§ 173. The Rheumatism goes off either by Stool, by turbid thick Urine which drops a great Proportion of a yellowish Sediment, or by Sweats: and it generally happens that this last Discharge prevails towards the Conclusion of the Disease. It may be kept up by drinking an Infusion of Elder Flowers. At the Beginning however Sweating is pernicious.
§ 174. It happens also, though but very seldom, that Rheumatisms determine by depositing a sharp Humour upon the Legs; where it forms Vesications, or a kind of Blisterings; which burst open and form Ulcers, that ought not to be healed and dried up too hastily; as this would occasion a speedy Return of the rheumatic Pains. They are disposed to heal naturally of themselves, by the Assistance of a temperate regular Diet, and a few gentle Purges.
§ 175. Sometimes again, an Abscess is formed either in the affected Part, or in some neighbouring one. I have seen a Vineyard Dresser, who after violent Pains of the Loins, had an Abscess in the upper Part of the Thigh, which he neglected for a long Time. When I saw him, it was of a monstrous Size. I ordered it to be opened, when at once above three Pots of [41] Matter rushed out of it: but the Patient, being exhausted, died some Time after it.
Another Crisis of the Rheumatism has happened by a kind of Itch, which breaks out upon all the Parts adjacent to the Seat of this Disease. Immediately after this Eruption the Pains vanish; but the Pustules sometimes continue for several Weeks.
§ 176. I have never observed the Pains to last, with considerable Violence, above fourteen Days, in this Species of the Rheumatism; though there remains a Weakness, Numbness, and some Inflation, or Puffing, of the adjoining Parts: and it will also be many Weeks, and sometimes even Months; especially if the Distemper attacked them in the Fall, before the Sick recover their usual Strength. I have known some Persons, who, after a very painful Rheumatism, have been troubled with a very disagreeable Sensation of Lassitude; which did not go off till after a great Eruption, all over the Body, of little Vesications or Blisterings, full of a watery Humour; many of them burst open, and others withered and dried up without bursting.
§ 177. The Return of Strength into the Parts affected may be promoted by Frictions Night and Morning, with Flannel or any other woollen Stuff; by using Exercise; and by conforming exactly to the Directions given in the Chapter on Convalescence, or Recovery from acute Diseases. The Rheumatism may also be prevented by the Means I have pointed out, in treating of Pleurisies and Quinsies.
§ 178. Sometimes the Rheumatism, with a Fever, invades Persons who are not so sanguine, or abounding in Blood; or whose Blood is not so much disposed to Inflammation; those whose Flesh and Fibres are softer; and in whose Humours there is more Thinness and Sharpness, than Viscidity and Thickness. Bleeding proves less necessary for Persons so constituted, notwithstanding the Fever should be very strong. Some Constitutions require more Discharges by Stool; and after they are properly evacuated, some Blisters should be applied, which often afford them a sensible Relief as soon as ever they begin to operate. Nevertheless they should never be used where the Pulse is hard. The Powder [Nº. 25] answers very well in these Cases.
§ 179. There is another Kind of Rheumatism, called chronical, or lasting. It is known by the following Characters or Marks. 1. It is commonly unattended with a Fever. 2. It continues a very long Time. 3. It seldom attacks so many Parts at once as the former. 4. Frequently no visible Alteration appears in the affected Part, which is neither more hot, red, or swelled than in its healthy State; though sometimes one or other of these Symptoms is evident. 5. The former, the inflammatory, Rheumatism assaults strong, vigorous, robust Persons: but this rather invades People arrived at a certain Period of Life, or such as are weak and languishing.
§ 180. The Pain of the chronical Rheumatism, when left to itself, or injudiciously treated, lasts sometimes many Months, and even Years. It is particularly and extremely obstinate, when it is exerted on the Head, the Loins, or on the Hip, and along the Thighs, when it is called the Sciatica. There is no Part indeed which this Pain may not invade; sometimes it fixes itself in a small Spot, as in one Corner of the Head; the Angle of the Jaw; the Extremity of a Finger; in one Knee; on one Rib, or on the Breast, where it often excites Pains, which make the Patient apprehensive of a Cancer. It penetrates also to the internal Parts. When it affects the Lungs, a most obstinate Cough is the Consequence; which degenerates at length into very dangerous Disorders of the Breast. In the Stomach and Bowels it excites most violent Pains like a Cholic; and in the Bladder, Symptoms so greatly resembling those of the Stone, that Persons, who are neither deficient in Knowlege nor Experience, have been more than once deceived by them.
§ 181. The Treatment of this chronical Rheumatism does not vary considerably from that of the former. Nevertheless, in the first Place, if the Pain is very acute, and the Patient robust, a single Bleeding at the Onset is very proper and efficacious. 2. The Humours ought to be diluted, and their Acrimony or Sharpness should be diminished, by a very plentiful Use of a Ptisan of [42] Burdock Roots [Nº. 26]. 3. Four or five Days after drinking abundantly of this, the purging [43] Powder [Nº. 21] may be taken with Success. In this Species of the Rheumatism, a certain Medicine is sometimes found serviceable. This has acquired some Reputation, particularly in the Country, where they bring it from, Geneva; under the Title of the Opiate for the Rheumatism, tho' I cannot say for what Reason; as it is indeed neither more nor less than the Electuary Caryocostinum, which may be procured at our Apothecaries. I shall observe however, that this Medicine has done Mischief in the inflammatory Rheumatism, and even in this, as often as the Persons afflicted with it are feeble, thin and of a hot Temperament; and either when they have not previously taken diluting Drinks, or when it has been used too long. For, in such a Circumstance, it is apt to throw the Patient into an irrecoverable Weakness. The Composition consists of the hottest Spices, and of very sharp Purgatives.