HEUNIATISM, volume v.) For purposes of treatment, rheumatic arthritis should be carefully differen tiated from rheumatoid arthritis. The former is an affection of rheumatic origin, local in character, in which the neural element is absent. The latter is a general disease of debility, having no connection with rheumatism, in which the neural element plays a conspicuous part, and which occurs in cases with strong heredi tary histories of gout, struma, or plithisis, its last stage being osteoarthritis. Hugh Lane (1.ancet, Dec. 10, '92).
It is important to bear in mind that the joint is to be protected from ing movements. It is here that rheumatic differs from simple traumatic disease of the joints. In the latter a small amount of movement may not be painful, but in the former the opposite is the case. Massage is not apt to be of service ex cept in chronic cases, certainly not in acute ones. Rest on a splint is to be en forced, with the joint wrapped up in cotton or flannel. The application of cloths wrung out of hot alkaline solu tions may be tried. A piece of lint wet with chloroform liniment and covered with woolen cloths may give relief. Osler advises the use of the Paquelin cautery, lightly and rapidly stroked over the part, as a means of reducing pain. The use of leeches is not so efficacious as in traumatic cases. Cold applications are only to be advised when not dis tressing to the patient. The use of air baths must be decided by a cautious trial. The heat at first should not be great, and in many cases, particularly acute or subacute ones, local hot-air baths are not to be used at all.
General hot-air baths and also Turk ish baths are far more apt to be of service in all cases.
In treatment of arthritis by hot-air baths the patient lies in bcd. The tent which covers him is made of two large cradles, covered first with blankets, then with mackintosh sheets, and then again with blankets. The coverings must be arranged at the top of the tent in such a manner that a small opening can be made to let out the hot air when it has become saturated with moisture. If the packing be too tight, a counter opening must be made. The patient's neck should be wrapped as air-tight as possible. The cradles used are made of wire netting on a metal frame. The flue attached to the lamp passes through an opening in the blankets at the foot of the tent, and may be covered with as bestos or a wet cloth to protect the blanket. The lamp should be made with
out solder. The blanket which has cov ered the body is removed finally to allow of free evaporation from the surface of the skin. The patient is wiped down after the bath, and wrapped in dry blankets for the rest of the day.
As a rule, an opening need not be made till the patient breaks out in a good perspiration or complains of feeling too hot. The opening should be made at the top of the tent. This is the important point in the treatment.
This treatment is applicable to:— I. Subacute rheumatic arthritis.
2. Subacute arthritis following acute rheumatism, or rheumatoid arthritis, as sociated with pain and stiffness on move ment, with continual aching pains.
3. Impaired mobility following injuries to joints or to muscles in their neighbor hood, and cases of joint-trouble from tro phie causes or disuse. T. Sydney Short (Brit. Med. Jour., Nov. 26, '98).
Too vigorous local treatment is very apt to relight the trouble; coaxing, and not forcing, is our motto. This is true also of passive motion. What is gained by gentle persistent motion is apt to be retained, but what is acquired by forcible movements under anresthesia is apt to be lost and the joint remain stiffer than before. Notwithstanding the assertion of Treves ("System of Surgery," volume i, page 267), that rheumatism and gout have practically no effect on the diate future of an operation, care should - (11:,abilities resultingfrt in loss of motion in joints partial op t -at.t 114 are atilt. to be extremely un ,dt,,fat tor. antl only start the trouble ant %%, a- l hale stAn. and the total re !, it 1 is more satisfactory. 'rims, in the 'l %,-joint a formal incision is apt to bdter result than the removal of xe:toses. In one case I deliberately ex t the joint of the big, toe for an intractable rheumatic inflammation that Ind lasted over a year. resulting in par Cal disorganizing of the joint. While it pos,ible that rheumatism may, at have a septic element in it, the ractiee of tapping. and washing the joint ith a mild antiseptic solution is only to be followed with caution and in se leeted ca,es.