rated his fluids with azotized matters, and these must be gotten rid of through the skin and kidneys before his appetite for the food in question will again return. In the same way, relish or distaste for salt food is regulated by the excess or deficiency of muriate of soda in the blood. And thus a dog that has eaten largely of animal food becomes, for a short time afterwards, an herbivorous animal.

The simple and transient excess of the urates in the renal circulation furnishes, therefore, no indication for treatment; on the contrary, these salts are so extremely soluble that the kidneys have the power to secrete them in large quantities. But when, from long-continued exposure to cold, the existence of some forms of cutaneous diseases, chronic gastro-enteritis, or other causes, the functions of the skin become seriously impaired; the kidneys, having a double duty to perform, are often overtasked, and the result is that large quantities of nitrogenized elements are retained in the system, giving rise sometimes to distressing neuralgia, but oftener to a subacute form of rheumatism.

Certain diseases of the skin have long been noticed amongst the predisposing, and were believed to be in many instances the direct causes of rheumatism. The Dictionnaire des Sciences Médicales has the following in that portion of the article relating to the causes which give origin to, and predispose to this disease: "M. Giraudy, dans son édition de l'ouvrage de Raymond, sur les maladies qu'il est dangereux de guérir, rapporte avoir vu un rhumatisme causé par la répercussion d'une dartre farineuse." . . . "La répercussion (p. 448), la métastase d'un érysipèle ou d'une éruption cutanée aigué quelconque est souvent aussi la cause de la maladie dont nous traitons. On la voit surtout survenir à la suite de la rougeole et de la scarlatine." "Cyrillus, dans sa

vingt unième consultation, troisième centurie, parle aussi d'un rhumatisme causé par une rentrée," &c.

Some writers, looking upon these cutaneous eruptions as the effects rather than the causes of the inflammation in question, regarded their appearance as both critical and salutary. In the same dictionary, in sixty volumes, where the critical eruptions are spoken of, page 537, is the following: "Aussi nous bornerons nous à dire içi en résumé, qu'après une durée indéterminée du rhumatisme, surtout de celui qui est aigu, on a vu survenir, en différentes parties du corps, tantôt sur celles qui étoient souffrantes, tantôt indistinctement, en quantité fort variable, et durer plus ou moins de temps, des éruptions qui ont reçu le nom de gale, de dartre, de pourpre, de vesicule," &c. "Tissot a vu la crise secondaire être caractérisée par une éruption de vesicules, suivies d'ulcérations." And again: "Baillou pense que le principe qui produit ces différentes éruptions cutanées est le même qui, étant sur les muscles ou les articulations, occasionne le rhumatisme."

Baillou seems nearer the truth than those who regard the eruptions in question as amongst either the causes or effects of arthritic inflammation; for why may not the functions of the skin be disabled, and eruptions result as a consequence of the drainage through its perspiratory pores of fluids highly saturated with saline ingredients, just as nephralgia and, with a continuance of the cause, vascular lesions and inflammations of the kidneys are produced by the passage through their delicate vessels of irritating salts?

In the examples quoted, it is hardly possible that the metastasis or retrocession of the eruptions had any share in the production of rheumatism, but far more likely that the existence of the cutaneous affections had disabled the functions of the skin, and consequently that the retained nitrogenized elements were the true cause

of the inflammation in question. Be this as it may; one thing is most certain, that where, from any cause, the perspiratory functions of the cutaneous pores are seriously impaired, the azotized materials thrown back upon the circulation are in part gotten rid of by the vicarious acts of the kidneys, while the rest are retained, giving rise often to neuralgia, but still more frequently to subacute rheumatism. This condition of things is most generally brought on by constant exposure to a low temperature during sedentary occupations, and more particularly where these are carried on in apartments on the ground floor, or in cellars not duly ventilated and warmed.

In this form of the disease, great palliative relief is often obtained from the exhibition of the bitartrate and acetate of potassa, and also from the bicarbonates of soda and potassa; but the happiest effects result from the use of diaphoretics, hot baths, and all other agents calculated to restore the functions of the skin.

When, from a sudden check of perspiration, an individual experiences a sense of aching in all his limbs"courbature"-a hot-bath, a stimulating diaphoretic, or a pint of warm wine whey, with a Dover's powder at bedtime, generally affords prompt relief by restoring the function of the perspiratory pores. But when, from greater or longer continued disability in the functions of the skin, a fixed rheumatism exists, resort must be had to cimicifuga, eupatorium, or some other class of diaphoretic agents, such as sulphuret of antimony, guaiacum, &c. If dyspepsia exists as a concomitant trouble, it is often requisite, at the same time, to direct special treatment to the peculiar condition on which it may depend. It is in the relief of excessively chronic cases of dyspepsia, and more particularly that form of the disease depending on the follicular gastritis of Andral, and asso

ciated with neuralgia and chronic rheumatism, that the Thomsonians and hydropathists, and advocates of the Russian bath system, claim their chief triumphs. In long-continued functional disorders of the skin and mucous membranes, either one of these classes of hardy empiricisms will, provided it do not kill, often effect a

cure.

Thirdly. There is a form of rheumatism depending on the abnormal presence of earthy phosphates in the blood; and, under these circumstances, an excess of the triple phosphates of lime, soda, and magnesia, will often be found in the urine, but not uniformly; the solvency of these salts, and consequent capacity of the kidneys to eliminate them, depending, in great measure, on the proportion of phosphoric acid united with the earthy bases. As superphosphates they are readily secreted, and generally render the urine only slightly turbid, but occasionally as white as milk; and, still more rarely, being precipitated to the bas fond of the bladder, they come away in considerable quantities, and in form and consistence resembling soft mortar.

When the supply of phosphoric or some other acid is insufficient to render these earthy bases soluble, they are retained in the blood, giving rise to depressions of the nervous system, pain in the back (particularly over the lumbar region), nerve ache, rheumatism, and sometimes, on the point of being secreted, obstruct the tubuli uriniferi, giving rise to nephralgia, which may lead to congestion and inflammation of the kidneys.

It is particularly this form of rheumatism which occurs in the crowded wards of hospitals, where the nervous system of the inmates is depressed by previous diseases, and where they are constantly breathing an atmosphere charged with ammonia and carbon. It was probably this form of the disease which Sydenham

referred to when he spoke of scorbutic rheumatism. Saucers filled with muriatic acid, or some other suitable agent, ought to be constantly exposed in the wards of every hospital, in order to get rid of the ammonia, which not only acts as the vehicle for the spread of specific contagions, but serves, at the same time, together with other nitrogenized compounds and carbon, to depress the vitality of all who breathe it.

It is in this form of rheumatism, depending on triple phosphates, that citric acid is found to act so happily. Good cider-vinegar (acetic acid), or an infusion of tamarinds, will be found to act as well as lemonade. The lime, soda, and magnesia, which are here the immediate cause of diseased action, unite with citric, and still more readily with acetic acid, forming extremely soluble salts, which are easily eliminated by the skin and kidneys.

Three varieties of rheumatism have thus far been spoken of, two of which, depending on the presence of certain salts existing in the blood, can be gotten rid of by the use of appropriate solvents, while the other form of the disease can generally be managed by restoring the functions of the skin.

There is still a fourth variety of rheumatism, depending, it would seem, upon the presence in the blood of those compounds which are found in the urine, and called extractive matters, the chemical composition of which is not yet ascertained. Cases resulting from this cause frequently run on for months or years, uninfluenced by any known remedies, and, in spite of all experimental efforts to arrest their progress, result finally in permanent distortion of the joints, chronic bronchitis, with structural alterations of the heart, and, sooner or later, in death.

These extractive matters are produced by some fault, either in the primary or secondary assimilation; and