Before we take up diet in rheumatism let us see what rheumatism is, and if possible what causes it, etc. First we have acute articular rheumatism, or rheumatic fever; next we have subacute or chronic rheumatism, then muscular rheumatism, and last rheumatoid arthritis, also called rheumatic gout and arthritis deformans. The predisposing causes are heredity, exposure to damp, the inconveniences of poverty, etc. There are cases of forms of rheumatism, so called, coming from some vice in the system acting as blood poison. The lithaemic or bilious individual is liable to chronic rheumatism as he is to chronic gout, but possibly from different causes. In acute rheumatism, or rheumatic fever, the fever is fairly high, the pulse quick, hard, and full, and the sweats free and very acid. Pain on movement is intense, and yet the patient always wants to move. In my own experience acute rheumatism is not nearly so prevalent as it was thirty years ago.

Does uric acid cause rheumatism, as it is supposed to cause gout? This is an important matter as to the diet. The most advanced workers and thinkers now say, no, it comes from a pathogenic germ and from the toxins these germs elaborate. This germ has not yet been satisfactorily isolated for identification. It probably most frequently enters the system through the tonsils. Taking this view, the uric acid found so often in the urine of the rheumatic is a result and not a cause of the rheumatism. One difference between rheumatism and gout is the former most frequently comes with a chill and gout does not. The toxaemia of either may cause a chill, but it comes most frequently in rheumatism.

Inclined, as I am, to believe that rheumatic fever is caused by a pathogenic microbe giving out its toxins into the system and these toxins acting chiefly on the fibrous tissues, I think the diet then must be one to support the system while the cause exhausts itself and is destroyed by remedies.

As a help to the diet, wear wool always next the skin day and night, and sleep on woollen blankets, and not on linen or cotton sheets. To protect the heart, so often involved in these cases, remain as nearly as possible at absolute rest for two weeks at least after convalescence.

The salicylates appear to be the remedy now. As to diet, the important part for us, in the acute attack take milk, cooked or raw. Raw is probably best. Add fifteen grains of table salt to each glass. Also put about sixty grains of bicarbonate of soda (not potash, it is bad for the kidneys) in the milk each twenty-four hours. Use soups made from milk and vegetables and from oysters and milk and clams and milk. Do not use animal broths, they are too high in nitrogen and are not good for the serous membranes.

Lemonade sweetened with saccharin is a good drink and plenty of it. Drink water, all you are able, night and day. Use distilled water or the alkaline waters, as Saratoga Vichy or Bedford water.

In gout it has been said that the secretion of hydrochloric acid by the glands of the cardiac end of the stomach is defective. Large doses of hydrochloric acid are a proper remedy here, and at the same time it helps pancreatic digestion. This helps the tissue cells, which in gout do not thoroughly oxidize the nutrients brought to them, owing to defectivc gastric digestion. As a result of this we get uric acid deposited wherever the circulation is most sluggish. Under this plea one must not eat vegetables and carbohydrates alone, but some meat and nitrogenous foods must be taken to stimulate gastric digestion, etc.

Chronic Rheumatism

In this form avoid damp and cold. Have plenty of air in your sleeping-apartments night and day, and also sunlight when possible. Wear wool and sleep on wool always. Radiant heat and superheated air baths, mud baths, electric baths, massage, and such remedies are all useful here.

It is difficult to differentiate chronic rheumatism from chronic gout. It may be found out by therapeutic tests by medicines. As to diet, it will be-sufficient to say here, let those suffering from chronic rheumatism follow absolutely the rules laid down for those suffering from chronic gout and they will get the best results and live on the diet best adapted to their needs.

Now, as to the diet in rheumatic gout, called also arthritis deformans, rheumatoid arthritis, etc. This is more common in women than in men. Rheumatic gout is not true gout. In the early stages it is often curable or capable of being restrained for a considerable time. In its later stages it is incurable. In this disease you must not starve yourself. Let the diet be as liberal and as good as you can digest. Eat beef, mutton, poultry, game, fish, shell-fish, milk, eggs, plenty of fats especially, and all vegetables. Be somewhat careful of spinach, tomatoes, rhubarb, and very sour fruits. As a rule, fruits, and plenty of them, are most useful in this diet. Milk is best, but it is not necessary to avoid coffee, tea, cocoa, and chocolate in moderate amounts, especially if sweetened with saccharin, just enough to take off the bitter edge. Saccharin somewhat slows digestion in any but small amounts, but in these cases is better than too much cane sugar or even levulose. Drink, as I have said, oceans of water night and day. Claret, sauterne, beer, and spirits in soda water may be used. Wine and spirits in the carbonic acid water are better than champagne. Live out of doors and have plenty of air and sunlight in the sleeping apartments. At night have air also, and sleep in wool and on wool, and wear wool in daytime, too. When able, live in a dry climate with plenty of sunshine. For the anaemia common in these cases the iron waters, natural or artificial, are grand remedies. Moving the stiff joints at regular intervals is a good adjunct to diet