Rheumatism is a constitutional disease, characterized by certain local manifestations. These manifestations are due to inflammation, acute or chronic, of the synovial membrane lining the joints, of certain serous membranes, particularly those of the heart, and of fibrous tissue elsewhere in the body. Rheumatism is classified as acute articular rheumatism and chronic rheumatism.

In acute articular rheumatism the lining membranes of the joints are inflamed. In the course of the disease certain complications involving internal organs are liable to arise. The parts more likely to become affected are the serous membranes, the endocardium and pericardium lining and surrounding the heart.

The attack usually begins suddenly. Sometimes there is a slight amount of fever for a day or two preceding the joint affection; sometimes the pain and tenderness of the joints precede the fever, but usually these symptoms appear together. The disease may attack any joint of the body, and is indeed very seldom confined to one or two. The affected joints are swollen, red and extremely tender. Pain is not so great except when attempting to move, or when disturbed or jarred. The slightest movement causes the most excruciating pain. Swelling is most apparent when the knees, ankles or wrists are the joints involved. The swelling is usually in proportion to the severity of the inflammation. One joint after another generally becomes involved. Sometimes upon attacking a new joint all tenderness and swelling disappear from the joints first involved. The fever ranges in this disease between 102 and 108 degrees. Profuse sweating is a common symptom.

The disease very rarely proves fatal. When it does it is due to the extension of the inflammation to the heart, and the development of pericarditis. Even then the number of deaths during the acute attack is very small, but in the fact that the heart is so frequently attacked lies the danger of the disease, for, as explained under the head of diseases of the heart, the great majority of valvular diseases of the heart are due to endocarditis developed during an attack of acute rheumatism. Usually, however, the lesion of the valves causes no inconvenience until a number of years afterward. The heart is more likely to become involved the more intense the disease. Other organs, such as the pleura, the peritoneum and the membranes enveloping the brain, have been known to suffer inflammation during the attack, but it is extremely rare. The head is usually free from pain. The duration of the attack varies from ten days to five or six weeks. There are sometimes relapses. One who has once suffered from acute rheumatism' is more liable to subsequent attacks.

Treatment: Nothwithstanding the popularity of salicylic acid, or the salicylate of soda, in the treatment of rheumatism during the last few years, we believe that as much or more may be accomplished by the use of what has been known as the alkaline treatment. The alkali, either bicarbonate of potassa or soda, should be given in full doses, every three or four hours. Lemon juice may be added to the dose and taken while effervescing. As soon as the urine is rendered alkaline (which may be told by testing with litmus paper, which turns to blue if dipped into an alkaline fluid), the dose should be greatly diminished, and taken thereafter only once or twice a day. Tonics are useful. Quinine in two-grain doses may be given. Tincture of aconite applied to the swollen joints often affords relief. Chloroform liniment or soap liniment is used for this purpose. The salicylate of soda is much employed - perhaps at this time more than any other remedy.

Chronic rheumatism differs from the acute variety in the degree of severity of the symptoms, and in their duration. In mild cases the patients are able to go about their work, but suffer more or less pain in the affected joints. In other cases, more severe, the patient is confined to his bed, and frequently, with those about their avocations, there is more or less deformity of the joints.

Treatment: The alkalies may be used in small doses; also the salicylate of soda. Iodide of potassium is sometimes very useful, and in malarious districts quinine is to be employed.

The local applications to the joints here are of more importance than in the acute Variety. Tincture of aconite, tincture of iodine and chloroform liniment are very useful.