RHEUMATISM 18 RHINE arises from implication of the heart, which frequently occurs. The younger the patient the greater the liability to these complications, which usually re- sult in more or less permanent impair- ment of the heart's action. Another con- dition, much less common, but extremely fatal, is known as rheumatic hyperpy- rexia, and is characterized by a very rapid rise of temperature to 108° or 110°, with head symptoms in the form either of drowsiness or of violent de- lirium. The patient should be strictly confined to bed between blankets (i. e., without sheets), and be clothed in flannel; he must be carefully protected from draughts, and from undue pressure of the bed clothes, and supplied with light nourishment and diluent drinks. Under such conditions, without other treatment, most cases recover in the course of time. Till the last quarter of the 19th century there was no general agreement as to what more should be done. In 1876 Strieker in Berlin and Maclagan in Eng- land called attention to a new method of treatment. This method consists in the administration of salicin, or of one of its derivatives (salicylic acid, salicylate of soda, etc.). In rheumatic hyperpyrexia the only treatment that has been found effectual is immersion in a tepid bath as often as the tempera- ture rises to a dangerous point. Con- valescence is usually very slow, and it is necessary to keep the patient in bed and on low diet for some time after the fever has disappeared to diminish the tendency to relapse. At this stage tonics, especially quinine and iron, are generally useful. Chronic Rheumatism. — Chronic painful affections of the joints sometimes fol- low rheumatic fever and are clearly a consequence of it. The name is often erroneously applied to chronic and in- sidious forms of gout. There is another form of disease to which most of the cases of so-called "chronic rheumatism" belong, probably distinct from both rheu- matism and gout, popularly so called, though it is often called "rheumatic gout," which deserves separate mention. Osteo-arthritis (chronic rheumatic ar- thritis and rheumatic arthritis are among its many other names) is char- acterized in most cases by a very chronic course, by pain and stiffness in one or more of the joints, with creaking on movement, and by destructive changes of the cartilages of the affected joints, with enlargement of the ends of the bones in their neighborhood. It is more common in women than in men; most often be- gins at or after middle life, though oc- casionally even in childhood. Muscular rheumatism is the name usually given to painful affections of the muscles for which no clear cause is dis- coverable. RHINE (German, Rhein; Dutch, Rijn), the finest river of Germany, and one of the most important rivers of Eu- rope, its direct course being 460 miles and its indirect course 800 miles (about 250 miles of its course being in Switzer- land, 450 in Germany, and 100 in Hol- land) ; while the area of its basin is 75,000 square miles. It is formed in the Swiss canton Grisons by two main streams called the Vorder and Hinter Rhein. The Vorder Rhein rises in the Lake of Toma, on the S. E. slope of the St. Gothard, at a height of 7,690 feet above the sea, near the source of the Rhone, and at Reichenau unites with the Hinter Rhein, which issues from the Rheinwald Glacier, 7,270 feet above sea - level. Beyond Reichenau, which is 7 miles W. of Coire, the united streams take the common name of Rhine. From Coire the Rhine flows N. through the Lake of Constance to the town of that name, between which and Basel it flows W., forming the boundary between Swit- zerland and Germany. At Basel it turns once more to the N. and enters Ger- many; and, generally speaking, it pur- sues a N. course till it enters Holland, below Emmerich, when it divides into a number of separate branches, forming a great delta, and falling into the sea by many mouths. The chief of these branches are the Waal and Lek, which unite with the Maas; the Yssel and Vecht, which diverge to the Zuyder Zee; and that which retains the name of Rhine, a small stream that passes Ley- den and enters the North Sea. In the German part of its course the chief trib- utaries it receives on the left are the 111, Nahe, Moselle (with the Saar), Ahr, and Erft; and on the right the Neckar, Main, Lahn, Sieg, Ruhr, and Lippe. In Switzerland its tributaries are short and unimportant, and this part of its course is marked by the Falls of the Rhine at Schaffhausen, where the river is pre- cipitated in three leaps over a ledge of rocks 48 to 60 feet in height, and by the cataracts of Lauterberg and the rapids of Rheinfelden. The chief towns on its banks are Constance and Basel in Switzerland; Spires, Mannheim, Mainz, Coblentz, Bonn, Cologne, and Diis- seldorf, with Worms and Strasburg not far distant, in Germany; Arnheim, Utrecht, and Leyden, in Holland. Its breadth at Basel is 750 feet; between Strasburg and Spires from 1,000 to 1,- 200 feet; at Mainz, 1,500 to 1,700 feet; and at Emmerich, where it enters the
