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ly a few days and go off again, may distinguish rheumatic fi like a common cold. Others idiopathic or brain fev are protracted for months or though the two are occasi even years, as I before re- ally found in combination, e marked, when of course the marked by its appropri term chronic applies with strict signs. propriety. The most impor
With respect to the lo tant variety of the disease is symptoms, which are the ca that which is termed rheumat- of the general disorder of: ic fever, the term fever, howe- tem just described, the p ver, merely serving to express in the affected parts is of the general febrile action that
very severe, and is atteni is taking place, and which is with much swelling and r symptomatic as in other in- ness of the skin, and tend flammations. The severity ness to the touch. Th and occasionally the danger of arise from the inflamma this, makes it deserving of spreading from the ligan further attention.
tous structure, to the surrou Rheumatic fever, as it is call- ing parts. When the infl ed, frequently begins with cold- mation has continued for ness and shivering, which are few days in any particu soon followed by heat, and part, it commonly begins this by sweating. The fe- decline, but a similar train brile symptoms are modified symptoms appears in so in some degree by the habit other part, and follows a s of the patient, and the dura- lar course. Thus, as an tion of the disease. In strong ample, after one hand subjects, the heat is greater, wrist have been affected in the sweatings more profuse, manner mentioned, the of and the pulse is fuller and will be seized; then perh stronger, than in any other in- the elbow, and, in success flammation. The frequency the shoulders, feet, knees, le of pulse, however, is not pro- &c.; till, in its turn, alo portionably great. The blood, every part of the body wh when drawn, is more highly ligamentous structure ex buffed and cupped, than in participates in the dise other inflammation. The And it not unfrequently tongue is covered with a white pens, that when it has instead of a brownish fur; and seemingly run its course, i there is, in ordinary cases, no news its attack on one or n headache or disturbance of of the parts that had the sensorial functions. By ly suffered, by which its du these last mentioned signs, you tion altogether is greatly F
longed. This is much more small; there is considerable likely to happen if the inflam- depression of the general mation is quickly taken off strength, and much irregularifrom
any part by local means; ty in the state of various funcsuch as leeches, but especially tions, such as I described to f cold applications are made you in detail when speaking use of: but where the inflam- of the effects of inflammation nation in any part is allowed on the system. to run its course, such a re Terminations. —- Rheumacurrence seldom happens. It tism, in a great proportion of ieems as if in the former case, instances, goes off entirely he diseased action only was without injury to the strucemoved, the disposition re- ture, and this though it may aaining behind; whereas, in have continued for a great he latter, the disposition ap- length of time. But sometimes, lears to be worn out by the in consequence of adhesions pntinuance for a certain time taking place, and the deposi[ the inflammatory action. tion of coagulable lymph, stiffway,
the disease is of- ness, and rigidity of the parts in protracted for eight or ten remain, by which motion is I twelve weeks, when it gra- impaired. Suppuration is a Wally declines; sometimes go- rare occurrence, both because g off entirely, at others leav- ligamentous structure is not g the local symptoms behind, much disposed to this change, hough in a mitigated form; and perhaps because the innd thus the acute disease lays flammation that occasionally he foundation for the chronic. takes place in the surrounding The pyrexia, or general fe- cellular membrane, is seldom nile state of body, continues in a sufficient degree for such i accompany the local affec- a purpose. in; but after a time, as per
'I have thus given you, genips three or four weeks, it tlemen, the general character sumes a remittent form, be- of rheumatism, in its ordinary ? aggravated towards even- and legitimate form. But Ś and through the night, sometimes it attacks, or rather aen the sweating is the most induces inflammation, in other ofuse. The
and other parts of greater importance to cal symptoms follow a simi- life, and thus is liable to beP course.
come dangerous, though in itin weak and irritable habits, self it can hardly be so consid also when the disease is dered. For the most part, it ig protracted, the pulse be- is in structures approaching mes frequent, hard, and somewhat to the ligamentous,
that inflammation is observed has been used to designateit. to arise during the course of But I much question the rheumatism. The periosteum priety of considering the is one of these; and hence cases as real rheumatisı : those aching pains in the bones while the mistake, if it be ore which patients often complain is productive of practical misof. The pericardium is anoth- chief, by suggesting the notion er part that frequently be- that such cases do not requre comes inflamed during rheu- to be treated like common nmatism, and which is denoted flammation, which however is by pain in the region of the quite contrary, to my expeheart, and great disorder in rience; as I shall have occathe action of this organ. The sion to state further to you, inflammation thus excited, con- when speaking of the treattinues in many cases after the ment of the disease. rheumatism has disappeared ;
Causes.—The general ex and in this way originate ma- citing causes of rheumatism ir ny chronic affections of the all its forms, is exposure to celd heart.
the application and effect a Sometimes the brain or its which are in general so direc membranes suffer, the signs of and obvious, as not to be mis inflammation in this organ pre- taken. In fact, we have no senting themselves, such as certain knowledge of any oth severe headache, and often ers. Syphilitic pains are in delirium, which now and then deed liable to be confounde prove quickly fatal.
The at times with those of genuin Tungs or pleura, or both, still rheumatism, and can only be more frequently suffer, a con- distinguished by inquiring int siderable number of cases of all the circumstances of th acute rheumatism being at- case, by which its real natut tended in their course with may generally be discovered evident signs of pulmonic in As with respect to man flammation. These cases of other diseases, the operatin inflammation arising acciden- of the cause is much influere tally during the course of rheu- by predisposition, which isi matism, have been considered some individuals constitution and called rheumatism of the and even hereditary; wh heart of the brain and of this exists, the disease will the lungs; and even the scle- readily produced by any ore rotic coat of the eye has been nary exposure to cold. Ti supposed to be the seat of disposition to this disease rheumatism at times, and the also influenced by season a term rheumatic ophthalmia weather. Thus it is most i
quent in the spring, and espe- by the nature and functions of cially when long easterly winds the part affected : and hence prevail
. At such times, the the necessity of considering indisease
be said to be ep- flammation in all its forms and idemic.
varieties, in order to successNature of Rheumatism.-I ful practice. This you will have already told you that find to be the case in regard this disease consists in inflam- to our present subject, and it mation of the ligamentous applies still more strongly to structure, and there is no rea- the case of cerebral inflammason to believe the inflamma- tion, as we shall see when we tion to be different in nature come to the investigation of from common inflammation as what is called idiopathic fever. it appears in other parts. The From what I have now said, difference in character and in you will not be surprised to treatment, is owing to the dif- learn that the proper treatference in structure, and the ment of rheumatism is a disdifferent laws by which this tinct point of inquiry, not to structure is governed. be altogether determined by
Prognosis.—In itself, rheu- the case of other inflammamatism, though a disease of tions. great suffering, can hardly be Now the treatment of rheusaid to be attended with dan- matism is different under difger, though it sometimes ferent circumstances; and we proves fatal in the way of me- shall best understand the subtastasis, that is, by giving rise ject, by again adverting to the to inflammation in other parts division before pointed out, of importance to life. I think into the simple state of the I have observed that the se- disease, where the affection is condary inflammations thus local and partial in extent, and produced are more easily re- that where it is attended with moved by art, than when tak- pyrexia or general disorder of ing place as primary diseases. system, or what is termed Where there is so general a rheumatic fever. disposition to inflammation in
Slight and recent rheumathe system, it appears to have tic affections either subside of the effect of lessening the dis- themselves, or require only the position in particular parts. treatment of a common cold,
Treatment of Rheumatism.— as a moderate degree of abstiNot only are the symptoms of nence, or at most the exhibiinflammation different, but its tion of a mild sudorific. The general course and treatment severer affections of the sort, likewise, are much modified such as lumbago or sciatica,
are so painful, and so incapa- tic nerve is apt to be involved citate the patient for all exer- in the inflammation.
It then tion, as to demand a more ac- frequently happens, that the tive practice.
If the patient only pain the patient complains is vigorous, bloodletting once of, is about the knee or the or twice, and that to a pretty ankle. In this case, it is a considerable amount, is of de- question whether our topical cided advantage, and adds applications are best made at much to the efficacy of our the origin of the disease at other remedies. In weak per- the hip joint, or at the part sons, bloodletting may be dis- where the pain is situated ? pensed with
Counterirrita- Blistering, for example, the tion of various kinds, general knee or ankle? I am inclined or local, are next to be em- to the latter opinion, though ployed. Sudorifics, as the hot- it is difficult to determine the bath, camphor and opium, the point satisfactorily. ammonia, and various other
In the really chronic form active stimulants, come under of rheumatism, which is somethe former head. Active vo- times left after the acute dismiting and purging conduce to ease, but which also often arises the same end. I have often almost imperceptibly, the pain succeeded in relieving lumba- is not violent, but constant, and go, by half a grain of the ela- is increased both by warmth terium, which generally excites and motion at first, but grows both vomiting and purging, easier after a time. The limbs following it by opium in the become stiff
, and the muscles dose of a grain or two. Warm waste, partly perhaps from fomentations to the loins, blis- want of use. In some instances, ters, and stimulating liniments, the hands become useless from are likewise all of use in a the enlargement of the joints, greater or less degree.
--nodosity as it has been callLumbago is liable to be cd, and their subsequent cone confounded with nephritic af- traction. These chronic states fections ; but a little attention of rheumatism are best relievwill enable you to distinguish ed by the warm bath, by stibetween them : you have only mulants of the most powerful to recollect the diagnostic kind, such as ammonia and the signs of nephritis and of renal guaiacum in large doses, and calculi; the distinction then is the oil of turpentine.
Camsufficiently easy. So when the phor with opium, and other ligamentous structure about sudorifics, are likewise of serthe hip joint is the seat of vice. Along with these, local rheumatism, the great ischia- agents are not to be neglected,