Rheumatism

Treatment.—Absolute rest in bed is essential to prevent, if pos sible, damage to the heart. The patient should lie between blank ets and wear flannel garments; the affected joints should be given complete rest and be wrapped in cotton wool and the weight of the bed clothes supported over them. Sodium salicylate appears to have a specific effect in the acute stages by relieving pain, low ering temperature and cutting short the attack. It should be given frequently and in fairly large doses for the first 24 hours and then the interval lengthened and the dose decreased; care must be ex ercised not to produce toxic symptoms. The drug is of less use in children than in adults as it does not seem to have any influence in arresting the cardiac inflammation. Aspirin may succeed when salicylates fail. Some authorities render the urine alkaline with sodium bicarbonate.

Subacute Rheumatism.

No definite dividing line exists be tween this and the acute condition. All symptoms are less marked, heart lesions are common and the duration may be long.

Chronic Rheumatism.

This is a term loosely applied to pain and stiffness in the joints. Some think it cannot be separated from rheumatoid arthritis (q.v.), others that it is an inflamma tion of the fibrous tissues round a joint. One or more joints may be affected and become slightly swollen, and after a time they may be felt to creak on movement. It is usually brought on by cold and wet, and the pain is most marked after rest. The general health is little affected unless the pain be severe and continuous. It rarely follows acute rheumatism.

Muscular Rheumatism.

This is a painful affection of volun

tary muscles clue to inflammation of their fibrous and tendinous attachments. It results from overstrain and exposure to cold and damp. There is intense pain on attempted movement involving the muscles affected; when the muscles are at rest the pain disap pears. The commonest forms are: (I) Lumbago (q.v.), affecting the lower part of the back. Stooping, and more especially rising again, cause severe pain; (2) Torticollis or stiff neck, affecting the muscles on one side of the neck. Salicylates are sometimes of use in the chronic varieties, but active treatment is usually re quired such as the various applications of heat, massage, hot douches or electricity. In chronic rheumatism the waters at vari ous spas are often of great benefit, and wintering in a warm, dry, sunny climate is an advantage when practicable. In muscular rheumatism rest of the affected muscles is essential.

Special clinics for rheumatic diseases are in existence in Europe apart from that treatment given to chronic forms in the various spas. (See MINERAL WATERS.) At the time of writing the British Red Cross is proposing to establish in thickly populated centres of the country fully equipped clinics for the treatment of rheu matism in adult sufferers. The project is receiving cordial sup port by the Ministry of Health, various friendly societies and trade unions and the medical profession.

See H. Warren Crowe, Chronic Arthritis and Rheumatism (London, 1926) and Bacteriology and Surgery of Chronic Arthritis and Rheumatism, with End-results of treatment (London, 1927).

(P. L.-B.)