Chronic rheumatism.—­Causes.—­Heredity may predispose to it.  It is most common in those who are exposed to hard labor in the cold and wet; especially in women about middle age.  It occasionally follows sub-acute, but rarely acute rheumatism.

Symptoms.—­Many large joints are usually affected; sometimes it may be only one joint; at times, the small joints only are affected.  It may be only on the one side.  It usually persists in the joints involved, but may attack others.  The chief symptoms are stiffness of the joints, especially after a rest and this diminishes after some motion, also pain, which grows worse in damp weather.  The joints may be tender to the touch, slightly swollen, rarely red.  They may in time become entirely stiff and deformed.  The general health may be good or there may be anemia, dyspepsia and valvular disease due to sclerosis,—­hardening of the valves of the heart.

Prognosis.—­This is good as to life, but the disease is often progressive.

Treatment.  Preventive.—­A warm, dry, unchangeable climate, good surroundings, good food; keep the stomach and bowels and kidneys in good condition, avoid taking cold.  Do not sit down in a draft to “cool off.”  Do not go into a cool room in summer when you are warm or sweated.  Do not sleep in a bed that has not been used for months and kept for “company.”  Do not dry your clothes in the kitchen and in that way make the whole house steamy and damp.  Do not sleep under unaired damp covers or in a damp night dress.  Always air and dry your bedding and night dress before using.  Do not take a hot bath and go into a cool room to cool off, but wrap yourself up so as to be warm and cool off gradually.  Any additional cold will cause more rheumatism.

[322 Mothers’ remedies]

Sleeping rooms on the first floor are an abomination for rheumatic persons.  Do not sit down in wet clothes, stockings or shoes.  Take them off immediately on getting home, wipe yourself dry and put on dry garments.  Care in such little seemingly foolish things will do wonderful things for a rheumatic person.  I had two rheumatic attacks in my first year of practice.  Since then I have learned caution and through a hard and busy life I have kept myself reasonably well by looking after such little aids and cautions as, the above.  I never sit down for any length of time in damp or wet clothes, and if I can do that, persons that are not driven like doctors can do the same.  These cautions apply to not only this kind of rheumatism, but to all kinds of rheumatism, neuralgias, and to inflammatory diseases, such as neuritis, tonsilitis, pneumonia, pleurisy, etc.  Hot air baths, Hot Springs, massage will be more effectual in this disease than in the former.  Iodide of potash also is very useful.  Flannel underwear, heavy and light weight, is very beneficial in rheumatism.  Great benefit can be derived at home by wrapping the affected joints in cold cloths, covering with a thin