usable, in this disease at least, by unprofessional persons. Many other modes of treating acute rheumatism might be detailed, but the foregoing are sufficient; sufficient at least as provisional means in the hands of an unprofessional person till the case is seen by a medical man, which it ought to be as quickly as possible. The reader is again referred to Carditis" in connexion with this article. As regards the local treatment of the inflamed joints, little is to be done in a disease which shifts its site as rapidly as acute rheumatism; for even if it can be driven from one joint, it must, as long as the poison is in the constitution, shew itself elsewhere, it may be in the heart; above all things, leeching the joints, unless under peculiar circumstances, of which a medical man only can judge, is to be avoided-hot bran bags sometimes give relief, but probably the following plan laid down by Dr. Bentley Todd, will be the most advantageous local method of treatment. When the joints are much swollen and painful, much ease may be given by enveloping them in a large quantity of the soft carded cotton-" cotton wool." over which there is wrapped completely a piece of oiled silk. By this air tight covering, the joints are kept in a perfect vapour bath, and when it is removed after twelve or twenty-four hours, the wool will be found saturated with moisture which is strongly acid. Dr. Todd says, this treatment affords great relief, supports and keeps the limb steady, and at the same time promotes sweating. It is also serviceable in gout. There are few diseases so tantalizingly tedious as acute rheumatism, it may disappear quickly, possibly in a week, or it may extend its visitation, ebbing or flowing, to ten, twelve, or fifteen weeks, in spite of treatment, apparently the best directed; but yet, provided the heart, the diaphragm, the brain remain unaffected, it is free from danger, and generally speaking, does not leave joints which have been severely affected, worse than they were before. It is very rarely the case that matter forms in consequence of rheumatic inflammation. It has been said, that there is a rheumatic predisposition: not only does this shew itself in a tendency to attacks of acute rheumatism properly so called, but it tends to modify any inflammatory action in the body, as for instance in the eye, when it gives rise to the peculiar "rheumatic inflammation." The causes of acute rheumatism already pointed out, will suggest to most persons the precautions to be adopted, especially * Sheet Gutta Percha will do. when liability to the disease exists. Cold and wet are particularly to be guarded against, and after exposure, the preventive measures already laid down adopted. Flannel or woollen worn next the skin, must always be regarded as one of the chief preventives; it should of course be proportioned in thickness to the season and temperature. Some persons imagine that their liability to rheumatism, either acute or chronic, is increased by flannel; if it is, it is probably because the wool keeps the skin in too excited a state, and by increasing perspiration increases the risk of suppression; in such cases, woven silk when it can be afforded, is useful, or spun cotton, may be used in winter: many rheumatic patients find their chief protection in an under dress of chamois leather. At all events, perfect warm clothing, and protection against suppressed perspiration, is essential in all such cases. Many of the above precautionary measures apply likewise to chronic rheumatism. Persons of full habit, liable to rheumatic attacks, should eschew malt liquor generally, should take animal food sparingly, and avoid violent exertions which heat the body. Persons of spare or feeble habit, may live better, and indeed require to keep up the condition of the body to as good a pitch as possible. By Chronic Rheumatism, in the proper sense, should be meant a disease somewhat resembling the acute form, accompanied with but slight febrile derangement, if there is fever at all, and affecting one or more of the joints, generally the smaller ones, which continue for a greater or less length of time swollen and tender, the inflammation either subsiding without effect, or after long continuance, causing permanent thickening around the joints, probably with permanent distortion; the process being more or less accompanied with pain. In this form of rheumatism, instead of heat, there is often a sensation of cold around the affected parts. The chronic nature of this disease must generally place it under proper medical control; the chief efforts of the unprofessional must be, to correct any slight deviations from the general health, to protect the affected parts especially from cold, by means of warm clothing, and to use friction, either with simple oil, or by means of the soap and opium liniment. Much comfort is not only derived from friction, but if combined with proper exercise of the joint or joints, it may do much to prevent permanent deformity. In chronic rheumatism, warmth of climate is of much importance, and as much should be done towards the attainment of this, as circum stances will permit. Sir James Clark recommends Nice and Rome, as the best European climates, but these, of course, are the resources only of the wealthy. Australia, however, is open to the poorer classes. Warm bathing, especially the saline bath, such as is furnished by Bath or Buxton, or Ashby-de-la-Zouch, is of the highest service in cases of chronic rheumatism, and in all cases of long standing, should, if possible be had recourse to. The charities connected with many of the baths, are available to the poor. their action. The effect of the acupuncture needles, above alluded to, in curing muscular, and also nervous rheumatism, such as sciatica, is sometimes almost magical, but, how the simple introduction of a needle into the substance of the body, acts so as almost instantaneously to remove a most painful affection, it is very difficult to say. In using electric or galvanic appliances for the use of chronic rheumatism, those apparently which keep up a slight, but continued electric excitement, are most useful. The electric chains of Pulvermacher, seem well adapted for this purpose. &c. Refer to-Acupuncture-Carditis-Gout, RHUBARB, MEDICINAL. -Rhubarb Root. Well known as this valuable medicine is, there is yet considerable uncertainty respecting which of the many recognized species of rheum, or rhubarb, yields the true medicinal drug. A species known as the Rheum palmatum, is considered to be the most likely source of the best rhubarb, but it is not improbable, that other species of the genus rheum, yield much of the rhubarb root imported from the East, and it is certain that different species of rhubarb are cultivated in this country, and on the continent, both for adulterating the genuine article, when in the form of powder, and for simulating it in substance, being "dressed up" in a manner similar to the real root. Dr. Royle says, "The greater part of the rhubarb of commerce, grows in Chinese Chronic rheumatism, properly so called, is such as above described, but the term rheumatism, or rheumatic pain, is also used to a great variety of anomalous pains, and from this has arisen considerable confusion. The best marked of these is "muscular rheumatism," which affects chiefly the thick muscles, such as those of the shoulders, arms, neck, loins, &c. This form of rheumatism often comes on suddenly, after exposure to a current of cold air, sometimes after cold bathing; its chief characteristic is severe pain, when the affected muscles are thrown into action. This muscular rheumatism seems to be a purely local affection, and is generally removable by purely local remedies. Of these, the best is a large hot bran poultice, or some other means of applying heat and moisture, applied over the affected part, for eight or twelve hours; this often at once cures-care must of course be taken, to protect the part to which the heat has been applied by a covering of flan-Tartary, and is gathered in summer from nel. After the hot application is removed, if the heat does not entirely cure, and even instead of it at times, the soap and opium liniment, either alone, or combined with one-third turpentine added, may be used with advantage; two or three tea-spoonfuls being well rubbed into the part every six or eight hours. In situations where other means are wanting, counter-irritation, by means of pieces of metal dipped in boiling water, and applied to the skin, or by means of Dr. Corrigan's hammer-see_Counter-irritation -may be resorted to. In rheumatism of the thick muscles about the shoulder, the use of the acupuncture needles often removes the affection in a strikingly rapid manner, indeed, sometimes in a few minutes. Any notice of rheumatism at the present day must be imperfect, without some allusion to electric and galvanic agencies; galvanic rings, electric chains, &c. That these appliances are at times of apparent service in cases of chronic rheumatism is undoubted, and if such is the case, we are not justified in rejecting their aid, because we cannot exactly explain the why and wherefore of plants six years old. When dug up, it is cleansed, peeled, cut into pieces, bored through the centre, strung on a string, and dried in the sun." A portion of this rhubarb goes to China, the remainder passes through Russia, and is known in this country as Russian or Turkey rhubarb. When genuine, this rhubarb is always a superior drug, chiefly on account of the care bestowed upon the examination of the samples, before they pass the Russian factory, through which they are transferred to the European markets. At this factory the inferior samples of the root, are, or ought to be rejected. Russian or Turkey rhubarb "varies in shape, being irregularly roundish and angular, from the bark having been shaved off with a knife; some pieces are cylindrical, a few flattish, many of them pierced with holes. Externally smooth, of a yellow colour; internally, the texture is rather dense; fracture uneven, irregularly marked with white and red veins, having a strong, and peculiar slightly aromatic odour, a bitter, rather astringent taste, feels gritty when chewed, and produces a powder For infants and children, rhubarb alone, or combined with calomel or grey powder when requisite, forms a most excellent medicine; the chief objections are, the bulk, and taste, which render it sometimes difficult to administer. It should be remembered, that in persons who are taking rhubarb, the urine acquires a deeper colour, from the drug. Rhubarb is sometimes thought to be injurious to persons who suffer from head affections, such a tendency to apoplexy, or epilepsy. The fact is not confirmed. of a bright yellow colour." The grittiness | To make the "tincture of rhubarb :" Take is owing to the presence of numerous crys- of rhubarb sliced, two ounces and a halftals of oxalate of lime, that salt being found saffron, three drachms liquorice root, in the rhubarbs generally. Chinese, or East bruised, six drachms-ginger, bruised, six Indian rhubarb, is probably derived from drachms-proof spirit, two pints-macerate the same source as the Russian, which it for a week and strain. resembles in essentials, although less uniformly good. English rhubarb is cultivated chiefly near Banbury, in Oxfordshire. "It is the kind frequently sold by men dressed up as Turks, as genuine Turkey rhubarb. The pieces vary in shape, some being ovoid, others cylindrical, smoothed externally, and rubbed with a yellow powder, light, rather spongy, with a reddish hue. It is rather mucilaginous in taste, and a little astringent. Its odour feeble, but unpleasant. Few medicines are more extensively used than rhubarb, few are more valuable or safer. The most characteristic action of rhubarb, is that of a mild, but effectual aperient, the action depending upon the amount of the dose; it rarely gripes; it exerts, moreover, a beneficial tonic action upon the stomach. On account of its astringency, rhubarb is apt to leave a tendency to constipation, after its purgative effect is over. Rhubarb may be taken alone, as an aperient, in doses of from ten to thirty grains, either simply mingled with water, or made into pills. Some persons habitually carry a piece of the root in their pockets, and cut off small fragments as they think them required. Infusion of rhubarb, is made according to the London Pharmacopeia, by infusing for two hours, three drachms of the sliced root, in a pint of boiling water. The preparation is too weak for an efficient aperient, but may be used as a stomachic. The compound rhubarb pill, one of the best forms of common aperient we possess, has been already considered-see Pills. The compound rhubarb powder, is better known as Gregory's Powder, or Gregory's Mixture. The - See Gregory's Powder. tincture or compound tincture of rhubarb, is an extensively used, and most valuable remedy, chiefly as a stomachic cordial, and anti-spasmodic; it ought rarely to be given as an aperient, on account of the large amount of spirit which must necessarily be taken with it in this form, by most persons; a few individuals, however, of weak habits, whose bowels are very easily acted upon, find it beneficial, not only for its aperient action, but for its subsequent tonic and astringent powers. When increased action is required in such cases, the tincture of rhubarb and aloes, is a useful preparation. *Royle's Materia Medica. RHUBARB, GARDEN-Is too well known in its numerous varieties to require description; its agreeable acid depends on the presence of the oxalic and malic acids, which it contains abundantly. As a cooling article of diet, it is wholesome for most persons, but some cannot take it without suffering after, from stomach disorder, and others who have any tendency to certain urinary disorders, must most strictly avoid it; indeed, if garden rhubarb is too freely indulged in, it may give rise to urinary irritation. When used as food, garden rhubarb exerts an aperient action upon the bowels. This is increased, if shortly after it has been eaten, a moderate dose of magnesia be swallowed. Refer to-Oxalic Acid. RIBS.-The ribs are the curved bones which inclose the chest. -fig. A.- and upper part of the abdomen. They are twelve in number on each side. Of these the first seven on each side -Fig. A, 1, 1— are directly connected with the breast bone or "sternum"-Fig. A, 3-and are called the true ribs, the remaining five are called the false ribs, of these the upper three are indirectly connected with the breast bone, by means of cartilages attached to the cartilage of the last two ribs, the lowest two -Fig. A, 2, 2-are unconnected with the breast bone, or other ribs in front, and are therefore called floating ribs. The "cartilages"-Fig. A, 4, 4-by which the seven superior ribs are connected with the breast bone, and by which the three upper false ribs, are connected with the cartilage of the last true rib are very elastic in early life; as, however, age advances, they become less so, and ultimately, are converted into bone. The posterior extremity, or head of the rib is attached to the spine-Fig. B.-by means B times its bulk in the dry state. It is unquestionable that rice is well adapted as food to the inhabitants of those warm climates, in which it flourishes so luxuriantly, and that its unstimulating nourishment must be conducive to health, whilst at the same time its blandness, to the palate and stomach, can be corrected by the aromatic condiments which usually grow under the same climate, as that which brings the grain to perfection. In climates like our own, rice, probably, could not form a staple article of food, but as an addition to other food, it is of the highest value, and especially to the food of the young, in the form of puddings, &c., care being taken that the grain is thoroughly cooked, a point not always attended to; nothing can be more indigestible than half cooked rice. In puddings and the like, this is less likely to occur, than when the grain is dressed as a vegetable, and required to present the distinctness of grain. The property of rice, in tending to confine the bowels, renders it a valuable adjunct to sick cookery, when such an effect is required; in this case it is most beneficial in the form of "ground rice," or of riceflour. In cases of diarrhoea, or of irritability of the stomach or bowels, rice water, that is water prepared from rice, as barley-water is from barley, is very useful as a drink. It may be flavoured with lemon-peel, or any other condiment. If the case is a severe one, the solution of a tea-spoonful of isinglass or gelatine in every pint of the "water," is a useful addition. Arrack, a spirit used by the Orientals, is made from rice. Refer to-Grains. RICKETS-is a disease in which the bones lose their earthy constituents, and consequently their natural hardness, become soft like gristle, and somewhat brittle, so that they are not only easily bent, but easily broken. The term rickets is usually applied to this softening, when it occurs in childhood, but a similar disease also of ligaments-Fig. B, 1-which admit of a certain amount of movement. These ligaments are so strong, as completely to resist displacement of the bone by violence, fracture, generally about the angle, taking place instead.-See Fractures. The ribs are likewise attached in front to the breast bone, by means of ligaments, and are connected to each other, by short "inter-attacks adults, especially females. Rickets costal" muscles, which act in the efforts, both of inspiration, and of expiration. RICE. This well known grain, although far below most others of the class in actual nutritive power-not yielding more than 3 or 4 per cent. of plastic nutriment-forms the staple article of food to millions, in warm climates, especially in Asia, and is largely used as an occasional article of diet in this country. Its chief constituent is starch, of which it contains 80 per cent., and when it is cooked in water, it absorbs that fluid so largely, as to swell to many is a constitutional disease, and is very generally associated with a tendency to scrofula, either hereditary, or engendered by poor living and unhealthy influences, such as deficient ventilation and light, impure damp air, and bad food. Rickets may show itself within the first few months after birth, but is more generally perceived when the child first attempts to walk, and the limbs give way under the weight of the body. Coincident with, or rather preceding the evidence of weakness in the bones, the child's general health is observably impaired; there is languor and pallor, with dingy complexion, loss of flesh, tumidity of the belly, impaired or fickle appetite, and unhealthy secretion from the bowels; in fact, the child presents the evidences of progressive scrofulous disease. Not unfrequently there is an approach to the cretin head and features. -See Cretin. It need scarcely be said, that a child, showing the symptoms above detailed, cannot too soon be placed under proper medical attendance, for life and future well-being are at stake. Every means for improving the constitution will be requisite. If the situation is an unhealthy one, removal, if possible, should be effected; if the child is still at the breast, unless there is positive evidence that the milk is of good quality, it should be weaned. Animal broths will probably be required even for infants, certainly, along with animal food, for older children. Clothing will require attention as regards its warmth, and tonic and other medicines, especially iron, must be requisite. For a child of a year old, powders, containing half a grain of grey powder, and three grains of carbonate of iron in each, are a very useful remedy, given twice a day for some time. The above are only general directions, for such a disease as rickets ought always to be under proper medical care. In the later stages, when the bones are very soft, much care will be required in moving, to avoid inflicting either pain or injury. Very many children who become ricketty die, but a certain number recover, and though perhaps with distorted limbs, yet become robust in health, the bones becoming quite firm and strong, even more so than those of other persons. Many children, without becoming the subjects of confirmed rickets, yet exhibit the tendency in an enlarged state of the extremities of the long bones, especially those of the fore-arm, at the wrist. Such an indication ought never to be neglected, every possible means, by change of air, by diet, clothing, and medicine, should be used to improve the child's general health. The powders above recommended will be useful, or five drops of the tincture of muriate of iron may be given twice a day in water, the bowels being regulated by simple aperients, and an occasional dose of grey powder. To resume, it must be borne in mind that rickets is a disease of debility, and of an enfeebled constitution, which every means must be used to counteract. The deficiency of earthy matter in the bones, naturally suggests the use of lime, which may be given in the form of lime-water, along with milk. The use of salt, by the affected children, should be insisted on. Rickets, or softening of the bones in adults, occurs, as might be expected, in the debilitated, and in those of depraved constitution; it is most common in females, and the pregnant state seems to favour its establishment and progress; it has also been thought to be dependent on the gouty and rheumatic constitution. The disease is often preceded by severe pains in the limbs and bones, which are apt to be considered as rheumatic. As in the case of children, rickets or bonesoftening in adults, requires every means to be used for invigorating the constitution, but the proper remedies, and their application, must be regulated by a medical man. When a female has at any period of life been the subject of rickets, the fact may seriously affect the capability of her becoining a mother, either with safety to her own life or that of her child; for as the bones of the pelvis-see Pelvis-partake of the general softening, and yield under pressure, the exit of the child into the world may be rendered impossible or nearly so. The fact should not be lost sight of. Refer to Scrofula, &c. RIGOR is the sudden sensation of cold, accompanied with shaking, or in other words, the "shivering" which precedes the inflammatory stage of many acute diseases. It is probably a nervous affection, for it occurs likewise in many states of the body in which there is neither fever nor inflammation. It is a common symptom of the presence of bile on the stomach; it is a concomitant on the passage of gall-stone or of gravel; it often occurs at the commencement of labour, and may even be caused in a slight degree by certain sounds.-See Shivering. RING-FIXED.-See Finger. RINGWORM.-The real nature of this very troublesome affection of the skin has been the subject of much dispute. By some it has been classed as essentially a "pustular" disease, but the probably correct view is that which regards it as an affection of the hair, and of the hair follicles, and that when pustules do arise, they are the product of continued irritation. The most usual site of the disease is the scalp, but it is apt to appear on, or to extend to the forehead, the neck, the arms, and hands. Generally, the first indications of the presence of ringworm, are the falling or breaking off of the hair which leaves a bald generally circular patch, and the itching which accompanies the disorder. If examined at this time, the patch will be found scurfy, slightly red, with the irregularly broken hairs protruding. If the disease be unchecked by |