Chapter XI.Of the Rheumatism.Sect.163.The Rheumatism may exist either with or without a Fever. The first of these may be classed among the Diseases, of which I have already treated; being an Inflammation which is manifested by a violent Fever, preceded by Shivering, a subsequent Heat, hard Pulse, and a Head-ach. Sometimes indeed an extraordinary Coldness, with general Uneasiness and Inquietude, exists several Days before the Fever is perceived. On the second or third Day, and sometimes even on the first, the Patient is seized with a violent Pain in some Part of his Body, but especially about the Joints, which entirely prevents their Motion, and which is often accompanied with Heat, Redness and a Swelling of the Part. The Knee is often the first Part attacked, and sometimes both the Knees at once. When the Pain is fixed, an Abatement of the Fever frequently happens; though in some other Persons it continues for several Days, and increases every Evening. The Pain diminishes in one Part after a Duration of some Days, and then invades some other. From the Knee itdescends to the Foot, or mounts to the Hip, to the Loins, the Shoulder-blades, Elbow, Wrist, the Nape of the Neck, and frequently is felt in the intermediate Parts. Sometimes one Part is quite free from Pain, when another is attacked; at other Times many Parts are seized nearly at the same Instant; and I have sometimes seen every Joint afflicted at once. In this Case the Patient is in a very terrible Situation, being incapable of any Motion, and even dreading the Assistance of his Attendants, as he can scarcely admit of touching, without a sensible Aggravation of his Pains. He is unable to bear even the Weight of the Bed-clothes, which must be, as it were, arched over his Limbs by a proper Contrivance, to prevent their Pressure: and the very walking across the Chamber increases his Torments. The Parts in which they are the most excruciating, and obstinate, are the Region of the Loins, the Hips, and the Nape or hinder Part of the Neck.§ 164. This Disease is also often extended over the Scalp and the Surface of the Head; and there the Pains are excessive. I have seen them affect the Eyelids and the Teeth with inexpressible Torment. As long as the Distemper is situated in the more external Parts, the Patient, however painful his Situation may prove, is in no great Danger, if he be properly treated: but if by some Accident, some Error, or by any latent Cause, the Disease be repelled upon an internal Part or Organ, his Case is extremely dangerous. If the Brain is attacked, a frantic ragingDeliriumis the Consequence; if it falls upon the Lungs, the Patient is suffocated: and if it attacks the Stomach or the Bowels, it is attended with the most astonishing Pains, which are caused by the Inflammation of those Parts, and which Inflammation, if violent, is40speedily fatal. About two Years since I was called to a robust Man, whose Guts were already in a gangrenous State, which was the Consequence of a Rheumatism, that first attacked one Arm and one Knee; the Cure of which had been attempted by sweating the Patient with some hot Remedies. These indeed brought on a plentiful Sweat; but the inflammatory Humour seized the Intestines, whose Inflammation degenerated into a Gangrene, after a Duration of the most acute Pain for thirty-six Hours; his Torments terminating in Death two Hours after I saw him.§ 165. This Malady however is often in a less violent Degree; the Fever is but moderate, and ceases entirely when the Pain begins; which is also confined to one, or not more than two Parts.§ 166. If the Disease continues fixed, for a considerable Time, in one Joint, the Motion of it is impaired for Life. I have seen a Person, who has now a wry Neck, of twenty Years standing, in Consequence of a Rheumatism in the Nape of the Neck; and I also saw a poor young Man fromJurat, who was Bed-ridden, and who had lost the Motion of one Hip and both Knees.He could neither stand nor sit, and there were but a few Postures in which he could even lie in Bed.§ 167. An obstructed Perspiration, an inflammatory Thickness of the Blood, constitute the most general Cause of the Rheumatism. This last concurring Cause is that we must immediately encounter; since, as long as that subsists, Perspiration cannot be perfectly re-established, which follows of Course, when the Inflammation is cured. For which Reason this Distemper must be conducted like the other inflammatory ones, of which I have already treated.§ 168. As soon as it is sufficiently manifest, the GlysterNº. 5, should be injected; and twelve Ounces of Blood be taken from the Arm an Hour after. The Patient is to enter upon a Regimen, and drink plentifully of the PtisanNº. 2, and of Almond Milk or EmulsionNº. 4. As this last Medicine may be too costly in Country Places for the poor Peasantry; they may drink, in Lieu of it, very clear Whey, sweetened with a little Honey. I have known a very severe Rheumatism cured, after twice bleeding, without any other Food or Medicine, for the Space of thirteen Days. The Whey also may be happily used by Way of Glyster.§ 169. If the Distemper is not considerably asswaged by the first Bleeding, it should be repeated some Hours after. I have ordered it four Times within the first two Days; and some Days after I have even directed a fifth Bleeding.But in general the Hardness of the Pulse becomes less after the second: and notwithstanding the Pains may continue as severe as before, yet the Patient is sensible of less Inquietude. The Glyster must be repeated every Day, and even twice a Day, if each of them is attended only with a small Discharge; and particularly if there be a violent Head-ach. In such Cases as are excessively painful, the Patient can scarcely dispose himself into a proper Attitude or Posture to receive Glysters: and in such Circumstances his Drinks should be made as opening as possible; and a Dose of the Cream of TartarNº. 24should be given Night and Morning. This very Medicine, with the Assistance of Whey, cured two Persons I advised it to, of rheumatic Pains, of which they had been infested with frequent Returns for many Years, and which were attended with a small Fever.Apples coddled, Prunes stewed, and well ripened Summer Fruits are the properest Nourishment in this Disease.We may save the Sick a good deal of Pain, by putting one strong Towel always under their Back, and another under their Thighs, in order to move them the more easily. When their Hands are without Pain, a third Towel hung upon a Cord, which is fastened across the Bed, must considerably assist them in moving themselves.§ 170. When the Fever entirely disappears, and the Hardness of the Pulse is removed, I haveordered the PurgeNº. 23with a very good Effect; and if it is attended with five or six Motions, the Patient is very sensibly relieved. The Day but one after it may be repeated successfully, and a third Time, after an Interval of a greater Number of Days.§ 171. When the Pains are extremely violent, they admit of no Application: Vapour-Baths however may be employed, and provided they are often used, and for a considerable Time, they prove very efficacious. The Purpose of these Baths is only to convey the Steam of boiling Water to the Parts affected; which may always easily be effected, by a Variety of simple and easy Contrivances; the Choice of which must depend on the different Circumstances and Situation of the Sick.Whenever it is possible, some of the emollientApplicationsNº. 9, should be continually employed. A half Bath, or an entire Bath of warm Water, in which the Patient should remain an Hour, after sufficient Bleedings and many Glysters, affords the greatest Relief. I have seen a Patient, under the most acute Pains of the Loins, of the Hips, and of one Knee, put into one. He continued still under extreme Torment in the Bath, and on being taken out of it: but an Hour after he had been put to Bed, he sweated, to an incredible Quantity, for thirty six Hours, and was cured. The Bath should never be made use of, until after repeated Bleedings, or at least otherequivalent Evacuations: for otherwise timed, it would aggravate the Disease.§ 172. The Pains are generally most severe in the Night; whence it has been usual to give composing soporific Medicines. This however has been very erroneous, as Opiates really augment the Cause of the Disease, and destroy the Efficacy of the proper Remedies: and, even not seldom, far from asswaging the Pains, they increase them. Indeed they agree so little in this Disease, that even the Patient's natural Sleep at the Invasion of this Complaint, is rather to his Detriment. They feel, the very Moment they are dropping asleep, such violent Jirks as awaken them with great Pain: or if they do sleep a few Minutes, the Pains are stronger when they awake.§ 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 of41Matter 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 evenMonths; 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 tooperate. Nevertheless they should never be used where the Pulse is hard. The PowderNº. 25answers 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 theSciatica. 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 of42Burdock RootsNº. 26. 3. Four or five Days after drinking abundantly of this, the purging43PowderNº. 21may 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 ElectuaryCaryocostinum, 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.§ 182. When general Remedies have been used, and the Disorder still continues, Recourse should be had to such Medicines, as are available to restore Perspiration; and these should be persisted in for a considerable Time. The PillsNº. 18, with a strong Infusion of Elder Flowers, have often succeeded in this Respect: and then after a long Continuance of diluting Drinks, if the Fever is entirely subdued; if the Stomach exerts its Functions well; the Patient is no ways costive; if he is not of a dry Habit of Body; and the Part affected remains without Inflammation,the Patient may safely takethe PowderNº. 29, at Night going to Bed, with a Cup or two of an Infusion ofCarduus benedictus, or the blessed Thistle, and a Morsel of Venice Treacle of the Size of a Hazel Nut, or a Filberd. This Remedy brings on a very copious Sweating, which often expells the44Disease. These Sweats may be rendered full more effectual, by wrapping up the affected Part in a Flanel dipt in the DecoctionNº. 27.§ 183. But of all these Pains, the Sciatica is one of the most tedious and obstinate. Nevertheless I have seen the greatest Success, from the Application of seven or eight Cupping-Glasses on the tormented Part; by which, without the Assistance of any other Remedy, I have cured, in a few Hours, Sciaticas of many Years standing, which had baffled other Remedies. Blisters, or any such stimulating Plaisters, as bring on a Suppuration and Discharge from the afflicted Part, contribute also frequently to the Cure; tho' less effectually than Cupping, which should be repeated several Times. Green Cere-cloth, commonly called Oil-cloth, (whether the Ingredients be spread on Taffety or on Linen) being applied to the diseased Part, disposes it to sweat abundantly, and thus to discharge the sharp Humour which occasions the Pain.Sometimes both theseApplications, but especially that spread on Silk (which may be applied more exactly and closely to the Part, and which is also spread with a different Composition) raise a little Vesication on the Part as Blisters do. A Plaister of Quicklime and Honey blended together has cured inveterate Sciaticas. Oil of Eggs has sometimes succeeded in such Cases. A Seton has also been successfully made in the lower Part of the Thigh. Finally some Pains, which have not yielded to any of these Applications, have been cured by actual burning, inflicted on the very Spot, where the most violent Pain has been felt; except some particular Reason, drawn from an anatomical Knowlege of the Part, should determine the Surgeon not to apply it there. The Scull or Head should never be cauterized with a burning Iron.§ 184. The hot Baths ofBourbon,Plombiers,Aix-la-Chapelleand many others are often very efficacious in these chronical Pains: notwithstanding I really think, there is no rheumatic Pain that may not be cured without them. The common People substitute to these a Bath made of the Husk of Grapes, after their Juice is expressed, which cures some by making them sweat abundantly. Cold Baths however are the best to keep off this Disease; but then they cannot always be safely ventured on. Many Circumstances render the Use of them impracticable to particular Persons. Such as are subject to this chronical Rheumatism, would do very well to rub their whole Bodies every Morning, if theycould, but especially the afflicted Parts, with Flanel. This Habit keeps up Perspiration beyond any other Assistance; and indeed sometimes even increases it too much. It would be serviceable too, if such Subjects of this cruel Disease wore Flanel all over their Skin, during the Winter.After a violent Rheumatism, People should long be careful to avoid that cold and moist Air, which disposes them to relapse.§ 185. Rheumatic People have too frequent a Recourse to very improper and hurtful Medicines, in this Distemper, which daily produce very bad Consequences. Such are spirituous Medicines, Brandy, and Arquebusade Water. They either render the Pain more obstinate and fixed, by hardening the Skin; or they repell the Humour to some inward Part. And Instances are not wanting of Persons who have died suddenly, from the Application of Spirit of Wine upon the Parts, that were violently afflicted with the Rheumatism. It also happens sometimes that the Humour, having no Outlet through the Skin, is thrown internally on the Bone and affects it. A very singular Fact occurred in this Respect, an Account of which may be serviceable to some Persons afflicted with the Disease. A Woman at Night was chaffing the Arm of her Husband, who had the Rheumatism there, with Spirit of Wine; when a very lucky Accident prevented the Mischief she might have occasioned by it. The Spirit of Wine took Fire from the Flame of the Candle she made use of, and burned the diseased Part. It wasdrest of Course, and the Suppuration that attended it, entirely cured the Rheumatism.Sharp and greasy Unctions or Ointments produce very bad Effects, and are equally dangerous. ACaries, a Rottenness of the Bones, has ensued upon the Use of a Medicine called, The Balsam of Sulphur with Turpentine. I was consulted in 1750, three Days before her Decease, about a Woman, who had long endured acute rheumatic Pains. She had taken various Medicines, and, among the rest, a considerable Quantity of a Ptisan, in which Antimony was blended with some purging Medicines, and a greasy spirituous Balsam had been rubbed into the Part. The Fever, the Pains, and the Dryness of the Skin soon increased; the Bones of the Thighs and Arms became carious: and in moving the Patient no more than was necessary for her Relief and Convenience, without taking her out of her Bed, both Thighs and one Arm broke. So dreadful an Example should make People cautious of giving or applying Medicines inconsiderately, even in such Diseases, as appear but trifling in themselves. I must also inform the Readers, there are some rheumatic Pains, which admit of no Application; and that almost every Medicine aggravates them. In such Cases the afflicted must content themselves with keeping the Parts affected from the Impressions of the Air, by a Flanel, or the Skin of some Animal with the Fur on.It is also more advisable sometimes to leave a sufferable and inveterate Pain to itself, especially in old or weakly People, than to employ too many Medicines, or such violent ones, as should affect them more importantly than the Pains did.§ 186. If the Duration of the Pains fixed in the same Place, should cause some Degree of Stiffness in the Joint affected, it should be exposed twice a Day to the Vapour of warm Water, and dried well afterwards with hot Linen: then it should be well chaffed, and lastly touched over with Ointment of Marsh-mallows. Pumping, if superadded to this Vapour, considerably increases its Efficacy. I directed, for a Case of this Sort, a very simple Machine of white Tin, or Lattin, which combined the Application of the Steam and the Pump.§ 187. Very young Children are sometimes subject to such violent and extended Pains, that they cannot bear touching in any Part, without excessive Crying. We must be careful to avoid mistaking these Cases, and not to treat them like Rheumatisms. They sometimes are owing to Worms, and go off when these have been discharged.
Chapter XI.Of the Rheumatism.Sect.163.The Rheumatism may exist either with or without a Fever. The first of these may be classed among the Diseases, of which I have already treated; being an Inflammation which is manifested by a violent Fever, preceded by Shivering, a subsequent Heat, hard Pulse, and a Head-ach. Sometimes indeed an extraordinary Coldness, with general Uneasiness and Inquietude, exists several Days before the Fever is perceived. On the second or third Day, and sometimes even on the first, the Patient is seized with a violent Pain in some Part of his Body, but especially about the Joints, which entirely prevents their Motion, and which is often accompanied with Heat, Redness and a Swelling of the Part. The Knee is often the first Part attacked, and sometimes both the Knees at once. When the Pain is fixed, an Abatement of the Fever frequently happens; though in some other Persons it continues for several Days, and increases every Evening. The Pain diminishes in one Part after a Duration of some Days, and then invades some other. From the Knee itdescends to the Foot, or mounts to the Hip, to the Loins, the Shoulder-blades, Elbow, Wrist, the Nape of the Neck, and frequently is felt in the intermediate Parts. Sometimes one Part is quite free from Pain, when another is attacked; at other Times many Parts are seized nearly at the same Instant; and I have sometimes seen every Joint afflicted at once. In this Case the Patient is in a very terrible Situation, being incapable of any Motion, and even dreading the Assistance of his Attendants, as he can scarcely admit of touching, without a sensible Aggravation of his Pains. He is unable to bear even the Weight of the Bed-clothes, which must be, as it were, arched over his Limbs by a proper Contrivance, to prevent their Pressure: and the very walking across the Chamber increases his Torments. The Parts in which they are the most excruciating, and obstinate, are the Region of the Loins, the Hips, and the Nape or hinder Part of the Neck.§ 164. This Disease is also often extended over the Scalp and the Surface of the Head; and there the Pains are excessive. I have seen them affect the Eyelids and the Teeth with inexpressible Torment. As long as the Distemper is situated in the more external Parts, the Patient, however painful his Situation may prove, is in no great Danger, if he be properly treated: but if by some Accident, some Error, or by any latent Cause, the Disease be repelled upon an internal Part or Organ, his Case is extremely dangerous. If the Brain is attacked, a frantic ragingDeliriumis the Consequence; if it falls upon the Lungs, the Patient is suffocated: and if it attacks the Stomach or the Bowels, it is attended with the most astonishing Pains, which are caused by the Inflammation of those Parts, and which Inflammation, if violent, is40speedily fatal. About two Years since I was called to a robust Man, whose Guts were already in a gangrenous State, which was the Consequence of a Rheumatism, that first attacked one Arm and one Knee; the Cure of which had been attempted by sweating the Patient with some hot Remedies. These indeed brought on a plentiful Sweat; but the inflammatory Humour seized the Intestines, whose Inflammation degenerated into a Gangrene, after a Duration of the most acute Pain for thirty-six Hours; his Torments terminating in Death two Hours after I saw him.§ 165. This Malady however is often in a less violent Degree; the Fever is but moderate, and ceases entirely when the Pain begins; which is also confined to one, or not more than two Parts.§ 166. If the Disease continues fixed, for a considerable Time, in one Joint, the Motion of it is impaired for Life. I have seen a Person, who has now a wry Neck, of twenty Years standing, in Consequence of a Rheumatism in the Nape of the Neck; and I also saw a poor young Man fromJurat, who was Bed-ridden, and who had lost the Motion of one Hip and both Knees.He could neither stand nor sit, and there were but a few Postures in which he could even lie in Bed.§ 167. An obstructed Perspiration, an inflammatory Thickness of the Blood, constitute the most general Cause of the Rheumatism. This last concurring Cause is that we must immediately encounter; since, as long as that subsists, Perspiration cannot be perfectly re-established, which follows of Course, when the Inflammation is cured. For which Reason this Distemper must be conducted like the other inflammatory ones, of which I have already treated.§ 168. As soon as it is sufficiently manifest, the GlysterNº. 5, should be injected; and twelve Ounces of Blood be taken from the Arm an Hour after. The Patient is to enter upon a Regimen, and drink plentifully of the PtisanNº. 2, and of Almond Milk or EmulsionNº. 4. As this last Medicine may be too costly in Country Places for the poor Peasantry; they may drink, in Lieu of it, very clear Whey, sweetened with a little Honey. I have known a very severe Rheumatism cured, after twice bleeding, without any other Food or Medicine, for the Space of thirteen Days. The Whey also may be happily used by Way of Glyster.§ 169. If the Distemper is not considerably asswaged by the first Bleeding, it should be repeated some Hours after. I have ordered it four Times within the first two Days; and some Days after I have even directed a fifth Bleeding.But in general the Hardness of the Pulse becomes less after the second: and notwithstanding the Pains may continue as severe as before, yet the Patient is sensible of less Inquietude. The Glyster must be repeated every Day, and even twice a Day, if each of them is attended only with a small Discharge; and particularly if there be a violent Head-ach. In such Cases as are excessively painful, the Patient can scarcely dispose himself into a proper Attitude or Posture to receive Glysters: and in such Circumstances his Drinks should be made as opening as possible; and a Dose of the Cream of TartarNº. 24should be given Night and Morning. This very Medicine, with the Assistance of Whey, cured two Persons I advised it to, of rheumatic Pains, of which they had been infested with frequent Returns for many Years, and which were attended with a small Fever.Apples coddled, Prunes stewed, and well ripened Summer Fruits are the properest Nourishment in this Disease.We may save the Sick a good deal of Pain, by putting one strong Towel always under their Back, and another under their Thighs, in order to move them the more easily. When their Hands are without Pain, a third Towel hung upon a Cord, which is fastened across the Bed, must considerably assist them in moving themselves.§ 170. When the Fever entirely disappears, and the Hardness of the Pulse is removed, I haveordered the PurgeNº. 23with a very good Effect; and if it is attended with five or six Motions, the Patient is very sensibly relieved. The Day but one after it may be repeated successfully, and a third Time, after an Interval of a greater Number of Days.§ 171. When the Pains are extremely violent, they admit of no Application: Vapour-Baths however may be employed, and provided they are often used, and for a considerable Time, they prove very efficacious. The Purpose of these Baths is only to convey the Steam of boiling Water to the Parts affected; which may always easily be effected, by a Variety of simple and easy Contrivances; the Choice of which must depend on the different Circumstances and Situation of the Sick.Whenever it is possible, some of the emollientApplicationsNº. 9, should be continually employed. A half Bath, or an entire Bath of warm Water, in which the Patient should remain an Hour, after sufficient Bleedings and many Glysters, affords the greatest Relief. I have seen a Patient, under the most acute Pains of the Loins, of the Hips, and of one Knee, put into one. He continued still under extreme Torment in the Bath, and on being taken out of it: but an Hour after he had been put to Bed, he sweated, to an incredible Quantity, for thirty six Hours, and was cured. The Bath should never be made use of, until after repeated Bleedings, or at least otherequivalent Evacuations: for otherwise timed, it would aggravate the Disease.§ 172. The Pains are generally most severe in the Night; whence it has been usual to give composing soporific Medicines. This however has been very erroneous, as Opiates really augment the Cause of the Disease, and destroy the Efficacy of the proper Remedies: and, even not seldom, far from asswaging the Pains, they increase them. Indeed they agree so little in this Disease, that even the Patient's natural Sleep at the Invasion of this Complaint, is rather to his Detriment. They feel, the very Moment they are dropping asleep, such violent Jirks as awaken them with great Pain: or if they do sleep a few Minutes, the Pains are stronger when they awake.§ 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 of41Matter 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 evenMonths; 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 tooperate. Nevertheless they should never be used where the Pulse is hard. The PowderNº. 25answers 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 theSciatica. 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 of42Burdock RootsNº. 26. 3. Four or five Days after drinking abundantly of this, the purging43PowderNº. 21may 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 ElectuaryCaryocostinum, 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.§ 182. When general Remedies have been used, and the Disorder still continues, Recourse should be had to such Medicines, as are available to restore Perspiration; and these should be persisted in for a considerable Time. The PillsNº. 18, with a strong Infusion of Elder Flowers, have often succeeded in this Respect: and then after a long Continuance of diluting Drinks, if the Fever is entirely subdued; if the Stomach exerts its Functions well; the Patient is no ways costive; if he is not of a dry Habit of Body; and the Part affected remains without Inflammation,the Patient may safely takethe PowderNº. 29, at Night going to Bed, with a Cup or two of an Infusion ofCarduus benedictus, or the blessed Thistle, and a Morsel of Venice Treacle of the Size of a Hazel Nut, or a Filberd. This Remedy brings on a very copious Sweating, which often expells the44Disease. These Sweats may be rendered full more effectual, by wrapping up the affected Part in a Flanel dipt in the DecoctionNº. 27.§ 183. But of all these Pains, the Sciatica is one of the most tedious and obstinate. Nevertheless I have seen the greatest Success, from the Application of seven or eight Cupping-Glasses on the tormented Part; by which, without the Assistance of any other Remedy, I have cured, in a few Hours, Sciaticas of many Years standing, which had baffled other Remedies. Blisters, or any such stimulating Plaisters, as bring on a Suppuration and Discharge from the afflicted Part, contribute also frequently to the Cure; tho' less effectually than Cupping, which should be repeated several Times. Green Cere-cloth, commonly called Oil-cloth, (whether the Ingredients be spread on Taffety or on Linen) being applied to the diseased Part, disposes it to sweat abundantly, and thus to discharge the sharp Humour which occasions the Pain.Sometimes both theseApplications, but especially that spread on Silk (which may be applied more exactly and closely to the Part, and which is also spread with a different Composition) raise a little Vesication on the Part as Blisters do. A Plaister of Quicklime and Honey blended together has cured inveterate Sciaticas. Oil of Eggs has sometimes succeeded in such Cases. A Seton has also been successfully made in the lower Part of the Thigh. Finally some Pains, which have not yielded to any of these Applications, have been cured by actual burning, inflicted on the very Spot, where the most violent Pain has been felt; except some particular Reason, drawn from an anatomical Knowlege of the Part, should determine the Surgeon not to apply it there. The Scull or Head should never be cauterized with a burning Iron.§ 184. The hot Baths ofBourbon,Plombiers,Aix-la-Chapelleand many others are often very efficacious in these chronical Pains: notwithstanding I really think, there is no rheumatic Pain that may not be cured without them. The common People substitute to these a Bath made of the Husk of Grapes, after their Juice is expressed, which cures some by making them sweat abundantly. Cold Baths however are the best to keep off this Disease; but then they cannot always be safely ventured on. Many Circumstances render the Use of them impracticable to particular Persons. Such as are subject to this chronical Rheumatism, would do very well to rub their whole Bodies every Morning, if theycould, but especially the afflicted Parts, with Flanel. This Habit keeps up Perspiration beyond any other Assistance; and indeed sometimes even increases it too much. It would be serviceable too, if such Subjects of this cruel Disease wore Flanel all over their Skin, during the Winter.After a violent Rheumatism, People should long be careful to avoid that cold and moist Air, which disposes them to relapse.§ 185. Rheumatic People have too frequent a Recourse to very improper and hurtful Medicines, in this Distemper, which daily produce very bad Consequences. Such are spirituous Medicines, Brandy, and Arquebusade Water. They either render the Pain more obstinate and fixed, by hardening the Skin; or they repell the Humour to some inward Part. And Instances are not wanting of Persons who have died suddenly, from the Application of Spirit of Wine upon the Parts, that were violently afflicted with the Rheumatism. It also happens sometimes that the Humour, having no Outlet through the Skin, is thrown internally on the Bone and affects it. A very singular Fact occurred in this Respect, an Account of which may be serviceable to some Persons afflicted with the Disease. A Woman at Night was chaffing the Arm of her Husband, who had the Rheumatism there, with Spirit of Wine; when a very lucky Accident prevented the Mischief she might have occasioned by it. The Spirit of Wine took Fire from the Flame of the Candle she made use of, and burned the diseased Part. It wasdrest of Course, and the Suppuration that attended it, entirely cured the Rheumatism.Sharp and greasy Unctions or Ointments produce very bad Effects, and are equally dangerous. ACaries, a Rottenness of the Bones, has ensued upon the Use of a Medicine called, The Balsam of Sulphur with Turpentine. I was consulted in 1750, three Days before her Decease, about a Woman, who had long endured acute rheumatic Pains. She had taken various Medicines, and, among the rest, a considerable Quantity of a Ptisan, in which Antimony was blended with some purging Medicines, and a greasy spirituous Balsam had been rubbed into the Part. The Fever, the Pains, and the Dryness of the Skin soon increased; the Bones of the Thighs and Arms became carious: and in moving the Patient no more than was necessary for her Relief and Convenience, without taking her out of her Bed, both Thighs and one Arm broke. So dreadful an Example should make People cautious of giving or applying Medicines inconsiderately, even in such Diseases, as appear but trifling in themselves. I must also inform the Readers, there are some rheumatic Pains, which admit of no Application; and that almost every Medicine aggravates them. In such Cases the afflicted must content themselves with keeping the Parts affected from the Impressions of the Air, by a Flanel, or the Skin of some Animal with the Fur on.It is also more advisable sometimes to leave a sufferable and inveterate Pain to itself, especially in old or weakly People, than to employ too many Medicines, or such violent ones, as should affect them more importantly than the Pains did.§ 186. If the Duration of the Pains fixed in the same Place, should cause some Degree of Stiffness in the Joint affected, it should be exposed twice a Day to the Vapour of warm Water, and dried well afterwards with hot Linen: then it should be well chaffed, and lastly touched over with Ointment of Marsh-mallows. Pumping, if superadded to this Vapour, considerably increases its Efficacy. I directed, for a Case of this Sort, a very simple Machine of white Tin, or Lattin, which combined the Application of the Steam and the Pump.§ 187. Very young Children are sometimes subject to such violent and extended Pains, that they cannot bear touching in any Part, without excessive Crying. We must be careful to avoid mistaking these Cases, and not to treat them like Rheumatisms. They sometimes are owing to Worms, and go off when these have been discharged.
Of the Rheumatism.
Sect.163.
Sect.163.
The Rheumatism may exist either with or without a Fever. The first of these may be classed among the Diseases, of which I have already treated; being an Inflammation which is manifested by a violent Fever, preceded by Shivering, a subsequent Heat, hard Pulse, and a Head-ach. Sometimes indeed an extraordinary Coldness, with general Uneasiness and Inquietude, exists several Days before the Fever is perceived. On the second or third Day, and sometimes even on the first, the Patient is seized with a violent Pain in some Part of his Body, but especially about the Joints, which entirely prevents their Motion, and which is often accompanied with Heat, Redness and a Swelling of the Part. The Knee is often the first Part attacked, and sometimes both the Knees at once. When the Pain is fixed, an Abatement of the Fever frequently happens; though in some other Persons it continues for several Days, and increases every Evening. The Pain diminishes in one Part after a Duration of some Days, and then invades some other. From the Knee itdescends to the Foot, or mounts to the Hip, to the Loins, the Shoulder-blades, Elbow, Wrist, the Nape of the Neck, and frequently is felt in the intermediate Parts. Sometimes one Part is quite free from Pain, when another is attacked; at other Times many Parts are seized nearly at the same Instant; and I have sometimes seen every Joint afflicted at once. In this Case the Patient is in a very terrible Situation, being incapable of any Motion, and even dreading the Assistance of his Attendants, as he can scarcely admit of touching, without a sensible Aggravation of his Pains. He is unable to bear even the Weight of the Bed-clothes, which must be, as it were, arched over his Limbs by a proper Contrivance, to prevent their Pressure: and the very walking across the Chamber increases his Torments. The Parts in which they are the most excruciating, and obstinate, are the Region of the Loins, the Hips, and the Nape or hinder Part of the Neck.
§ 164. This Disease is also often extended over the Scalp and the Surface of the Head; and there the Pains are excessive. I have seen them affect the Eyelids and the Teeth with inexpressible Torment. As long as the Distemper is situated in the more external Parts, the Patient, however painful his Situation may prove, is in no great Danger, if he be properly treated: but if by some Accident, some Error, or by any latent Cause, the Disease be repelled upon an internal Part or Organ, his Case is extremely dangerous. If the Brain is attacked, a frantic ragingDeliriumis the Consequence; if it falls upon the Lungs, the Patient is suffocated: and if it attacks the Stomach or the Bowels, it is attended with the most astonishing Pains, which are caused by the Inflammation of those Parts, and which Inflammation, if violent, is40speedily fatal. About two Years since I was called to a robust Man, whose Guts were already in a gangrenous State, which was the Consequence of a Rheumatism, that first attacked one Arm and one Knee; the Cure of which had been attempted by sweating the Patient with some hot Remedies. These indeed brought on a plentiful Sweat; but the inflammatory Humour seized the Intestines, whose Inflammation degenerated into a Gangrene, after a Duration of the most acute Pain for thirty-six Hours; his Torments terminating in Death two Hours after I saw him.
§ 165. This Malady however is often in a less violent Degree; the Fever is but moderate, and ceases entirely when the Pain begins; which is also confined to one, or not more than two Parts.
§ 166. If the Disease continues fixed, for a considerable Time, in one Joint, the Motion of it is impaired for Life. I have seen a Person, who has now a wry Neck, of twenty Years standing, in Consequence of a Rheumatism in the Nape of the Neck; and I also saw a poor young Man fromJurat, who was Bed-ridden, and who had lost the Motion of one Hip and both Knees.He could neither stand nor sit, and there were but a few Postures in which he could even lie in Bed.
§ 167. An obstructed Perspiration, an inflammatory Thickness of the Blood, constitute the most general Cause of the Rheumatism. This last concurring Cause is that we must immediately encounter; since, as long as that subsists, Perspiration cannot be perfectly re-established, which follows of Course, when the Inflammation is cured. For which Reason this Distemper must be conducted like the other inflammatory ones, of which I have already treated.
§ 168. As soon as it is sufficiently manifest, the GlysterNº. 5, should be injected; and twelve Ounces of Blood be taken from the Arm an Hour after. The Patient is to enter upon a Regimen, and drink plentifully of the PtisanNº. 2, and of Almond Milk or EmulsionNº. 4. As this last Medicine may be too costly in Country Places for the poor Peasantry; they may drink, in Lieu of it, very clear Whey, sweetened with a little Honey. I have known a very severe Rheumatism cured, after twice bleeding, without any other Food or Medicine, for the Space of thirteen Days. The Whey also may be happily used by Way of Glyster.
§ 169. If the Distemper is not considerably asswaged by the first Bleeding, it should be repeated some Hours after. I have ordered it four Times within the first two Days; and some Days after I have even directed a fifth Bleeding.But in general the Hardness of the Pulse becomes less after the second: and notwithstanding the Pains may continue as severe as before, yet the Patient is sensible of less Inquietude. The Glyster must be repeated every Day, and even twice a Day, if each of them is attended only with a small Discharge; and particularly if there be a violent Head-ach. In such Cases as are excessively painful, the Patient can scarcely dispose himself into a proper Attitude or Posture to receive Glysters: and in such Circumstances his Drinks should be made as opening as possible; and a Dose of the Cream of TartarNº. 24should be given Night and Morning. This very Medicine, with the Assistance of Whey, cured two Persons I advised it to, of rheumatic Pains, of which they had been infested with frequent Returns for many Years, and which were attended with a small Fever.
Apples coddled, Prunes stewed, and well ripened Summer Fruits are the properest Nourishment in this Disease.
We may save the Sick a good deal of Pain, by putting one strong Towel always under their Back, and another under their Thighs, in order to move them the more easily. When their Hands are without Pain, a third Towel hung upon a Cord, which is fastened across the Bed, must considerably assist them in moving themselves.
§ 170. When the Fever entirely disappears, and the Hardness of the Pulse is removed, I haveordered the PurgeNº. 23with a very good Effect; and if it is attended with five or six Motions, the Patient is very sensibly relieved. The Day but one after it may be repeated successfully, and a third Time, after an Interval of a greater Number of Days.
§ 171. When the Pains are extremely violent, they admit of no Application: Vapour-Baths however may be employed, and provided they are often used, and for a considerable Time, they prove very efficacious. The Purpose of these Baths is only to convey the Steam of boiling Water to the Parts affected; which may always easily be effected, by a Variety of simple and easy Contrivances; the Choice of which must depend on the different Circumstances and Situation of the Sick.
Whenever it is possible, some of the emollientApplicationsNº. 9, should be continually employed. A half Bath, or an entire Bath of warm Water, in which the Patient should remain an Hour, after sufficient Bleedings and many Glysters, affords the greatest Relief. I have seen a Patient, under the most acute Pains of the Loins, of the Hips, and of one Knee, put into one. He continued still under extreme Torment in the Bath, and on being taken out of it: but an Hour after he had been put to Bed, he sweated, to an incredible Quantity, for thirty six Hours, and was cured. The Bath should never be made use of, until after repeated Bleedings, or at least otherequivalent Evacuations: for otherwise timed, it would aggravate the Disease.
§ 172. The Pains are generally most severe in the Night; whence it has been usual to give composing soporific Medicines. This however has been very erroneous, as Opiates really augment the Cause of the Disease, and destroy the Efficacy of the proper Remedies: and, even not seldom, far from asswaging the Pains, they increase them. Indeed they agree so little in this Disease, that even the Patient's natural Sleep at the Invasion of this Complaint, is rather to his Detriment. They feel, the very Moment they are dropping asleep, such violent Jirks as awaken them with great Pain: or if they do sleep a few Minutes, the Pains are stronger when they awake.
§ 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 of41Matter 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 evenMonths; 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 tooperate. Nevertheless they should never be used where the Pulse is hard. The PowderNº. 25answers 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 theSciatica. 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 of42Burdock RootsNº. 26. 3. Four or five Days after drinking abundantly of this, the purging43PowderNº. 21may 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 ElectuaryCaryocostinum, 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.
§ 182. When general Remedies have been used, and the Disorder still continues, Recourse should be had to such Medicines, as are available to restore Perspiration; and these should be persisted in for a considerable Time. The PillsNº. 18, with a strong Infusion of Elder Flowers, have often succeeded in this Respect: and then after a long Continuance of diluting Drinks, if the Fever is entirely subdued; if the Stomach exerts its Functions well; the Patient is no ways costive; if he is not of a dry Habit of Body; and the Part affected remains without Inflammation,the Patient may safely takethe PowderNº. 29, at Night going to Bed, with a Cup or two of an Infusion ofCarduus benedictus, or the blessed Thistle, and a Morsel of Venice Treacle of the Size of a Hazel Nut, or a Filberd. This Remedy brings on a very copious Sweating, which often expells the44Disease. These Sweats may be rendered full more effectual, by wrapping up the affected Part in a Flanel dipt in the DecoctionNº. 27.
§ 183. But of all these Pains, the Sciatica is one of the most tedious and obstinate. Nevertheless I have seen the greatest Success, from the Application of seven or eight Cupping-Glasses on the tormented Part; by which, without the Assistance of any other Remedy, I have cured, in a few Hours, Sciaticas of many Years standing, which had baffled other Remedies. Blisters, or any such stimulating Plaisters, as bring on a Suppuration and Discharge from the afflicted Part, contribute also frequently to the Cure; tho' less effectually than Cupping, which should be repeated several Times. Green Cere-cloth, commonly called Oil-cloth, (whether the Ingredients be spread on Taffety or on Linen) being applied to the diseased Part, disposes it to sweat abundantly, and thus to discharge the sharp Humour which occasions the Pain.Sometimes both theseApplications, but especially that spread on Silk (which may be applied more exactly and closely to the Part, and which is also spread with a different Composition) raise a little Vesication on the Part as Blisters do. A Plaister of Quicklime and Honey blended together has cured inveterate Sciaticas. Oil of Eggs has sometimes succeeded in such Cases. A Seton has also been successfully made in the lower Part of the Thigh. Finally some Pains, which have not yielded to any of these Applications, have been cured by actual burning, inflicted on the very Spot, where the most violent Pain has been felt; except some particular Reason, drawn from an anatomical Knowlege of the Part, should determine the Surgeon not to apply it there. The Scull or Head should never be cauterized with a burning Iron.
§ 184. The hot Baths ofBourbon,Plombiers,Aix-la-Chapelleand many others are often very efficacious in these chronical Pains: notwithstanding I really think, there is no rheumatic Pain that may not be cured without them. The common People substitute to these a Bath made of the Husk of Grapes, after their Juice is expressed, which cures some by making them sweat abundantly. Cold Baths however are the best to keep off this Disease; but then they cannot always be safely ventured on. Many Circumstances render the Use of them impracticable to particular Persons. Such as are subject to this chronical Rheumatism, would do very well to rub their whole Bodies every Morning, if theycould, but especially the afflicted Parts, with Flanel. This Habit keeps up Perspiration beyond any other Assistance; and indeed sometimes even increases it too much. It would be serviceable too, if such Subjects of this cruel Disease wore Flanel all over their Skin, during the Winter.
After a violent Rheumatism, People should long be careful to avoid that cold and moist Air, which disposes them to relapse.
§ 185. Rheumatic People have too frequent a Recourse to very improper and hurtful Medicines, in this Distemper, which daily produce very bad Consequences. Such are spirituous Medicines, Brandy, and Arquebusade Water. They either render the Pain more obstinate and fixed, by hardening the Skin; or they repell the Humour to some inward Part. And Instances are not wanting of Persons who have died suddenly, from the Application of Spirit of Wine upon the Parts, that were violently afflicted with the Rheumatism. It also happens sometimes that the Humour, having no Outlet through the Skin, is thrown internally on the Bone and affects it. A very singular Fact occurred in this Respect, an Account of which may be serviceable to some Persons afflicted with the Disease. A Woman at Night was chaffing the Arm of her Husband, who had the Rheumatism there, with Spirit of Wine; when a very lucky Accident prevented the Mischief she might have occasioned by it. The Spirit of Wine took Fire from the Flame of the Candle she made use of, and burned the diseased Part. It wasdrest of Course, and the Suppuration that attended it, entirely cured the Rheumatism.
Sharp and greasy Unctions or Ointments produce very bad Effects, and are equally dangerous. ACaries, a Rottenness of the Bones, has ensued upon the Use of a Medicine called, The Balsam of Sulphur with Turpentine. I was consulted in 1750, three Days before her Decease, about a Woman, who had long endured acute rheumatic Pains. She had taken various Medicines, and, among the rest, a considerable Quantity of a Ptisan, in which Antimony was blended with some purging Medicines, and a greasy spirituous Balsam had been rubbed into the Part. The Fever, the Pains, and the Dryness of the Skin soon increased; the Bones of the Thighs and Arms became carious: and in moving the Patient no more than was necessary for her Relief and Convenience, without taking her out of her Bed, both Thighs and one Arm broke. So dreadful an Example should make People cautious of giving or applying Medicines inconsiderately, even in such Diseases, as appear but trifling in themselves. I must also inform the Readers, there are some rheumatic Pains, which admit of no Application; and that almost every Medicine aggravates them. In such Cases the afflicted must content themselves with keeping the Parts affected from the Impressions of the Air, by a Flanel, or the Skin of some Animal with the Fur on.
It is also more advisable sometimes to leave a sufferable and inveterate Pain to itself, especially in old or weakly People, than to employ too many Medicines, or such violent ones, as should affect them more importantly than the Pains did.
§ 186. If the Duration of the Pains fixed in the same Place, should cause some Degree of Stiffness in the Joint affected, it should be exposed twice a Day to the Vapour of warm Water, and dried well afterwards with hot Linen: then it should be well chaffed, and lastly touched over with Ointment of Marsh-mallows. Pumping, if superadded to this Vapour, considerably increases its Efficacy. I directed, for a Case of this Sort, a very simple Machine of white Tin, or Lattin, which combined the Application of the Steam and the Pump.
§ 187. Very young Children are sometimes subject to such violent and extended Pains, that they cannot bear touching in any Part, without excessive Crying. We must be careful to avoid mistaking these Cases, and not to treat them like Rheumatisms. They sometimes are owing to Worms, and go off when these have been discharged.