LECTURE 22. 0)1 Rheumatism, and the Diagnosis oj . Gout and Rheumatism. IN this Lecture I shall make some observations on Rheumatism, and also on the distinctions which exist betw een that affection and Gout. Rheumatism, like gout, derivos its name from the supposition that the fluid5 were principally affected. The tendency to rheumatism, like that cf gout, exists more strongly in some -families than in others ; and I have seen several examples in which persons having a tendency to rheumatism

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... re verv liable to chronic affections of tile heart and attacks of in3arHmation of the pericardium. The tendency to rheumatism, however, i far more frequency acquired than hereditary, being generally connected with great or sudden alternations in the surr ouad ing temperature. Indeed the most common exciting cause of rheumatism is cold, or a low or variable temperature of the atmosphere. Rheumatism, therefore, prevails more in the spring and winter, hut it not unfreqnently occurs in wet autumns, and even in summer when the mornings and evenings are cold, and the middle of the day hot. People are often attacked by rheumatism after having been drenched in the rain, and especially if they sit down and rest in their wet clothes ; or after sleeping in damp beds, or wearing damp linen ; or from being exposed to currents of cold air; and Sometimes it arises from leaving off some part of the dress, such as m flannel waistcoat, or the like. Rheumatism, when once indnced, has three forms. As far as the inflammation is concerned, it is either acute.. subacate or chronic. The acute and subacute merely differ in degree, in as much ars in the acute the local inflammatlon is more severe and the fever is higher. The chronic fom of rheumatism is principally distinguished by the absence of fever. Wilen n patient is attacked by the acute cr subacute form, lie has a very hot skin, a rapid round pulse generally ranging from 110 to 120, or 130 ; there is all aching numb pain in the affected part, which amounts to very acute pain oa any motion of that part. The; e is very little redness or swelling at i h:'st about the site of the pain, and the patient is liable to abatements and inci cases of the fever; the former commonly occurring towards tnorning', the latter towards evening; and where the pain is urgent the skin is often moist. The urine is generally scanly, high coloured, and turbid. The larger joints arc more frequently the seats of rheumatism than the small ones ; the pain frequently wanders from one part to another, or shoots in the course of the muscles ; and we have instances of spasm attacking the bowels., and more particularly the iuterrosfal muscles, which should always be nar-rowly noticed, since they are sometimes the precursors of inflammation within the abdomen or chest. The duration of acute and subacute rheumatism is various, but there is one observation applicable to this affection, namely, if it be not checked at the onset by prompt and proper measures, it most frequently has a sort