Indeed, one of the most serious effects of these recurring painful conditions is the dread produced lest they should cause such progressive affections in and around joints as would eventually make the patients bed-ridden. There are a certain number of cases of so-called rheumatoid arthritis which produce very serious changes in joints with inevitable crippling and quite beyond all possibility of repair. These cases are often spoken of as chronic rheumatism and it is the solicitude produced by the dread of them that makes the worst part of the discomfort in many a so-called chronic rheumatic case. If their affection is to be progressive, then the patients foresee a prolonged confinement to bed in the midst of severe pain, hopeless of ultimate cure. It may be said at once that these cases of rheumatoid arthritis have nothing to do with rheumatism, represent a special acute infection, are never a sequela of any of the rheumatic conditions and are {243} fortunately very rare. This assurance of itself is quite sufficient to make ever so much better a great many patients who feel that they suffer from rheumatism. The painful conditions that are described under the term chronic rheumatism would seem to be quite beyond any power of the will to affect. They are at least supposed to represent very definite changes in the tissues, usually of chronic character and therefore not amenable to any remedies except those of physical influence. Besides, they are so frequent that surely if there were any question of the will being able to control them or bring relief for them, most sufferers would discover this fact for themselves and apply the remedy from within. It is not to be expected that a very great many people would suffer pains and aches that are worse in rainy weather if all that was needed was the exertion of their will power either to throw off the affection or to perform such exercises and activities as would gradually make their conditions better. In general it is felt that painful conditions of this kind cannot be affected by the will and that distinctly material and not psychic therapeutics must be looked to for their relief.