
separately. 
This disease sometimes makes its attack 
without any previous warning : in general, 
however, the inflammation of the Joint is 
for some days preceded by great languor 
and dulness both of body and mind, dozi- 
ness, giddiness, wakefulness, or unrefreshing 
sleep, wandering pains, a deficiency of 
moisture in the feet, and there is sometimes 
a coldness, numbness, and sense of prickling 
in the feet and legs : these symptoms are 
often, in a greater or less degree, accompa- 
nied with frequent cramps of the muscles 
of the legs and toes, an universal turges- 
cence of the veins, occasional chills, acidity 
and flatulence in the stomach, and an in- 
creased or impaired appetite. The appe- 
tite is, however, frequently more keen than 
usual on the day preceding the attack of the 
fit. On going to bed, the patient enjoys 
his usual natural sleep until about two or 
three o’clock in the morning, when he is 
