OF THE RHEUMATISM.
This disease has often a resemblance to the gout. It generally attacks the joints with exquisite pain, and is sometimes attended with inflammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually distinguished into acute and chronic; or the rheumatism with and without a fever.
CAUSES.——The causes of a rheumatism are frequently the same as those of an inflammatory fever, viz. an obstructed perspiration, the immoderate use of strong liquors, and the like. Sudden changes of the weather, and all quick transitions from heat to cold, are very apt to occasion the rheumatism. The most extraordinary case of a rheumatism that I ever saw, where almost every joint of the body was distorted, was a man who used to work one part of the day by the fire, and the other part of it in the water. Very obstinate rheumatisms have likewise been brought on by persons not accustomed to it, allowing their feet to continue long wet. The same effects are often produced by wet clothes, damp beds, sitting or lying on the damp ground, travelling in the night, &c.
The rheumatism may likewise be occasioned by excessive evacuations, or the stoppage of customary discharges. It is often the effect of chronic diseases, which vitiate the humours; as the scurvy, the lues venerea, obstinate autumnal agues, &c.
The rheumatism prevails in cold, damp, marshy countries. It is most common among the poorer sort of peasants, who are ill clothed, live in low damp houses, and eat coarse unwholesome food, which contains but little nourishment, and is not easily digested.
SYMPTOMS.——The acute rheumatism commonly begins with weariness, shivering, a quick pulse, restlessness, thirst, and other symptoms of fever. Afterwards the patient complains of flying pains, which are increased by the least motion. These at length fix in the joints, which are often affected with swelling and inflammation. If blood be let in this disease, it has generally the same appearance as in the pleurisy.
In this kind of rheumatism the treatment of the patient is nearly the same as in an acute or inflammatory fever. If he be young and strong, bleeding is necessary, which may be repeated according to the exigencies of the case. The body ought likewise to be kept open by emollient clysters, or cool opening liquors; as decoctions of tamarinds, cream of tartar whey, senna-tea, and the like. The diet should be light, and in small quantity, consisting chiefly of roasted apples, groat-gruel, or weak chicken-broth. After the feverish symptoms have abated, if the pain still continues, the patient must keep his bed, and take such things as promote perspiration; as wine-whey, with spiritus Mindereri, &c. He may likewise take, for a few nights, at bed-time, in a cup of wine-whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder.
Warm bathing, after proper evacuations, has often an exceeding good effect. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affected. Great care must be taken that he do not catch cold after bathing.
The chronic rheumatism is seldom attended with any considerable degree of fever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There is seldom any inflammation or swelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients it often proves extremely obstinate, and sometimes incurable.
In this kind of rheumatism the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chiefly of vegetable substances, as stewed prunes, coddled apples, currants or gooseberries boiled in milk, is most proper. Arbuthnot says, “If there be a specific in aliment for the rheumatism, it is certainly whey,” and adds, “That he knew a person subject to this disease, who could never be cured by any other method but a diet of whey and bread.” He likewise says, “That cream of tartar in water-gruel, taken for several days, will ease rheumatic pains considerably.” This I have often experienced, but found it always more efficacious when joined with gum guaiacum, as already directed. In this case the patient may take the dose formerly mentioned twice a-day, and likewise a tea-spoonful of the volatile tincture of gum guaiacum, at bed-time, in wine-whey.