286 RHEUMATISM RHINE lost. The inflammation at first affects one or two joints, rarely three ; after a variable time it commonly leaves the joints first affected as suddenly as it attacked them, and fastens on some other articulation ; often however new joints are attacked without the disease leaving its original seat. As a rule, the larger joints are the ones most liable to be attacked, the knees, elbows, ankles, wrists, and hips; more rarely the smaller joints of the toes and fin- gers become affected. Besides the articula- tions, acute rheumatism frequently attacks the heart, not by metastasis, or transference of the inflammation from one part to the other, but by seizing on the fibrous textures of the heart as on one of the series of textures liable to the disease. Sometimes the pericardium is attacked (pericarditis), sometimes the lining membrane of the heart's cavities (endocarditis). (See HEART, DISEASES'OF THE.) The younger the patient, tho more liable is the heart to be affected ; so that when rheumatism occurs previous to adult age, tho heart is attacked in a large majority of cases. The rheumatic con- stitution is frequently hereditary, and rheuma- tism h peculiarly a complaint of cold, damp seasons and climates; but beyond this we know but little of tho causes which induce it. The disease sometimes disappears in 10 or 12 days, sometimes lasts for months, while in other cases again it may lapse into a subacute or chronic state and continue indefinitely. Rheu- matism, when uncomplicated, is rarely attend- ed with immediate danger to life ; but by damaging tho heart it often lays the founda- tion for incurable disease. Occasionally fatal cases are met with. Acute rheumatism has been treated in a great variety of ways. Bleeding, mercurials, mercurials with purga- tives, opium, sulphate of quinine, and nitrate of potassa in large doses have been at various times resorted to. Of these methods, those by large doses of sulphate of quinine and by nitrate of potassa have seemed to have an in- fluence in controlling and cutting short the disease, and the treatment by quinine appears to be successful in the acutest and most vio- lent attacks ; but they are both subject to in- convenience and dangers which counterbalance their advantages. The treatment which is most generally relied on is the alkaline. Tartrate of potash and soda (Rochelle salt) or acetate of potash is given in full doses short of pro- ducing purgation, until the urine is rendered alkaline. Occasionally a purgative may be re- quired, or an opiate may be given at night to produce sleep. The treatment by lemon juice, advocated by Dr. Garrod, is in truth an alka- line treatment, the acid citrate of potash con- tained in the lemon juice being eliminated by the kidneys as a carbonate. Chronic rheuma- tism presents itself under two forms. In one the joints are swollen and painful, the pain being aggravated by motion ; there is no gen- eral fever, and the appetite may be good and the digestion sound. The affection is exceed- ingly obstinate, attacking new joints without leaving those first affected ; it frequently at- tacks the smaller joints, rendering them per- manently swollen and deformed, while the im- mobility to which the joints are sometimes re- duced may cause atrophy of the muscles con- nected with them. The treatment is unsatis- factory ; sometimes alkalies or diuretics are of service, sometimes iodide of potassium seems of use ; while the native sulphur waters, such as those of Sharon, St. Catharine's, the Vir- ginia sulphur springs, &c., used both externally and internally, are frequently of great service. In the second variety of chronic rheumatism, sometimes termed passive rheumatism, the joints are neither red nor swollen, but sim- ply stiff and painful, the pain being increased by motion, but not preventing labor or exer- cise. It is aggravated by cold and damp and relieved by heat. Warm salt water baths, and the use of flannel and stimulating liniments, afford some relief. Where it is possible, re- moval to a warm climate is advisable. RUIN, Bas. See ALSACE-LORRAINE. Kill V Hani. See 1 1 .r i - Unix. RHINE (Ger. Rhein ; Dutch, Rijn or Ryn ; Fr. Rhin ; anc. Ithenug), one of the principal rivers of Europe, having its sources in the Swiss canton of Orisons, and flowing into the North sea by an extensive delta of five mouths in Holland, after a circuitous but general N. N. W. course of about 800 m. The Rhine is usually divided into three parts, the upper, middle, and lower, the first lying within and along part of the boundary line of Switzerland, the second between Basel and Cologne, and tho third between Cologne and the sea. The river originates in the Lepontine Alps in three branches, the Vorder, Mittel, and Hinter Rhein, the first and most western of which is con- sidered tho principal source. It rises in lat. 46 38' N., Ion. 8 48' E., in the small lake of Toma, on the E. side of a mountain of tho St. Gothard group, 7,687 ft. above tho sea, runs as a torrent for about 12 m., during which it descends nearly 4,000 ft., and is joined at Dissentis by the Mittel Rhein from the right. It then flows in a general E. by N. direction for about 86 m. to Reichenau, where it receives the Hinter Rhein, also from the right, and becomes about 180 ft. wide, and navigable for river boats. Having continued the same course to Coire, it thence flows through a valley about 50 in. long and from 1 to 2 m. wide in a northerly direction to the lake of Constance, and for part of the dis- tance forms the boundary line separating tho principality of Liechtenstein and the Austrian district of Vorarlberg from Switzerland. Af- ter issuing from the lake at Constance it flows for a few miles in a westerly direction, till it enters the .Untersee, which is about 30 ft. lower than the lake of Constance. It con- tinues its course in the same direction to the falls of Schaffhausen, a little way below the town of that name, where the surface of the
