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Treatment of Rheumatism

blood-letting, time, bleeding, disease, patient and bleedings

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TREATMENT OF RHEUMATISM.

If the pathology of rheumatism has been unsatisfactory, its treat ment has been not less so. There is probably no disease in which so many different modes of treatment have been had recourse to. There is none in which medicinal treatment has until within recent times more completely failed to shorten the duration of the malady. The special mode of treatment in vogue at a given time has generally depended on the views held regarding the nature and mode of pro duction of the disease. During the last century and the first half of this rheumatism was regarded as a " phlegmasia," as an inflammation dependent, like other inflammatory affections, on exposure to cold, and differing from them only in the nature of the textures involved. The treatment of inflammation was at that time essentially antiphlo gistic and consisted in the adoption of various means of depletion. The chief of these was bleeding. Sydenham wrote in 1666, that "the cure of rheumatism is to be sought by blood-letting." His rule was to take ten ounces of blood as soon as he saw the patient, to repeat the operation the following day, to do it again in a day or two, and, for the fourth and generally the last time, three or four days later. But he was not satisfied with the results of this practice; for in 1679, ten years before his death, he says in a letter to Dr. Brady : "I like yourself have lamented that rheumatism cannot be cured without great and repeated losses of blood. This weakens the patient at the time; and if he have been previously weak, makes him more liable to other diseases for some years. . . . Reflecting upon this I judged, it is likely that diet, simple, cool, and nutritious, might do the work of repeated bleedings, and save the discomforts arising therefrom. Hence I gave my patients whey instead of bleeding them." He gives the particulars of a case treated dietetically, in which the patient "recovered his full strength, escaping all such discomforts as ten years before a similar attack, which I treated by bleeding, had en tailed upon him."

Cullen, though he regarded blood-letting as " the chief remedy of acute rheumatism," and taught that " large and repeated bleedings during the first few days of the disease seem to be necessary," was careful to add that "to this some bounds are to be set; for very pro fuse bleedings occasion a slow recovery and, if not absolutely effec tual, are ready to produce a chronic rheumatism." Though the indiscriminate use of the lancet was condemned by many able observers, such as Heberden, Fowler, Latham, and others, bleeding continued, till well on in this century, to be the sheet-anchor in the treatment of acute rheumatism.

"In undertaking the treatment of acute or subacute rheumatism, whether we view the inflammatory state of the aponeurotic mem branes as primary and idiopathic, or secondary and symptomatic, it is necessary in the first instance to adopt the antiphlogistic method of treatment, and to carry it on with some degree of energy, and to a considerable extent.

"The different branches of the antiphlogistic regimen requisite in the treatment of rheumatism are blood-letting, general and local, the occasional employment of cathartics, the occasional employment of emetics, especially tartar emetic, the use of diaphoretics, and the use of revellents.

"First. General blood-letting in order to be beneficial ought to be performed early in the disease, and carried to a considerable extent. . . . It should be carried at first to twenty or twenty-five or thirty ounces at once if possible; and within twenty-four hours to as much more.

" Secondly. The influence of general blood-letting must be aided by the conjoined operation of various adjuvants. Full vomiting pro duced by ipecacuanha and antimony is in the majority of cases requi site; and complete evacuation of the bowels by eccoprotics and even cathartics is quite indispensable.

" Thirdly. It is of the utmost importance, in attempting the thor ough removal of rheumatic pains, to conjoin with blood-letting, or after its use, the administration of full doses of tartrate of antimony.

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