It is particularly in the matter of treatment by drugs that the necessity of persevering steadily in any plan which is adopted be comes most obvious, for even in the eases in which the effects of drugs are most marked no improvement is to be looked for from day to day, and the disease may even appear to progress unchecked for weeks or even for a month or two before the case takes a turn and improvement becomes manifest. It is probably because these facts are not sufficiently appreciated that many look upon the treat ment of arthritis deformans by drugs as so hopeless, and that in so many cases one drug after another is tried in quick succession and without apparent benefit.
The drugs which are most in repute in the treatment of this dis ease are iodine and the iodides, arsenic, and cod-liver oil.
Free iodine may be administred in form of tincture in sherry, or solid iodine may be included in a pill. Iodide of potassium is much employed, but the long continuance of such treatment is open to objec tion, and iodide of iron, which is highly spoken of by Sir A. Garrod, is probably the best of the iodides in such cases. Its tonic proper ties are of great value in the treatment of arthritis deformans, and iron in any form is often of much value, especially in those cases in which anaemia is a conspicuous symptom. I have seen very remark able improvement in some cases under the continuous administration of syrup of the iodide of iron alone for a period of six months or a year, and it is probable that the efficacy of this drug is increased by the addition of some preparation of arsenic. As to the efficacy of arsenic alone I cannot speak so positively, but I believe that it forms a useful adjunct to the iron treatment. It may be conveniently pre scribed in the form of liquor sodii arseniatis with the syrup or as solid sodium arsenate with the pill of iodide of iron.
In the more acute cases quinine is sometimes given with advan tage, but although the salicylate of sodium frequently affords some relief when the articular pain is very acute, I have never seen any marked or permanent improvement or the arrest of the disease re sult from its administration, and there are obvious objections to its continuous administration in large closes over a long period in such cases. Cod-liver oil forms a valuable adjunct to other remedies, and unless there is some reason to the contrary it should be taken con tinuously during the colder months. For those patients who are un able to take the oil as such, some of the various emulsions or prep arations of cod-liver oil and maltine may be substituted. Other drugs which have been strongly recommended are the infusion of Fraxinus excelsior, Actea racemosa, and ichthyol.
It is not possible to prophesy in any given case how far a certain treatment will be efficacious. In a small proportion the improve ment is very conspicuous, and if the disease is in its early stages a condition approaching to complete cure may be attained. In a far larger proportion of cases the disease appears to be arrested, no fresh joints become attacked, and those already involved became less painful and swollen; but iu some instances our utmost efforts are powerless to arrest the progress of the morbid process. It is there fore necessary to watch the results of treatment during a period of several mouths before any sound prognosis can be safely given, and the patient should be warned that nothing startling in the way of amelioration is to be looked for.
In advanced cases with conspicuous osteophytic enlargement, and especially in those in which the deformities due to muscular contrac tion are already produced, little in the way of improvement can be looked for, and our efforts must be chiefly directed to the relief of the patient's sufferings. When the articular pain is intense salicylates may be tried for a short time, and relief may be obtained from local applications to the joints, such as belladonna and other liniments. Opium should be given with great caution in such a chronic disease, owing to the risk of establishing the opium habit.
In that form of intense pain which results from cramp, much re lief is not infrequently obtained from the administration of hy oscy amus, which is sometimes completely effectual in relieving or in warding off the painful muscular contractions.
The,-mat can be no question that cases of ar thritis deformaus are among those in which decided benefit is often derived from a judicious course at some mineral-water resort, and it is from the external application of such waters that good results are to be looked for. The watering-place selected should therefore be one in which the treatment by baths is efficiently carried out; and the line of treatment which has in my experience proved most effec tual is that which consists in massage combined with douching with out the actual immersion of the patient. Ordinary immersion baths appear to me to be far less beneficial and if too frequently repeated to do harm rather than good. It would seem that in this disease the mode in which the water is employed is of more importance than its chemical composition, but at several of the places at which the most satisfactory results are obtained the waters are of the sulphurous class.