the general affection. Blistering, applied to the pained part, may also be very effectual in removing the pain from it; but will be of little use, except where the pains are much confined to one part.

467. The several remedies mentioned from 451 to 455, moderate the violence of the disease, and sometimes remove it entirely; but they sometimes fail in this, and leave the cure imperfect. The attempting a cure by large and repeated bleedings, is attended with many inconveniencies, (see 140); and the most effectual and safe method of curing this disease is, after some general bleedings for taking off, or at least diminishing, the phlogistic diathesis, to employ sweating conducted by the rules laid down 168 and 169.

468. Opiates, except where they are directed to procure sweat, always prove hurtful in every stage of this disease.

469. The Peruvian bark has been supposed a remedy in some cases of this disease; but we have seldom found it useful, and, in some cases, hurtful. It appears to me to be fit in those cases only, in which the phlogistic diathesis is already much abated; and where, at the same time, the exacerbations of the disease are manifestly periodical, with considerable remissions interposed.

470. Calomel, and some other preparations of mercury, have been recommended in the acute rheumatism; but I believe they are useful only in cases of the chronic kind, or at least in cases approaching to the nature of these.

471. Having now treated fully of the cure of the acute rheumatism, I proceed to treat of the cure of the chronic, which is so frequently a sequel of the former.

472. The phenomena of the purely chronic rheumatism, mentioned in 439 and 440, lead me to conclude, that its proximate cause is an atony, both of the blood-vessels and of the muscular fibres of the part affected, together with a degree of rigidity and contraction in the latter, such as frequently attend them in a state of atony.

473. Upon this view of the proximate cause, the general indication of cure must be to restore the activity and vigour of the vital principle in the part; and the remedies for this disease, which experience has approved of, are chiefly such as are manifestly suited to the indication proposed.

474. These remedies are either external or internal.

The external are, the supporting the heat of the part, by keeping it constantly covered with

flannel: the increasing the heat of the part by external heat, applied either in a dry or in a humid form: the diligent use of the flesh-brush, or other means of friction: the application of electricity in sparks or shocks the application of cold water by affusion or immersion: the application of essential oils of the most warm and penetrating kind the application of salt brine: and, lastly, the employ ment of exercise, either of the part itself, so far as it can easily bear it; or of the whole body, by rid ing, or other mode of gestation.

475. The internal remedies are, 1, Large doses of essential oil drawn from resinous substances, such as turpentine; 2, Substances containing such oils, as guaiac; 3, Volatile alkaline salts; 4 These, or other medicines directed to procure sweat, (169); and, lastly, calomel, or other pre paration of mercury, in small doses, continued for some time.

476. These (463, 464) are the remedies suċcessfully employed in the purely chronic rheumat ism and there are still others recommended; as bleeding, general and topical; burning; blister ing; and issues: but these appear to me to be chiefly, perhaps only, useful when the disease still partakes of the nature of acute rheumatism.

CHAP. XIII.

477. I

OF THE TOOTHACH OR ODONTALGIA.

HAVE formerly considered this disease as a species of rheumatism, to be treated upon the same principles as those delivered in the preceding chapter; but now, from more attentive consideration, I am led to consider the toothach as a distinct disease. Whilst the most of what has been delivered in the last chapter proceeds upon the supposition that the rheumatism depends upon a certain state of the blood-vessels, and of the motion of the blood in them, without this being produced by the irritation of any acrid matter applied; I judge, that in the toothach, though there are often the same circumstances in the state of the blood-vessels as in the cases of rheumatism, these circumstances in toothach always arise from the application of an acrid matter to the nerves of the teeth.

478. This disease is often no other than a pain felt in a particular tooth, without any inflammatory affection being at the same time communicated to the neighbouring parts. This, however, is rarely the case; and for the most part, together with the pain of the tooth, there is some degree of pain and of inflammatory affection communicated to

the neighbouring parts, sometimes to the whole of those on the same side of the head with the af fected tooth.

479. This inflammatory affection seems to me to be always an affection of muscles, and of the membranous parts connected with these, without any tendency to suppuration; and such an affec tion, as is excited by cold in similar parts elsewhere. It is from these circumstances that I conclude the affection to be of the rheumatic kind.

480. It is possible that the muscles and membranes of the jaw may be affected by the same causes which produce the rheumatism in other parts; and it is also possible, that a rheumatic diathesis at first produced by irritation, may sub. sist in the muscles and membranes of the jaw, so that the inflammatory affection may be renewed by certain causes, without any new application of acrid matter: but I am persuaded that either of these occurrences are very rare, and I have never been able to ascertain any cases of toothach to be of these kinds. I consider it, therefore, as highly probable, that this rheumatic affection of the jaws, which we name toothach, is always dependent upon some immediate application of acrid matter to the nerves of the teeth.

481. It is, however, to be observed, that this

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