Causes of Rheumatism.—Among the causes which predispose to rheumatism must be placed an hereditary tendency and the ago and temperament of the individual. The period of life most subject to acute rheumatism is from puberty to 35 years of age, and persons of full plethoric habit are said to be more liable to its attacks than those of an opposite temperament. It is supposed by many, among whom may be cited the names of M. Andral (` Anatomie Pathologique '), M. C. Roche (` Dietionnaire de Medicine et de Chirur gie). and Dr. Barlow (' Cyelopredia of Practical Medicine), that an absolute or relative condition of plethora is essential to the develop ment of rheumatism; and the blood, according to these authorities, may be either excessive in quantity or altered in quality. " There are sonic individuals," observes M. Andral, " who naturally make a greater quantity of blood than others. When the bloodvessels contain a greater proportion of the nutritive fluid than is necessary to supply the demands of the different organs, the superabundant quantity becomes a permanent source of excitation to the solids, and at the same time the blood has a remarkable tendency to accumulate in different organs; so that in such a ease the whole system is in a general state of excitation, and some of the organs may become the seat of local congestion of various degrees of duration and intensity." In applying these doctrines to the disease we are considering, he observes, " if we mark the symptoms and progress of acute rheumatism, we find that very often a well-marked febrile action, with a strong reaction, but without any symptom whatever of local affection, precedes the pain. In a word, there is first an inflammatory fever, and then rheumatism. Next observe the extreme mobility of the rheumatic pains. They run along, in a manner, wherever the blood is distributed ; the application of leeches often removes the pain from one part, but it soon shifts to another, and not unfrequently it quits tho articulating tissues and fixes on different internal organs, producing, by the derangement of their functions, symptoms more or less severe. It often happens that bleeding from a large orifice puts an end to the disease, ss if, by diminishing the mass of blood, it proportionally diminished the stimulus that promoted all these shifting irritations." It is then, when the body is in this predisposed condition, from any of the before-mentioned causes, that exposure to a continued draught of cold air or a shower of rain becomes the immediate exciting cause of an attack of rheumatism.
Whatever may be the general condition of plethora, which has been observed in certain cases, there can be no doubt that rheumatism will only come on in certain conditions of the blood. It has been observed that during rheumatism considerable quantities of Mille acid and 1:that° of ammonia occur in the urine, and there seem s to be little doubt that in all eases of rheumatism there is an accumui.stion in the blood of some eubetanco which acts as a ma Series numb/. This sub stance is not identified, but between the substances of the food on the one hand and the excretions:of the skin and kidneys on the other, there is a wide field for the production of abnormal products, which may be the cause of disease. It has been supposed by Dr. Todd and others, that the real materies sorb; is lactic acid in the blood. This, however, is at present problematical, but it is very certain that an abnormal condition of the blood is the most general antecedent of rheumatic disease.
Cold has been often supposed to be an absolute cause of rheumatism. But this is certainly not the case, as out of half a dozen men exposed to the same degree of cold only one may have rheumatism. This disease is also not more prevalent in hot climates, as compared with cold ones, than could be accounted for on the supposition of other causes than cold producing the disease. That cold is an exciting cause
when the body is already predisposed there can be no doubt.
Treatment of rkeumatism.—Dr. Haygarth, on being asked what was the beat remedy for acute rheumatism, is said to have replied, "Six wetk.e." The sagacity of this reply can be best estimated when the literature of acute rheumatism has been gone through. Blood-letting, calomel, opium, bark, alkalies, iodide of potassium, colchicum, aconite tartarised. antimony, nitrate of potash, brandy and water, infinitesimal doses,—have all had their advocates, and in every set of cured cases reported the average duration will be found to be about six weeks. It is not, however, to be supposed that the treatment of acute rheumatism is one of indifference. According to the severity of the eymptoms and the temperament of the individual the judicious physician will apply his treatment. The symptoms of disease of the heart should be watched for with anxiety, and where detected the treatment must be modified accordingly. Blood-letting is now seldom had recourse to. Opium to alleviate great pain and alkalies to act on the kidneys and bowels, and modify the condition of the blood, are recommended by all rational practitioners. Dr. Bennett, of Edin burgh, speaks highly of nitrate of potass. Local bleeding is occa sionally of service. In chronic rheumatism liniments over the inflamed joints, with iodide of potamium, and bark, and guaiaciun, with other tonics and stimulants, are valuable remedies. Cold bathing and mineral waters are adapted for some cases.
According to Dr. Elliotson, whether rheumatism be acute or chronic, the treatment should be exactly the same " You have only to make two diatinctions,—to ascertain whether it is the inflammatory form of the disease : whether the parts are hotter than they should be, and heat dots harm; or whether the part are cooler than they should be, and heat does good." In the one case he recommends antiplilogistie measures, and In the other stimulants; under the antiphlogistic mea sures, he comprehends bleeding and the administration of colchicum, the latter to be continued till it purges the patient. During the whole time of the treatment cold, lotions are applied to the inflamed joints. In the chronic form of rheumatism the joints are kept hot with flannels and rubbed with stimulating ointments and liniments, while the ammoniated tincture of guaiacuni, beginning with halfeiram doses, is given three times a day. Dr. Motion also considers that mercury le occasionally useful in both kinds of rheumatism. Lumbago and sciatica are most successfully treated by cupping the loins and the parts over the course of the great meiotic nerve, followed by the appli cation of blisters to the seine regions, and a general antiphlogistic regimen. In hemicrania great relief is frequently obtained by the application of heat to the part affected, as in wrapping up the head in flannel. Should the pain evince a tendency to return every evening, a large doe. of a narcotic should be administered just previous to the pproxyern, and if not relieved in two or three hours, a similar dose must be repeated; we are informed that one grain of stramonium fax an adult frequently acts like a charm in this affection. In rheuma talgia, when the parts are not hot, and the pain is not increased by heat, acupuncture and shampooing have been found of great service.
Where the joints are stiff and contracted, from long-continued In flammation, warm bathing, combined with frequent and persevering exercise of them, have been attended with the most signal /success.
(Sydenham, Opera Medics, "Tractatus de Podagra et Ilydropo;' Andrei, Anatomic Pathologipse ; C. Roche, Dietionnarre de AlWcine a dc Chirsorgie; Dr. Barlow, Cyclopeedia of Practical Medicine ; Dr. Ellionion, Practice of Medieine ; Dr. Bennett, Principles and Practice of Medicine ; Dr. Fuller, Rheumatism and Rheumatic Gout.)