The general symptoms of Rheumatism are so well known as to need little description. Rheumatic cases are usually divided into acute Rheumatism or Rheumatic Fever, and Chronic Rheumatism. The latter, when it attacks the Lumbar region, or "small of the back," is called Lumbago; when it affects the hip-joints it is known as Sciatica.

Attacks of Rheumatism may come on at any season of the year, but they are most frequent in the spring and fall, when the changes of temperature are great and sudden. All ages are liable to this complaint, but the very young less than those of more advanced ages, although there is little doubt that the foundation of a great deal of the suffering of mature years is laid in early life.

"Although acute Rheumatism somewhat resembles Gout, yet in some respects it differs from it. It does not usually come on as suddenly as a fit of the Gout, but, for the most part, gives the patient warning, by a slow and gradual increase of pain. Neither is it fixed to one spot like the Gout, but wanders from place to place. Again, it seldom attacks the small joints, but is confined chiefly to the larger, as the hip, knees, and shoulders. Acute Rheumatism is generally attended with a continued fever, whereas the Gout has periodical remissions. Rheumatic fever is usually preceded by shivering and a sense of cold; a quick and hard pulse follows; the veins near the part affected swell, and a throbbing pain is felt in the arteries. By degrees the pain increases, and the patient suffers cruel torture, which is increased on the least motion. Rheumatism, moreover, is not preceded by dyspeptic symptoms, as is usually the case with Gout, neither do chalky concretions form about the small joints and fingers, as in the latter.

Obstructed perspiration, occasioned either by wearing wet clothes, lying in damp linen, sleeping on the ground, or in damp rooms, working in damp situations, or by being exposed to cool air when the body has been much heated by exercise, or by coming from a crowded room or public place into the cool air is the cause which usually produces Rheumatism. Those who are much afflicted with this complaint are very apt to be sensible of the approach of wet weather, by finding wandering pains about them at that period; in fact, some are living barometers.

Acute Rheumatism usually comes on with lassitude and shivering, succeeded by heat, thirst, anxiety, restlessness, and a full and quick pulse, which, however, seldom exceeds 110 in a minute; the blood, when drawn from a vein, exhibits an inflammatory surface upon cooling, and the tongue is loaded with white fur; after a short time excruciating pains are felt in different parts of the body, but more particularly in the shoulders, wrists, knees and ankles, or in the hip; and these keep shifting from one joint to another, leaving a redness and swelling in every part attacked, as likewise a great tenderness to the touch. Towards evening there is usually an increase of fever, and during the night the pains become more severe, and shift from one joint to another.

Sometimes the pain is confined to a few joints; in other cases it affects many at the same time. Sometimes the inflammation extends to the diaphram, the heart, and the stomach, and these cases sometimes prove fatal. Persons who have been attacked with Rheumatic fever are more liable than others to disease of the heart.

In the course of the disease a considerable degree of sweating usually occurs, the secretion having a very peculiar and acid odour; but the sweating seldom removes the pains, and it is somewhat singular that the pained limbs frequently remain dry, while the rest of the body is covered with perspiration. In the beginning, the urine is without any sediment, but as the disease advances considerable sediment is deposited. There is seldom much headache; nor is the face flushed; and in most cases, there seems to be but little tendency to delirium. In general, there is neither nausea nor vomiting-; but the bowels are usually costive.

No disease is more apt to return on slight occasions, than Rheumatism, particularly the acute. Going out too early in the open air, too much exercise or an excess in diet, have occasioned a ret urn in all its former violence. Those who have suffered from the disease should therefore be particularly careful to avoid its exciting causes, and to guard against cold by warm clothing, and especially by wearing flannel next the skin.

Treatment

The principal point to be attended to in inflammatory rheumatism is to diminish the inflammation; and this, where the constitution is robust, the pulse strong, and the heat and inflammation great, is best accomplished by taking away a certain quantity of blood, the quantity to be regulated by the severity of the symptoms. If the bowels are confined, a dose or two of Castor Oil, or a Seidlitz Powder may be taken. These may be followed by the following:-Dissolve two grains of Tartar Emetic in a table-spoonful of water, add this and three drams of Tincture of Henbane to one pint of Oatmeal gruel. Two tablespoonfuls of this mixture may be taken every hour, till there is an improvement in the condition of the patient.

The diet must be confined to gruel, sago, arrow root, or corn starch. Any article of food or drink having a heating tendency must be avoided.

Chronic Rheumatism is seldom attended with inflammation or fever; it attacks all ages, and those who have been once attacked are liable at any time to a return of the complaint, if they expose themselves to the exciting causes. Chronic Rheumatism is attended with little danger, but occasionally an incurable stiffness in some of the joints is the result of repeated attacks.

Treatment

Almost every known medicine has been tried in this complaint, many of which have proved of very slight benefit. Colchicum, Elaterium, Opium, Guaiacum, Henbane, Hemlock, Camphor, Peruvian Bark, hot fomentations, cold Lotions, stimulating Liniments, the Vapour Bath, Electricity and Galvanism, and a multitude of other remedies have been tried, many of which have been of apparent benefit in some cases. Cases are on record in which one or two doses of Elaterium have cut short an attack, but the remedy is not one to be tried by inexperienced persons, as it is liable to produce very violent vomiting and purging, which, in fact, is its usual mode of action. Tincture of Guaiacum has been found beneficial in the Rheumatism of elderly persons, particularly those of a cold temperament. It may be taken in combination with Ammonia, as follows:

Ammoniated Tincture of Gruaiacum,.......One Ounce.

Simple Syrup,..................................One Ounce. - Mix, and take two teaspoonfuls three times a day.

In the majority of cases, particularly with patients in the prime of life, the remedy upon which most dependence is to be placed, is Colchicum; in fact, it may almost be considered a specific. It may be taken as follows:-

Wine of the Seeds of Colchicum,..........One Ounce.

Carbonate of Magnesia,.....................One Dram.

Water sufficient to make half a pint, two tablespoonfuls to be taken every four hours, till it produces either vomiting or purging; should it occasion headache, the dose must be diminished.

As there is usually a superabundance of acidity in the stomach and the system, the patient generally finds considerable relief from the Magnesia, in a very short time after it is taken. If the patient is unable to sleep at night, on account of pain, he may take 30 drops of Laudanum, or 30 drops of Tincture of Henbane, in a little water, on going to bed; or, if these affect the head, he may take instead, 10 grains of Bromide of Potash.

When the joints or the muscles have become stiffened from Rheumatism, considerable relief will be experienced from the application of Electricity; its use requires to be continued for a considerable time.

Acupuncturation (punctures made with needles) has been tried, and with complete relief, in some instances of severe rheumatic pain occupying a fleshy part. Before the pain has completely disappeared it has, however, on some occasions, been necessary to introduce the needles every third or fourth day, for six or seven times. Cupping and blistering over the seat of pain, as well as the application of leeches, have also been employed.

For local application, a great variety of combinations may be tried. The old, long-used liniment of Hartshorn and Oil may still be tried; the strength may be increased or diminished by adding more or less of the Spirit of Hartshorn. Either of the following liniments would also be found useful:-

Take Camphor.............................Half an Ounce.

Olive Oil,....................................Three Ounces.

Break the Camphor up small and leave it in the Oil, shaking occasionally, till it is dissolved. Or,

Take Spirit of Hartshorn,...............Half an Ounce.

Laudanum,.................................Half an Ounce.

Soap Liniment (Opodeldoc),............Two ounces. - Mix together. Keep the bottle well corked. Or,

Take Camphorated Spirit,..............One Ounce.

Spirit of Rosemary,.....................Half an Ounce.

Laudanum,..................................Half an Ounce.

Soap Liniment,............................Two Ounces.

Either of these preparations may be rubbed into the seat of pain for half an hour at a time, three or four times a day.

Persons subject to Rheumatism should be careful in their diet; living on wholesome, easily digestible food; and avoiding pickles and vinegar, or anything acid. They should dress warmly, wear-ing flannel next the skin; and should particularly avoid exposing themselves to cold or damp, or sudden changes of the weather.