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TREATMENT OF RHEUMATISM.

contains, citrates, malates, tartrates, &c., in a high state of dilution. We are in the habit, when we prescribe these salts, of giving them in too concentrated a form. Hence they often fail to be absorbed, and act as purgatives, instead of as renal depurants and alkalies. Colchicum, in the acute form of this disease, I believe to be very much over-estimated, but its administration is sanctioned by experience and demanded by custom, and not to prescribe it would, in the eyes of many, be almost a criminal neglect; but although of little value in the treatment of pure rheumatism, it is—in proportion as the disease assumes that hybrid type which we recognise as rheumatic gout, and which is always complicated with hepatic and portal congestion-invaluable; but as we shall presently have to enter more fully into its modus operandi when we discuss the treatment of gout, we may pass on to opium, the use of which was first advocated by Dr. Corrigan, of Dublin. It would be difficult to exaggerate the advantages which this valuable drug affords the practitioner in the treatment of this disease, and the comfort it gives the patient, harassed as he is by pain, and worn out by want of rest. But it is not merely as a palliative, by relieving pain and inducing sleep, that opium is so invaluable, but it is because, by its

sedative influence, it diminishes that energetic action of the heart which is occasioned by the presence of the irritating morbific matter in the blood, and under which that intense oxidation goes on which leads to super-fibrination of the blood and the constant accumulation in the circulation of partially decarbonized albuminous elements.

Opium, by diminishing the irritability of the heart, causes fibrination of the blood to go on less rapidly; and, by checking the rapidity with which destructive assimilation takes place, it causes it to be more effectually performed, and the effete albuminous tissues to be resolved into urea instead of uric acid.

In the treatment of acute rheumatism, our object is to check the rapidity with which oxidation is going on; in gout, on the other hand, our whole treatment is directed to its more rapid fulfilment. Between acute rheumatism and gout there are many types, and our successful treatment of such cases will depend on our directing our measures either to the promotion or diminution of oxidation, according to the predominance of either the rheumatic or gouty condition of the blood. Opium is the curb by which we check the pace at which oxidation of tissue goes on, colchicum the spur by which we promote it.

We may combine opium with purgatives, according to Dr. Chambers's plan, which is the best in the beginning, and we may then continue it every four hours in combination with our other remedies. The dose cannot be regulated by any arbitrary rules; very much larger doses than are given under ordinary circumstances are necessary, and may be given without producing any tendency to narcotism. Nitrate of potass, when taken into the circulation, unquestionably exercises a very powerful influence in repressing that excessive fibrination which is so remarkable in this disease, and which renders it so prone to light up inflammatory action in the serous and other highly-organized tissues in immediate contact with those fibrous structures in which the materies morbi is deposited. deposited. But although potassæ nitras is a very valuable adjuvant in the treatment of acute rheumatism, we must not trust to it alone. We are called on to do something more than save the lives of our patients, which it might possibly do by itself through its power in diminishing the risk of endocarditis, but it neither allays pain, nor neutralizes or expels the morbific matter from the circulation with the same certainty that other and equally available remedies do. The next, and, in my humble judgment, the most valuable class of re

medies, are the vegetable salts of potass. These salts, when given in a high state of dilution, become rapidly taken into the circulation, where they absorb oxygen and become converted into carbonates; and as uric acid is readily soluble in a dilute solution of carbonate of potass, the value of these renal depurants becomes at once apparent. The acetate is the best form in which to administer this remedy in rheumatism, both because it has a greater affinity for oxygen and is more agreeable in its taste. It requires to be given in a high state of dilution, about twentyfive grains every four hours; opiates should be combined with it, either the tinct. opii, or the pil. saponis cum opio, may be taken at intervals. Ten or fifteen grains of potassæ nitras may be advantageously combined with the acetate in acute cases; and in the subacute, where there is less tendency to endocarditis and more hepatic and portal congestion, both the opiates and the potassæ nitras may be omitted, and colchicum given in their stead. When the acetate of potass is administered, the character of the urine becomes speedily altered; instead of being scanty and high-coloured, and intensely acid and loaded with lithates, it becomes more abundant, much paler, and slightly alkaline; simultaneously the local and constitutional symptoms diminish, the

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tongue becomes cleaner, the pulse less full and frequent, the pain first diminishes, then disappears, and the swelling and enlargement of the joints subside with comparative rapidity, when we consider the intensity of the local excitement which has recently existed. We may now give some mild tonic: the decoct. cinchona is perhaps the best, with small doses of the acetate of potass to neutralize and prevent the accumulation of fresh morbific matter, and the action of the surface must be promoted by wearing flannel and fleecy hosiery, such clothing as will prevent the too rapid evolution of the animal heat, for those fibrous structures which have been the seat of recent rheumatic deposits are still weak, and in the highest degree sensitive to the depressing influence of cold and moisture. Some persons advocate the administration of quinine ab initio ; but I must confess myself at a loss to know on what principle. Theoretically, I not only see no reason for its administration, but many against it; practically tried, it will be found to aggravate all the symptoms to a degree that would convince any reasonable person that it was altogether contra-indicated. Taking a retrospect of the compound nature of the malady, of the great value which the different remedies