RHEUMATISM, Acute.
Rest in bed must be insisted upon as soon as the joint symptoms of rheumatic fever appear, as evidenced by pain, heat, redness and swelling with fever and perspiration. There is, perhaps, no other diseased con dition where absolute rest in the horizontal position is more clearly necessary. Endocarditis followed by permanent valvular mischief is decidedly less likely to occur in patients who have taken early to bed after the development of rheumatic fever and remained there afterwards for a long period.
The sick-room should be selected upon the ordinary sanitary principles, and it is better that it should not be upon the ground floor. The air of the room should be kept at a uniform temperature, and currents of cold atmosphere are to be avoided by arranging screens at a little distance around the patient's bed. The bed should consist of a good hair.mattress upon the top of a woven wire one or above a hard straw palliasse, feather beds being objectionable, both on account of the patient sinking into them and also because of his profuse sweating. Sheets (especially linen) must be dispensed with, and it adds greatly to the comfort of the patient if he be placed between light or thin flannel blankets. The bed-clothes should not be abundant, eider-down coverlets should be discarded, and a loose and thin flannel night-dress, which speedily absorbs the cutaneous moisture, is to be preferred to linen or cotton, and it should be slit down the middle and the sleeves treated in the same manner so as to permit of easy access to the cardiac region and the joints. Loosely-fitting drawers of the same material may also be worn. A bed-pan and urinal are essentials.
Diet.—This may with advantage consist entirely of milk, with farina ceous foods occasionally, and at a later stage beef tea, soups, chicken jelly, or concentrated beef essences may be administered after the subsidence of joint pains and fever. Latham insists upon the importance of a pure milk diet, and points out that soups and beef essences cause relapses. Other writers do not agree with him in this. Thirst may be relieved by
small quantities of ice sucked in the mouth, or by the frequent adminis tration of a wineglassful of equal parts of iced Kali water and milk, or by lemon juice diluted with three or four parts of water. Yeo's plan of administering lemonade made by boiling a lemon in i pint water and adding zo or 3o grs. Bicarbonate of Potash is a good way to relieve thirst, as it does not interfere with the administration of milk; the essential oil of lemon contained in the rind is liable to upset the stomach. The writer prefers effervescing Potash or Kali water to which a little fresh lemon juice has been added just before administration. This will also take the place of the grs. Citrate of Soda recommended to be added to each pint of milk, When the patient is able to take 4 pints milk daily diluted with kali water, all difficulty in dieting is removed.
Unless in the presence of complications, Alcohol should be avoided as a routine; but a moderate amount — a wineglassful of whiskey daily —may be permitted to those who have long accustomed themselves to it.
By the free use of the milk diet and alkaline drinks the eliminatory organs are kept active and the bowel may occasionally be flushed with a saline purgative. Constipation must be avoided, especially as the thoracic pressure is liable to be dangerously increased when the constipated patient attempts to use the bed-pan; hence the routine administration of a copious enema every second day at least is a wise precaution, as much mischief in cardiac cases may thereby be prevented.
Drug Treatment.—Salicylates should always be prescribed as a routine, though some eminent authorities recommend a pure Expectant or Peppermint water treatment, and publish excellent results from its use; nevertheless it is highly probable that these savants would resort very soon to the salicylic treatment should they themselves be unfortunate enough to become the victims of an acute attack of rheumatism, with its unbearable pains and discomforts.