SPEC. I. A. acuta thoracis. Spurious pleurisy. Peculiar GEN. XII. last varieties, that though they are less disposed to wander generally than the first, they are peculiarly apt to run into each other's proper field, and to affect the stomach, which, in consequence, becomes sometimes enormously flatulent and expanded, with a sense of heat like that of a burning coal. If the back or loins be pressed hard to obtain ease, the pain is transferred to the side or stomach; and if the pressure be followed up into the side, it returns with violence to the back or hips; or the breathing is impeded, and can only be carried on in an erect position*. character belonging to the local varieties. Local varie rheumatism Generally speaking, however, in these three varieties, ties of acute the disease is less erratic than in the first, and particumore dispos- larly in lumbago and sciatica. And it is owing to this ed to chronic fact that the loins and the hip, from having been more weakness. Treatment of the local varieties. Rubefacients. Friction. uniformly affected, are often so long, even after the complaint has subsided, before they recover any degree of tone, so that the patient is frequently a cripple for many months; and still suffers from chronic rheumatism, which, in these cases, proves no uncommon sequel to acute. Local applications, which are rarely of service in the first or articular variety, as the pain is so apt to wander from every joint to every joint, may in all these be frequently employed with more advantage; and where general and copious bleeding may be contra-indicated, leeches or cupping have often afforded considerable relief. The compound camphor liniment, as an elegant rubefacient, is perhaps more frequently employed than any other medicine of the same tribe; but it dries too soon upon the skin, and heats and stimulates without exciting moisture; and hence it is less useful than camphor dissolved in oil, or oil united with ammonia. In all these applications, however, the friction with a warm hand is of itself highly serviceable, and should be long persevered in and frequently repeated. And on this account it is, that essential advantage has often been derived in Cartheuser Diss. de Luinbagine rheumatica. Fr. 1755.—Scheid, Diss. de Lumbag, rheumat. Arg. 1704. GEN. XII.* Arthrosia SPEC. I. acuta. cases of lumbago, or where the rheumatism has fixed itself between the shoulders, by a waistcoat of the coarsest brown paper, worn close to the skin, which excites a gentle moisture, both by its perpetual friction matism. and the stimulus of the tar with which it is so largely Treatment. impregnated. Acute rheu Moxa. Blisters seem rarely to be of all the advantage we Blisters rarely very should expect; but the vesication from sinapisms suc- serviceable. ceeds better than that from cantharides, probably because it operates with a wider continuous sympathy, produces more general excitement, and hence proves a better diaphoretic. The burning of moxa is a favourite remedy on the Continent, but has been little tried in our own country. It does not seem to afford so much promise of relief as sinapisms or epithems of scraped horse-radish. The tartar emetic ointment has been also frequently Tartar made use of, and sometimes with success: it gives a per- ment. manent irritation, but the exulcerations it produces frequently prove foul and troublesome. Dr. Perceval of Dublin, in a manuscript note to the volume of Nosology, tells me that, in sciatica, he has known the pain removed by a sweating course of James's powder, after a considerable emaciation of the nates. emetic oint Bark and gentle stimulants, as guaiacum, bardana, and Tonics. seneka, may in every instance be used with advantage, with a liberal regimen and chalybeate waters. Sulphu- Sulphureous reous fumigation has also of late been very extensively funiigation: employed on the continent, and partially in our own country, in the cure of both the present and the ensuing species, and according to the testimony of those who have employed it, with great success. M. Galés of Paris, of Galés : who seems first to have tried it, affirms, that of sixty-five patients who were submitted to it, twenty-five were cured, thirty-two much relieved, while only eight received no benefit. Mr. Wallace, who has also tried it at Dublin, of Wallace. on a large scale, does not speak so decisively of its benefit in these complaints as in cutaneous eruptions *. Observations on Sulphureous Fumigation, as a remedy in Rheumatism and Diseases of the Skin. Dublin, 1820. GEN. XII. SPEC. II. Difficulty of arranging the disease len. SPECIES II. ARTHROSIA CHRONICA. Chronic Rheumatism. PAIN, WEAKNess, and rigidity of the LARGER JOINTS CONCERNING the proper position, and, in some sort, the nature of this disease, Dr. Cullen confesses himself at a great loss. In his Synopsis, he arranges it as a sequel of felt by Cul- acute rheumatism, and so explains it in his definition: yet he gives it a distinct name, that of Arthrodynia, for the express purpose, as he tells us, of having a distinct name at hand for any one who may choose to regard it as a separate genus; and whoever is so disposed is at full liberty, he adds, as to any objection of his own. Yet in his First Lines he takes a different view; and perhaps a more correct one than either of the above. Chronic rheumatism, instead of being a mere sequel of acute rheumatism, or a distinct genus, is here made a separate species of a common genus. "Of this disease," says Sometimes acute rheu a sequel of matism. Dr. Cullen," there are two species; the one named the acute, and the other the chronic rheumatism." And in his subsequent description of the latter, instead of the universal assertion in his earlier work, "pro sequela rheumatismi acuti rheumatismum chronicum dictum semper habeo," he modifies it by the word commonly. "The chronic," says he, " is commonly a sequel of the acute rheumatism." * Aph. CCCCL. SPEC. II. Arthrosia There can be no doubt, indeed, that it is so; but as, GEN. XII. in many instances, it is a distinct disease, characterized by symptoms of its own, and demanding a very different chronica. treatment, there can be as little doubt that it ought to be arranged as a distinct species; and in the present system it is thus arranged accordingly. same Chronic rheumatism. a distinct and hence to Varieties as Chronic rheumatism has as many, and nearly the Sometimes varieties as the acute. It becomes fixt in the loins, in the disease: hip, in the knee, but seldom in the thorax. Its symptoms are in most respects like those of acute rheumatism, only be treated of that there is little or no fever: so that while the general separately. heat is very considerable, and the pulse usually upwards of a hundred strokes in a minute in the acute species, in the acute the skin in the chronic species seldom exceeds its natural species. temperature, and the pulse is rarely quicker than eighty Symptoms. strokes; the joints are less swollen, and of a pale instead of being of a reddish hue, cold and stiff, and roused with difficulty to a perspiration; and always comforted by the application of warmth. The disease continues for an indefinite period, and sometimes only terminates with the life. The affected joint is occasionally debilitated to the utmost degree of atony, so as, when the acute pain is not present, to resemble very nearly a stroke of palsy. Cold, the common cause of the acute rheumatism, is also a common cause of chronic, even where the acute species has not preceded: and violent strains and spasms may be enumerated as other causes. But it is probable that in these cases the constitution is peculiarly disposed to rheumatic action. Cold the common ex citing cause. The treat ment to be founded on Every symptom proves most distinctly that the pre- A disease of sent is a disease of debility; and the mode of treatment debility. must be founded upon this idea. It is hence that stimulants of almost all kinds are found serviceable. Warm active balsams and resins, as those of copaiva and guaia- this view. cum, essential oils of all kinds, from resinous substances, Resinous as turpentine and amber; from aromatic or pungent and tereplants, as camphor and mustard, and especially cajeput, preparations. the green distilled oil from the leaves of the mela binthinate SPEC. II. GEN. XII. leuca Leucodendron, are all employed in their turn; sometimes alone, where they combine a sedative with a stimulant power, as camphor and cajeput, and sometimes rheumatism. in union with opirm, which often proves a very valuable addition. Arthrosia chronica. Chronic Alone with opium. Act usefully Hence the advantage of horse-radish and the alliacea. Most of these are, also, powerful diuretics; and as as diuretics. acute rheumatism is best and soonest removed by warm sudorifics, so chronic rheumatism seems to be chiefly relieved, and, indeed, radically cured, by diuretics of a like stimulus. Hence, horse-radish and garlic are often found serviceable; and turpentine still more so; which in truth forms the basis of the greater number of the medicines just enumerated How far the arum, or dulcamara, may Dulcamara. be specifically entitled to this character I cannot deter Arum. Meadow saffron. Local stimulants of service. moxa. Stimulant mine from my own practice. They are both introduced into the table of diuretics by Dr. Cullen, and are highly commended by many physicians of great celebrity for their arthritic virtues. But it is possible that whatever virtues of this kind they possess are rather derived from their stimulating the excretories generally, and rousing the entire system, than from their acting specifically upon the kidneys. The colchicum autumnale, which has sometimes proved serviceable, has more decided pretensions to a diuretic character. Local stimulants are, here, of more service than in the preceding species. The cautery of moxa has been Burning of more generally used on the Continent for chronic than for acute rheumatism, and is certainly more entitled to a trial. It is peculiarly recommended by baron Larrey. In our own country, however, practitioners have far more generally had recourse to cataplasms of ammonia, cataplasms. cummin, and mustard seeds, occasionally intermixed with euphorbium or cantharides: or, in their stead, have made use of friction, and, which is far preferable, the vapour-bath, brine, warm-bathing: and have afterwards kept the joint well clothed with flannel; and sent Electricity through the organ small shocks of electricity, or roused it and voltaism. * Recueil de Mémoires de Chirurgie, &c. 8vo. Paris, 1821. |