however, in ordinary cases, I can find no evidence; and, from the consideration of the remote causes, the symptoms, and cure of the disease, I think the supposition very improbable. The cause of an Ischias Nervosa assigned by COTUNNIUS, appears to me hypothetical, and is not supported by either the phenomena or method of cure. That, however, a disease of a rheumatic nature may be occasioned by an acrid matter applied to the nerves, is evident from the toothach, a rheumatic affection generally arising from a ca rious tooth. That pains resembling those of rheumatism, may arise from deep-seated suppurations, we know from some cases depending on such a cause, and which, in their symptoms, resemble the lumbago or ischias. I believe, however, that, by a proper attention, these cases depending on suppuration, may be commonly distinguished from the genuine cases of lumbago and ischias; and from what is said in 448, I judge it to be at least improbable, that a genuine lumbago or ischias does ever end in suppuration. 456. The proximate cause of rheumatism has been by many supposed to be a lentor of the fluids obstructing the vessels of the part; but the same consideration as in 241, 1, 2, 3, 4, and 5, will apply equally here for rejecting the supposition of a lentor. 457. While I cannot, therefore, find either evidence or reason for supposing that the rheuma tism depends upon any change in the state of the fluids, I must conclude, that the proximate cause of acute rheumatism is commonly the same with that of other inflammations not depending upon a direct stimulus. 458. In the case of rheumatism I suppose, that the most common remote cause of it, that is, cold applied, operates especially on the vessels of the joints, from these being less covered by a cellular texture than those of the intermediate parts of the limbs. I suppose further, that the application of cold produces a constriction of the extreme vessels on the surface, and at the same time an increase of tone or phlogistic diathesis in the course of them, from which arises an increased impetus of the blood, and, at the same time, a resistance to the free passage of it, and consequently inflam mation and pain. Further, I suppose, that the resistance formed excites the vis medicatrix to a further increase of the impetus of the blood; and, to support this, a cold stage arises, a spasm is formed, and a pyrexia and phlogistic diathesis are produced in the whole system. 459. According to this explanation, the cause of acute rheumatism appears to be exactly analogous to that of the inflammations depending on an increased afflux of blood to a part while it is exposed to the action of cold. But there seems to be also, in the case of rheumatism, a peculiar affection of the fibres of the muscles. These fibres seem to be under some degree of rigidity, and therefore less easily admit of motion; and are pained upon the exertions of it. It is also an affection of these fibres which gives an opportunity to the propagation of pains from one joint to another, along the course of the muscles; and which pains are more severely felt in the extremities of the muscles terminating in the joints, because beyond these the oscillations are not propagated. This affection of the muscular fibres attending rheumatism, seems to explain why strains and spasms produce rheumatic affections; and, upon the whole, shews, that, with an inflammatory affection of the sanguiferous system, there is also in rheumatism a peculiar affection of the muscular fibres, which has a considerable share in producing the phenomena of the disease. 460. Having thus given my opinion of the proximate cause of rheumatism, I proceed to treat of the cure. 461. Whatever difficulty may occur with respect to the explanation given 458, and 459, this remains certain, that in acute rheumatism, at least in all those cases which do not arise from direct stimuli, there is an inflammatory affection of the parts, and a phlogistic diathesis in the whole system; and upon these is founded the method of cure, which frequent experience has approved of. 462. The cure therefore requires, in the first place, an antiphlogistic regimen, and particularly a total abstinence from animal food, and from all fermented or spiritous liquors; substituting a vegetable or milk diet; and the plentiful use of bland diluent drinks. 463. Upon the same principle (450) at least with perhaps the same exception as above, bloodletting is the chief remedy of acute rheumatism. The blood ought to be drawn in large quantity, and the bleeding is to be repeated in proportion to the frequency, fullness, and hardness of the pulse, and to the violence of the pain. For the most part, large and repeated bleedings, during the first days of the disease, seem to be necessary, and accordingly have been very much employed: but to this some bounds are to be set; for very profuse bleedings occasion a slow recovery, and, if not absolutely effectual, are ready to produce a chronic rheumatism. 464. To avoid that debility of the system, which general bleedings are ready to occasion, the urgent symptom of pain may be often relieved by topical bleedings; and, especially when any swelling and redness have come upon a joint, the pain of it may be very certainly relieved by such bleedings; but, as the continuance of the disease seems to depend more upon the phlogistic diathesis of the whole system, than upon the affection of particular parts, so topical bleedings will not always sup. ply the place of the general bleedings proposed above. 465. To take off the phlogistic diathesis prevailing in this disease, purging may be useful, if procured by medicines which do not stimulate the whole system, such as the neutral salts, and which have in some measure a refrigerant power. Purging, however, is not so powerful as bleeding, in removing phlogistic diathesis; and, when the disease has become general and violent, frequent stools are inconvenient, and even hurtful, by the motion and pain which they occasion. 466. In acute rheumatism, applications to the pained parts are of little service. Fomentations, in the beginning of the disease, rather aggravate than relieve the pains. The rubefacients and camphire are more effectual in relieving the pains; but generally they only shift the pain from one part into another, and do little towards the cure of |