270 
PATHOLOGY. 
and the other caufes of inflammation in general. Males, 
and thofe between the time of puberty and thirty years 
of age, are the moll liable to acute rheumatifm. 
2. Arthrofia chronica, chronic rheumatifm: pain, 
weaknefs, and rigidity, of the larger joints and furround¬ 
ing mufcles; increaled by motion; relieved by warmth ; 
fpontaneoufly or eafily growing cold ; fever and fwelling 
flight, often imperceptible. 
The varieties are the fame as thofe of the preceding 
fpecies, of which Cullen regards the difeafe as a mere fe- 
quel. It appears however at times to be idiopathic; but 
it is often difficult to draw the line between the two; 
and indeed a variety of links conne6l acute and chronic 
rheumatifm together. In moll inftances, chronic rheu- 
matifm is the direct confequence of an attack of the 
acute form of the difeafe. The febrile fymptoms, the 
fwelling, and particularly the rednefsof the joints, have 
difappeared, and the general functions have refumed their 
healthy condition ; but Hill certain joints continue to be 
affefled with pains and ftiflhefs, which are particularly 
felt on motion, and are often accompanied by a fponta- 
neous coldnefs, and a torpor fometimes almoft amounting 
to paralytic. Thefe affe&ions are much influenced by 
the changes in the temperature and humidity of the at- 
mofphere; and are diltindtly aggravated by external cold, 
and relieved by external warmth. The parts affefted are 
not eafily made to perfpire; fo that, when the other 
parts of the body are brought into a Hate of free and 
warm perforation, that on the pained joints is only cold 
and clammy. The pains are alio, like thofe of acute 
rheumatifm, moll fevere in the night. 
This chronic affeftion of the joints, however, is very 
often altogether independent of any previous inflamma¬ 
tion and fwelling, and occurs in many perfons who have 
never been fubjeft to an attack of acute rheumatifm. It 
occurs, indeed, very frequently in perfons fomewhat ad¬ 
vanced in life, and beyond the period when the acute form 
of the malady is ufually feen. In thefe cafes it is commonly 
afcribed totheadion ofcoldjvery often to partial expofures 
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 oncefulfered from expofure of other parts of 
the body to cold. Thus, getting the feet wet will in¬ 
duce an attack of lumbago, fciatica, or a crick in the 
neck, according to the predifpofition induced in thefe 
relpe£live regions by former attacks. Many cafes of 
chronic rheumatifm, are afcribed, however, to violent 
ltrains of the mufcles of particular parts, occurring on 
fudden and fomewhat violent exertions, and even to 
fatigue from long-continued exertions of particular 
mulcles. 
As to the treatment of rheumatifm, this is different 
according to the ftage of the malady. In the firft llage 
of rheumatifm, free general bleeding mud be had recourfe 
to, followed by purgatives and local bleeding. When 
the difeafe is mitigated by thefe meafures, our endeavours 
may be direfted to the abatement of pain by means of 
opiates ; and alfo to the cure of the difeafe by certain 
remedies empirically adminiftered ; of thefe cinchona and 
opium have the greateft reputation. Indeed fome prafti- 
tioners have recommended thefe drugs at the onfet of 
the difeafe. This feems to us highly improper. The ob- 
je£l of cinchona can only be to ftimulate the veflels of 
the inflamed membrane, with a view to the recovery of 
their na'tural powers ; nor can opium be any further ad- 
vantageoufly exhibited than as it affuages pain, and thus 
removes one of the conditions of inflammation. Seeing 
the difpofition of rheumatifm to fuffer metaftafis, we 
(hould be very careful not to remove, by any other than 
conftitutional remedies, the local affeftion. Cold lotions 
may be ufed however to abate the violence of the inflam¬ 
mation. 
When the rheumatifm has become chronic , the curative 
meafures mull be changed. We fliould remove occafion- 
ally general plethora ; but our attention lliould for the 
moll part be dire6led to the nervous fyftem ; and we IhalS 
find topical remedies by no means ufelefs. In addition 
to the rigid adoption of the dyfpeptic treatment, a free 
ufe of guaiacum Ihould be relorted to ; or in fome cafes 
fmall dofes of antimony, calomel, and opium, w'ith warm 
fomentations to the affedled joints. 
When the fymptoms are mitigated, counter-irritants 
may be ufed with advantage. Some other fubllances 
have been employed, with occafional fuccefs, in the cure 
of different cafes of chronic rheumatifm, which do not 
appear to poffefs any quality in common, and the opera¬ 
tion of which, therefore, cannot be fatisfadlorily ex¬ 
plained. Among thefe we may mention Jutphur, which 
has long poffeffed a fort of popular reputation for the 
cure of lumbago, and fome other varieties of the difeafe. 
Taken nightly in a confiderable dofe, fo as to afl gently 
upon the bowels, it has fucceeded, in fome inftances, in 
affording a very fpeedy and marked alleviation of the 
fymptoms; but, on the other hand, it has very often 
failed to produce any effedt whatever; and under what 
circumftances thefe refpe£live variations in its operation 
occur, no one has been able to afcertain. 
As another expedient for the cure of chronic rheuma¬ 
tifm, the arfenicalfolulion of Dr. Fowler has been recom¬ 
mended ; and, if plethora and dyfpepfia be removed, it 
may be employed with fafety, and, as it feems to us, with 
fuccefs. 
The warm or tepid bath, from the temperature of 85° 
to 95 0 of Fahrenheit’s thermometer, has been much ufed, 
but feems to be fomewhat fuperfeded by the application 
of the vapour of hot water to the furface. Dr. Bardfley 
fays, “ whenever the joints were found fo rigid as to be 
nearly immoveable, and the pains upon motion exquilitely 
fevere, or when the mufcles had become contracted and 
almoft paralytic, and indeed in every protradled cafe of 
the difeafe of the hip-joint, lumbago, or fciatica, the va¬ 
pour of hot water, locally and properly applied, afforded 
(efpecially in conjunction with other topical applications) 
a fa fie and often fuccefsful remedy.” 
As counter-irritants in chronic rheumatifm, bliftering, 
iffues, or the ointment of emetic tartar, have been em¬ 
ployed with highly-beneficial effeCts. In flight cafes, 
rubefacients, or thofe fubllances which ftimulate the cuta¬ 
neous veflels, and excite a rednefs of the furface by cau- 
fing them to be diftended with blood, will be found ufe- 
ful, efpecially when their operation is aided by friction. 
Among other llimulants which have been employed 
for the cure of chronic rheumatifm, efpecially in thofe 
cafes which are obftinate and of long duration, or are ac¬ 
companied by confiderable torpor and rigidity, and a di¬ 
minution of the vital heat, the influence of the elcflric 
and galvanic fluids has been reforted to ; and many tefti- 
monies might be adduced in proof of the beneficial ope¬ 
rations of both thefe agents. Dr. Bardfley affirms, that 
the application of eledlricity by fparksand Ihocks, elpe- 
cially the former, was manifeftly advantageous; at the 
fame time he acknowledges, that it was chiefly in con- 
jundlion with the local application of vapour, and with 
tonics and anodynes adminiftered internally, that the 
moll marked advantages were produced. 
3. Arthrofis podagra, the gout: pain and inflamma¬ 
tion chiefly of the fmaller joints, returning after intervals; 
often preceded by, oralternating with, unulual affections 
of the llomach, or other internal parts; unfuppurative. 
Three varieties. 
a.. P. regularis: the articular pain, fwelling, and in¬ 
flammation, confiderable; continuing for feveral days, 
often with remiffions and exacerbations; then gradually 
difperfing, and leaving the conftitution in its ufual or 
improved health. 
/ 3 . P. larvata ; difguifed and lurking in the conftitution, 
and producing derangement in the digeftive or other 
funftions, with only flight and fugitive affe&ion of the 
joints. • 
y. P. complicata : the difeafe fixing on fome internal 
2 organ, 
