Ledum is one of our best remedies for rheumatism and gout, especially the latter. The great symptom which has always been regarded as the distinctive characteristic is the direction the pains takes, namely, going from below upwards. Like **Caulophyllum and some others, **Ledum seems to have a predilection for the smaller joints. Nodes form in them and the pains travel up the limbs. The pains are made worse from the warmth of the bed. the effusion into the joints is scanty and it soon hardens and forms the nodosities above mentioned. **Ledum, like Colchicum, causes acute, tearing pains in the joints; weakness of the limbs and numbness and coldness of the surface.
**Kalmia also has pains which travel upwards, but the character of the pains will distinguish. It may also be mentioned that **Ledum is an excellent remedy in erythema nodosum, which is of rheumatic origin. **Ledum produces and cures in certain cases an obstinate swelling of the feet. Wine aggravates all the symptoms of this drug. The characteristics of **Ledum may be thus summed up:
1. Upward extension of the pains
2. Tendency to the formation of nodes in the small joints.
3. Aggravation;by the warmth;of the bed.
4. Aggravation by motion.
It is useful, too, after the abuse of **Colchicum in large doses.
**Pulsatilla is usually brought prominently to mind when there is a tendency for the rheumatism to shift about, wandering rheumatic pains being one of its red strings. But other remedies have this symptom also, prominent among them being **Kalmia, Bryonia, Colchicum, Sulphur, Kali bichromicum and that member of the tissue family most resembling **Pulsatilla, namely, **Kali sulphuricum. There is little trouble in distinguishing **Pulsatilla from any or all of these remedies by its general symptoms. Kali sulphuricum, however, will give the most trouble, but it is not a well-proven remedy and need only be thought of to try when **Pulsatilla seems the remedy yet fails. Other characteristics of the **Pulsatilla rheumatism are the aggravation from warmth, aggravation in the evening, and the relief from cold. The knee, ankle and tarsal joints are the most usual seat of the trouble when **Pulsatilla is indicated. There is, too a restlessness with the remedy, the pains are so severe that the patient is compelled to moves, and slow, easy motion relieves, as also with **Lycopodium and Ferrum. A prominent use for **Pulsatilla is in gonorrhoeal rheumatism. The joints are swollen and the pains are sharp and stinging, with a feeling of subcutaneous ulceration. **Kali bichromicum is also a remedy for gonorrhoeal rheumatism, as well as for wandering rheumatic pains; it has relief in a warm room, which at once distinguishes it from **Pulsatilla. **Thuja is another remedy for gonorrhoeal rheumatism. Rheumatism dependent on disturbance of the liver or stomach is apt to find its remedy in **Pulsatilla.
**Kalmia is another of the remedies which have wandering rheumatic pains, and it is especially useful in rheumatism affecting the chest, or when rheumatism or gout shifts from the joints to the heart, driven there perhaps by external applications. It also has tearing pains in the legs, without swelling, without fever, but with great weakness, and in this symptom of weakness it resembles **colchicum. The pains about the chest in **Kalmia cases shoot down into the stomach and abdomen. The muscles of the neck are sore and the back is lames. Hering says that the rheumatism of **Kalmia “generally goes from the upper to the lower parts,” while Farrington says, “the **Kalmia rheumatism, like that of **Ledum, almost always travels upwards.” At any rate, the rheumatic pains are mostly in the upper parts of the arms and lower parts of the legs; and are worse when going to sleep. Inflammatory rheumatism, shifting from joint to joint, with tendency to attack the heart, high fever, excruciating pains, which, of course, are made worse by motion, will be benefited by **Kalmia. In valvular deposits **Kalmia and Lithium carbonicum are our foremost drugs.
The Rhododendron family, furnishes us another useful rheumatic remedy, besides **Ledum and Kalmia, which is **Rhododendron itself. Its great keynote is its susceptibility to changes in the weather, “barometer pains,”and its pains, like **Rhus, are worse during rest. It is especially adapted to rheumatism of the smaller joints, as we have already seem Ledum to be. Although **Kalmia has some action on the smaller joints, it is in a less degree than **Ledum or **Rhododendron.