The douche-massage treatment originated at Aix-les-Bains in Savoy where there is an abundant supply of hot sulphur water, and the results there obtained are often extremely encouraging.
Aachen or Aix-la-Chapelle may also be mentioned among the con tinental bath-places which may be visited with advantage by these patients.
In England the arrangements for carrying out the Aix treatment are especially admirable at Bath, and here there is a large sup ply of a thermal water with abundant mineral ingredients. Harro gate, celebrated for its sulphur water, may also be mentioned among bath-places suitable for these patients, and Woodliall Spa iu Lincoln shire, where the water is strongly saline and contains bromides and iodides.
Patients who prefer to go further afield may visit Hammam Whim or Hammani Meskoutin in Algeria, or Halouan les Bains in Egypt. At these latter places there is the additional advantage of a warm and equable winter climate which may contribute materially to the cure.
Indeed a winter sojourn iu such a climate as that of Egypt or the Canary Islands should be mentioned as in itself a valuable therapeu tic measure in cases of arthritis deformans which have not reached too advanced a stage.
Many of the American spas and climatic resorts will be found ef ficacious in such cases. It is important that the patients should not be subjected to any course of treatment which tends to have a debili tating effect, for such treatment has in the long run the inevitable re sult of aggravating rather than arresting the malady. General vapor baths come under this head. When taken they undoubtedly afford a temporary relief and enable the patient to move with more freedom, but this relief is dearly bought at the expense of a deterioration in the sufferer's condition which results when they are repeatedly taken.
This does not apply to the Berthollet local vapor baths, which are applied to separate limbs or portions of _limbs by means of specially constructed apparatus; and which sometimes form a valuable adjunct to other methods of thermal treatment.
In some cases in which other treatment fails, electric baths may be tried. A copper plate connected with the negative pole of a con stant-current battery is placed at the foot of the bath, and another similar plate connected with the positive pole is placed at its head.
The head and shoulders of the patient are supported by a wooden frame across which webbing is stretched, which prevents the body from coming into contact with the metallic plate.
The bath should be taken under skilled medical supervision, and the patient should remain in it for ten minutes while a current from about forty No. 1 Leclanche cells is passed through the water. As an alternative arrangement the current may be reduced, and the nega tive pole may be connected with handles which are held by the patient.
The late Dr. Steavenson spoke of good results which he had had from this treatment in arthritis deformans, and it is worth trying in cases which do not yield to other means; but I cannot say that in the eases in which I have watched the effect of electric baths in arthritis deformans, the results obtained have been very encourag ing, perhaps because these have usually been cases in which other modes of treatment have failed to give relief, and therefore hardly afforded a fair criterion of the value of the treatment.
A few words must be said about the local treatment of the affected joints. It is generally acknowledged to be undesirable to use such appliances as materially limit their movement, but in the more acute stages the patient may be unable to get about, and rest in bed or upon a sofa becomes not only advisable but even necessary. Dr. Kent Spender recommends that in such cases the joints should be sup ported, but not fixed, by mill-board splints. Wrapping in flannel ban dages, sponging with hot water, or covering with hot sand according to a recommendation of Haygarth's, will sometimes afford relief, as also may the application of liniments as already recommended.
A moderate amount of rubbing is also sometimes useful.
In the more chronic stages the patients should be encouraged to get about, but such an amount of exercise as is followed by pain last ing for some hours should be regarded as excessive and should be forbidden.