General Symptoms. — In the acute form the pain in the joints is so acute, and they are so sensitive to the slightest movement, that the patient dreads even a shaking of the bed he lies on. The joints are swollen, and red as well as painful. A high degree of fever attends the inflammatory affection of the joints; the pulse is full, strong and fast; the tongue is furred; the bowels generally costive; the urine scanty and high colored. The seat of the inflammation is rapidly changed from one joint to another, the pain subsiding to return perhaps as severely as before. Subacute Rheumatism. — In this form the pain is less severe, and there is a slighter amount of fever. It affects more the muscles than the joints. Of this kind are " lumbago," " rheumatic headache," etc. Rheumatic Affection of the Heart. — In the acute form, or " rheumatic fever," the coverings and interior of the heart are prone to become inflamed. The occurrence of this complication may be interred if pain be ieV in the region of the heart, attended with palpitation and difliculty of breathing. Treatment. — The several joints as they are affected should be wrapped round in cotton-wool, covered with gutta-percha tissue or oil-silk, the joint being previously gently rubbed with belladonna liniment. When the pain and inflammation first come on, the patient should, at bed-time, take the following powder: Calomel, 2 grains; Dover's powder, 10 grains. Mix. Next morning the patient should take the following draught: Infusion of senna, 2 ounces; tartrate of potash, 2 drachms; compound spirits of ammonia (salvolatile), one-half drachm. After the bowels have been freely open, the following medicine should be commenced: Bicarbonate of potash, 2 drachms; water, 6 ounces. Mix. Two tablespoonfuls to be taken, either alone or effervescing, with a tablespoonful of lemon juice, three times a day. The addition of ten minims of colchicum wine sometimes aids the effects of this mixture, but it is apt to produce sickness and purging. If there is great pain and want of sleep, or if the bowels are open too much, a grain of opium, or twenty minims of laudanum should be taken every night. The above alkaline mixture should not be continued too long, as it is apt to cause irrita- 360. MEDICINAL. tion of the intestines. As soon as the pain begins to subside, and the urine to assume its usual appearance, it should be stopped, and the following medicine substituted: Sulphate of quinine, i6 grains; dilute sulphuric acid, i drachm; water, 8 ounces. Mix. Two tablespoonfuls three times a day. If there be reason to suspect that the coverings of the heart are affec- ted, a blister should be applied on the front of the chest, over the seat of the heart. A low diet of milk, arrowroot, rice or sage, or beef tea, should be continued throughout the acute stage, with a change to a more liberal diet as the symptoms subside. Chronic Rheumatism. — Symptoms. — The pain of this form of rheumatism is less acute, and is more frequently situated in the muscles or their tendons than in the joints. The parts affected become stiff and painful on movement. There is not often much swelling or inflammation of the joints — except of the small joints, as of the fingers — after the disease has lasted long.

AI-modernized reading of the original text

General Symptoms. — In the acute form the pain in the joints is so acute, and they are so sensitive to the slightest movement, that the patient dreads even a shaking of the bed he lies on. The joints are swollen, and red as well as painful. A high degree of fever attends the inflammatory affection of the joints; the pulse is full, strong and fast; the tongue is furred; the bowels generally costive; the urine scanty and high colored. The seat of the inflammation is rapidly changed from one joint to another, the pain subsiding to return perhaps as severely as before. Subacute Rheumatism. — In this form the pain is less severe, and there is a slighter amount of fever. It affects more the muscles than the joints. Of this kind are " lumbago," " rheumatic headache," etc. Rheumatic Affection of the Heart. — In the acute form, or " rheumatic fever," the coverings and interior of the heart are prone to become inflamed. The occurrence of this complication may be inferred if pain be felt in the region of the heart, attended with palpitation and difliculty of breathing. Treatment. — The several joints as they are affected should be wrapped round in cotton-wool, covered with gutta-percha tissue or oil-silk, the joint being previously gently rubbed with belladonna liniment. When the pain and inflammation first come on, the patient should, at bed-time, take the following powder: Calomel, 2 grains; Dover's powder, 10 grains. Mix. Next morning the patient should take the following draught: Infusion of senna, 2 ounces; tartrate of potash, 2 drachms; compound spirits of ammonia (salvolatile), one-half drachm. After the bowels have been freely open, the following medicine should be commenced: Bicarbonate of potash, 2 drachms; water, 6 ounces. Mix. Two tablespoonfuls to be taken, either alone or effervescing, with a tablespoonful of lemon juice, three times a day. The addition of ten minims of colchicum wine sometimes aids the effects of this mixture, but it is apt to produce sickness and purging. If there is great pain and want of sleep, or if the bowels are open too much, a grain of opium, or twenty minims of laudanum should be taken every night. The above alkaline mixture should not be continued too long, as it is apt to cause irrita- tion of the intestines. As soon as the pain begins to subside, and the urine to assume its usual appearance, it should be stopped, and the following medicine substituted: Sulphate of quinine, i6 grains; dilute sulphuric acid, i drachm; water, 8 ounces. Mix. Two tablespoonfuls three times a day. If there be reason to suspect that the coverings of the heart are affected, a blister should be applied on the front of the chest, over the seat of the heart. A low diet of milk, arrowroot, rice or sage, or beef tea, should be continued throughout the acute stage, with a change to a more liberal diet as the symptoms subside. Chronic Rheumatism. — Symptoms. — The pain of this form of rheumatism is less acute, and is more frequently situated in the muscles or their tendons than in the joints. The parts affected become stiff and painful on movement. There is not often much swelling or inflammation of the joints — except of the small joints, as of the fingers — after the disease has lasted long.

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