The remote causes of this disease are, frequent vicissitudes of the weather ; cold suddenly applied to the body when under perspiration ; the long continued appli cation of cold, particularly when com bined with moisture, as when damp or wet clothes arc applied to the body or ettremities, for any considerable length of time ; plethora ; cold caught when the system is tinder the influence of the hy drargyrus; certain seasons of the year, as spring and autumn. The proximate cause is supposed to be an inflammation of the membranes and tendinous apt). neuroses 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 must not, however, push general eva cuations too far, as they not only retard the recovery of the patient, but frequent ly induce an obstinate chronic state of the disease : :opical evacuations, by means of leeches or cupping, may, after general blood-letting, be advantageously employ ed when the pain becomes fixed in the joints, attended with some degree of red ness and swelling : gentle saline or mer curial 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 ather or camphor, may he employed in combination with volatile salt orliartshorn; cooling muci laginious diluents arc to be taken freely : the diet should consist of food of little stimulus, and the cure will be further promoted by the warm bath. When the excitement has been subdued, bark, corn. bined with chalybeates, and myrrh or opiatea, combined with ipecacuanha, may be administered with great advantage : rubefacients are of service, and blister ing should be employed when the excite ment is considerably reduced, and the pain is much confined to one part. Bark has of late been recommended to be ad. ministered in every stage of the disease, and there is no doubt that it may be em ployed, 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 excitement, however, is considerable, it will he advisable to premise some ge neral evacuations.
The remote causes of Chronic Rheuma tism are, preceding acute rheumatism, cold applied partially to the body when heated, and most of the causes producing the other species. The proximate cause is supposed to be stony of the blood-yea sets and muscular fibres of the part af fected, together with some degree of ri gidity and contraction in those fibres : and the removal of this complaint 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 especially by the use of guaiacum and other warm resins, mustard-seed, and horse-raddish with a local application of volatile lini ments and the flesh-brush. The warm bath, or Buxton waters, may also be em ployed with advantage.
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 at tack without any previous warning: in general, the inflammation of the joint is for some days preceded by great angour and dulness both of body and mind, doziness, giddiness, wakefulness, or unrefrcshing 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, accompanied with frequent cramps of the muscles of the legs and toes, and universal turgescence of the veins, occasioqiil chills, acidity and flatulence'in the stomach, and an increas ed or impaired appetite. The appetite' is, however, frequently more keen than usual on the day preceding the attack of the fit. On going to bed the patient en joys his usual natural sleep until about two or three o'clock in the morning, when he is awakened by a very acute pain, most commonly in the first joint of the great toe : sometimes, however, it attacks other parts of the foot. The pain resembles that of a dislocated bone, and is attended with the sensation as if all but cold water was poured upon the part. There is at the same time more or less of a cold shivering, which abates as the pain in creases in violence, and is succeeded by a hot fit. The pain, from the commence ment, gradually becomes more violent : it is sometimes so acute, as to be com pared to a dog gnawing the part, and that and the fever continue in the same state, accompanied with great restless ness, till next midnight, when they gra dually remit, and after a continuance of twenty-four hours from the commence ment of the paroxysm, they commonly cease entirely : the patient falls asleep, during which a gentlopetspiration gene rally comes on, and on waking he finds the part affected somewhat red and swell ed. For some days the pain and fever re
turn in the evening, but with a less de gree of violence, and a remission takes place towards morning; and after these symptoms have continued for about ten or fourteen days, gradually becoming less severe, they generally cease altogether. Costiveness, an impaired appetite, chil liness of the body towards evening, are also to be reckoned among the symptoms of this disease.
The indications of cure are, in the pa roxysms, to moderate their violence and shorten their duration as much as can be done with safety ; and in the intervals to prevent the return of the paroxysms, or to render them less frequent and more moderate. The violence of the paroxysm will be moderated by blood-letting, which must be repeated according to the state of the pulse and degree of excitement, where the constitution is not worn down by repeated attacks ; leeches should be applied to the inflamed parts, and gentle cathartics should be administered : these parts should also be exposed to cool or cold air, and diluting liquids should be taken freely: the antiphlogistic regimen must be strictly adhered to : abstinence from wine, spirits, fermented liquors, and stimulating food, should be carefully enjoined, unless the system is very much debilitated; in which case a more nourish ing diet, and a small quantity of wine or of diluted spirits, may be allowed : after the excitement has been subdued by pro per evacuations, blisters may be employ: ed with advantage ;they are recommend ed by that enlightened physician Dr. Rush, to be applied to the legs and wrists : burning with moxa may be advised, or a leaf applied to the part affected will often afford considerable relief: boot lets made of oiled silk are an useful ap plication to gouty joints : when the vio lence of the symptoms is abated, opiates may be given with advantage, when the pain only returns during the night, and prevents sleep. When the constitution is broken down by repeated attacks of the disease, evacuations must be employed with caution, and it will in general be more advisable and safe to allow some animal food, and wine or diluted spirits : the parts affected should at the same time be wrapped in flannel, fleecy hosie ry, sr new-combed wool, and a gentle dia phoresis should be excited. When a swelling and stiffness remain in the joints, after the paroxysm has ceased, they wilt be removed by the diligent use of the flesh-brush, gentle exercise of the parts, and the Buxton or Bath waters, taken at the fountain head ; and where the gout has left a number of dyspeptic symptoms, the latter may be drank with considerable advantage. Purging immediately after a paroxysm will be very apt to induce a relapse. In the intervals we must en deavour to prevent a return of the pa roxysms, or to render them less violent : I. By temperance, which should be re gulated accordinc to the age, habits of life, and constitution of the patient. It is very probable that a diet, consisting of milk, vegetables, and water, would pre vent the recurrence of the disease : but in general fish, eggs, the white meats, and weak broths, may be taken in small quantities once a day, and a little salted meat may be eaten occasionally, and weak wine and water, or small beer, may be taken at meals. As there is a disposition in the gout to return in the spring and autumn, a greater degree of abstinence in eating and drinking will be necessary at those seasons than at any other period: and if any of the premonitory symptoms are then present, and the vigour of the system remains unimpaired, the disease may be often prevented from occurring by the loss of a few ounces of blood, or perhaps by an emetic or a gentle cathartic, and afterwards bathing the feet in warm water : a full dose of the tincture of opium might probably be of service. In the de: dine of life, or when the constitution is much debilitated, this abstemious mode of living must be commenced with cau tion, as it might be the means of inducing more violent and dangerous fits of the gout 2. By moderate labour and gentle exercise, as riding on horseback ; but more particularly walking. 3. By avoid ing cold, especially when it is combined with moisture. The feet should be kept constantly warm and dry, by means of socks and cork-soled shoes, and the pa tient should wear flannel next to the skin. 4. By the prevention of costiveness, by means of gentle laxatives, as aloetics combined with soap and rhubarb, or oil of castor. 5. By tonics, as the bark, quassia, and chalybeatea. 6. By the ex hibition of alkalies in various forms, as the fixed alkali, both mild and caustic, lime water, soap, and the absorbent earths ; and, lastly, by studiously avoiding the exciting causes. In the retrocedent spe cies, strong stimulants, both external and internal, should be instantly employed with an unhesitating hand ; and in the atonic species, the diet should be peculi arly generous, and compounded of spi ces and other aromatics.