RHEUMATISM is a painful affection of fibrous and muscular tissues, affecting principally the larger joints, and places covered by muscles; as the wrists, elbows, knees, hip-joint, back, and loins. The internal parts also, as the heart and diaphragm, are considered capable of being affected by rheumatism. When the joints about the back and loins are affected, the complaint is called lumbago; when the pain is in the hip-joint, it is called sciatica; and pleurodynia, or pain in the side, when the muscles of the chest are affected. Rheumatism may occur either with fever or without it; in the first case it is termed acute, and in the second chronic rheumatism. Not long after the application of the exciting cause, the patient feels pain and stiffness in one or more joints when he attempts to move them; this quickly increases till motion becomes almost impossible, from the excessive pain attending it. Along with this local and often very general pain there occur very strong fever, much thirst, heat, and dryness of skin, strength, fulness, and hardness of pulse. The feverish symptoms are somewhat increased towards evening; and when the patient gets warm in bed the pains are more severe. In a short time some of the affected joints swell, and the pain is a little relieved, but by no means removed. As to the causes of this malady, it may be remarked that rheumatism is a disease of the constitution, and is induced by a poison circulating in the blood, and probably carried from one joint to another. The tendency to rheumatism is hereditary; and in some families this predisposition is very marked, and the disease is excited by the most trifling causes. Cold and damp are the most common causes of the disease, and hence the poor suffer much from it. Persons who get their clothes wet or damp, and neglect to change them, are often seized with rheumatism. Acute rheumatism is most common between the ages of fifteen and forty. It is not a dangerous disease as long as it is confined to the joints, but there is always the risk of the heart being attacked. Dr Parr remarks regarding the diagnosis of this disease, that "rheumatism is often so blended with gout as to prevent our seeing which is the principal complaint. In general, rheumatism occurs in consequence of an evident cause, as cold; the gout without any such cause. Rheumatism has no preceding complaints; gout is preceded by languor, flatulency, and indigestion; rheumatism is the disease of the strong and active; gout, of those advanced in life; rheumatism attacks the larger, gout the smaller joints; rheumatic limbs, though swollen, are not red like gouty. The fever of gout remits irregularly; that of rheumatism has exacerbations in the evening, and remissions in the morning. These circumstances will contribute to the distinction; but the cases so often run into each other, and differ so transient and minute, that the greatest difficulty is found in the distinction of particular complaints. Rheumatic pains in the chest resemble pleurisy, and in the abdomen resemble inflammation of the bowels. In each case, the soreness to the
touch, the pain felt at the origin or insertions of the muscles, while the more appropriate symptoms of the real inflammation of the part are absent, will sufficiently mark the nature of the disease."
Acute rheumatism is to be considered as an inflammatory and febrile disease, and, as such, to be treated in the first instance by cautious blood-letting, in quantity proportioned to the violence of the disease and the strength and constitution of the patient. In all cases the bowels must be well opened. The best medicine for this purpose is a draught containing half an ounce of Epsom salts, twenty or thirty drops of antimonial wine, thirty drops of colchicum wine, and an ounce of senna infusion. After the saline purgative it is often advisable to bring out a copious sweat, and to continue that sweat over the whole body for thirty-six or forty-eight hours. The most effectual and approved method of this is to employ the compound powder of ipecacuan and opium, commonly called Dover's powder; of this we give 10 or 12 grains, having put flannels next the patient's skin, and put him in blankets. When this dose has brought out a sweat, it is to be encouraged by drinking plentifully of warm gruel or barley-water; but if it should fail to occasion perspiration, another dose must be given at an interval of four hours, and this repeated every four hours till a copious sweat breaks out over the whole body. It is proper to abstain from drinking till the sweat breaks out, as drinking too soon after taking the powder is apt to occasion vomiting. When the perspiration has continued general and copious for a sufficient time, the load of bedclothes is to be gradually diminished; the body is to be rubbed dry with warm flannel, and great care taken for some time not to expose it to cold. When the pain and stiffness of the joints continue after the sweating, some stimulating embrocation is proper, as turpentine ointment, or volatile liniment, or camphorated oil. If the pain still continue obstinate, it may be necessary to apply a blister to any of the joints or muscular parts that require it. The essence of mustard, which has gained some reputation as an external application in rheumatism, is composed of oil of turpentine, camphor, and a portion of rosemary, to which is added a small quantity of flour of mustard.
Chronic rheumatism is distinguished by the pained parts being cold and stiff, and not easily made to perspire; by being worse in cold weather than in warm; by the patient's being very sensible to the changes of weather; and by the general health being not very greatly impaired, at least till the disease has continued many months. The affected joints remain for a long time swollen and tender, and occasionally permanently thickened and distorted. The cure of chronic rheumatism is very difficult. Many expedients have been tried, and there is a necessity for varying the treatment in almost all instances of it. Sweating and friction are proper commencements, and these must be followed up by warm bathing, warm pumping, the use of the Bath waters, or sometimes by sea-bathing, by electricity,
Rhin. and the frequent use of the flesh-brush. The system is to be invigorated by bark, wine, iron, and other tonics. The ammoniated tincture of gusiac, in the dose of two or three drachms, has been employed with success; also the oil of turpentine, from ten to thirty drops mixed with honey, or what has been a good deal employed of late, cod-liver oil, from half an ounce to an ounce. The above doses are to be taken twice a-day, and persevered in for some time. Much attention is to be paid to the wearing of proper clothing, and not to expose the body to the vicissitudes of the weather, and especially to avoid cold and damp. Much benefit is often derived from wearing Pulvermacher's electric chains.