For external use a host of drugs have been employed to produce irritation of the skin, turpentine, iodine, camphor. and ammonia, for instance. To relieve the pain, chloroform, belladonna oint ments, methyl-salicylate, etc., have also been tried. Bannatyne advocates the ex ternal use of guaiacol in combination with an equal amount of olive-oil or combined with tincture of iodine (6 parts of guaiacol to 1 part of iodine); the odor of guaiacol can be masked by a few drops of the oil of cloves. The mixture is painted on the affected joint and covered with a dry dressing.
Electrical treatment has been advised, but is not so useful in this disease as in gout. I have tried the dielectric intro duction of lithia with a strong galvanic current in many cases, but I do not con sider it to be of much value against rheumatoid arthritis. Steavenson and Carrod employ an electric bath, through which a strong galvanic current of 50 to 200 milliamperes is allowed to pass for about ten minutes; as many patients are very sensitive to galvanic currents of this force, much circumspection is ad visable in the use of this treatment.
Thermal treatment has been employed for centuries and until recently the cur rent therapy of rheumatic gout consisted principally in advising a cure in alkaline, sulphurous, or in different springs (Bath, Aachen, Wildbad, etc.), and certainly many patients have profited from such a course. Of late the application of hot air baths has somewhat supplanted the use of water-baths. The apparatus con structed by Tallermann, Betz, Greville, and many other inventors make it pos sible to place the affected limb in a hot air bath at a temperature of SO° to 120° or even 150° C. This bath may be given daily, if the forces of the patient allow it; they produce a very strong perspira tion of the part in treatment, and, al though more moderately, of the whole body. The bath is very well borne by the patients, their temperature is only slightly raised by it, while the heart is not at all influenced. These baths are of great value to alleviate the pain and to combat the swelling and the stiffness of the joints.
The local, hot, dry-air bath is of little value in rheumatoid arthritis; but it is of great service in the treatment of liga mentous inflammations and in tenosyno vitis, whether rheumatic or of traumatic origin. The temperature considered of most value was the one ranging between 270° and 320° F. 11. C. Wood (Med.
News, July 17, '97).
In Germany competent observers have advocated a surgical treatment of the disease. Schiiller treats the affected joints by repeated injections of a ure of iodoform, 20 parts; acid-free glycerin, 250 to 400 parts; and guaiacol, 5 parts. The injection is made with every antiseptic precaution. As a rule, the pain continues for some days, but fever only exceptionally results. Twenty seven cases were treated in this manner; of these sixteen recovered almost com pletely. But the cure is more rapidly effected by incision of the affected joint, removal of the diseased synovial mem brane and the villous mass, and suturing of the wound with injection of the above-mentioned mixture in the articu lation. The joint is kept immovable for ten days and extended by a bandage.
After that the sutures and the bandage are removed and massage, electricity, inunctions, and baths are employed.
By this method Schtiller obtained a plete cure with absolutely normal move able joints.
In joint rheumatism the following ap plication is excellent:— II Menthol., 1 drachm.
Ac. salicyliei, 2 drachms.
Methyl salicylatis, 1 drachm.
Alcohol., q. s. ad I ounce.
Paint joints briskly with camel's-hair brush, cover with absorbent cotton and oiled silk, and bandage snugly, hut riot tightly.
So efficient has the above combination proved in personal hands that in by far the great majority of cases of acute articular rheumatism it has been pos sible to dispense with internal medicines altogether. The salicylic acid and methyl salicylate are rapidly absorbed and their presence can be demonstrated in the urine. In this way one is enabled to saturate the system with salicylates without disturbing the gastric function. After a few applications the epidermis begins to peel off and the surface be comes tender. When this occurs the ap plication should be stopped for a day or two and an emollient ointment should take its place. The menthol-salicylate alcohol application is useful in acute rheumatism only. In the subacute va riety its efficiency is very slight, while in chronic rheumatism it is practically nil. In the latter two varieties the best results are obtained from a 33-per-cent. ichthyol ointment or a 20-per-cent. ichthyol-glycerin solution, aided by the persistent and long-continued internal administration of ichthyol and potas sium iodide. W. J. Robinson (Merck's Archives. April. 19021.