Local are many agents which may be advantageously employed to relieve the arthritic manifestations. Absolute rest of the affected joints is the most important of these, but rarely will splints be deemed necessary. The meddlesome plan of applying lotions, liniments, counter-irritants, etc., is seldom justified, as these entail more or less movement of the articulation.
Fuller's alkaline lotion is still recommended in many textbooks: it consists of i oz. Laudanum, 4 oz. Bicarbonate of Potash, 2 oz. Glycerin, and 9 oz. Rose Water, which is recommended to be applied round the joints on lint. The opium in this preparation cannot effect any anodyne result, and any virtue it possesses can be better obtained by sponging the joint surface with a weak alkaline solution.
Painting or smearing the joint with the synthetic Oil of Wintergreen or Methyl Salicylate is often resorted to. The plan of applying strong Aconite and Belladonna liniments under oiled silk is a dangerous practice, as absorption is liable to occur.
The best routine to follow is to envelop the affected articulations in a layer of warmed absorbent wool fastened by a many-tailed bandage without any impervious dressing, as the latter is apt to cause retention of the irritating sweat. Some practitioners resort to the routine application of Antiphlogistine (Cataplasma Salicylicum Co.) or of Cataplasma Kaolini U.S., which contains Thymol, Methyl Salicylate, Oil of Peppermint with Kaolin, Boric Acid and Glycerin.
Blister have been employed from remote periods, to be dis carded and again brought into use from time to time under the influence of supposed advances in our knowledge of the pathology of inflammatory action. The late Dr. A. Ilarkin employed blistering in a different way from any of his predecessors; influenced by his theory that the endo cardium and the pericardial sac were to be regarded in the light of large joint surfaces, his first step in the treatment of acute rheumatism in every case was to apply a large blister over the cardiac area. The writer saw many cases which Harkin treated in this manner, and was surprised to find that a rapid and sometimes complete relief of all the classic symptoms of acute rheumatism followed, the joint pains, local swelling, redness and heat, together with the high temperature of the body, speedily disappearing. In some cases the symptoms never returned or returned
in a minor degree, whilst in others after a few days salicylates had to be resorted to, but the constitutional effects were unmistakable in most cases, though the joints were never blistered. It seemed probable that the absorbed cantharidin exerted some constitutional action. Caton after wards advocated the plan of preventing endocarditis through stimulating the trophic centres by vesicating the skin between the nipple and clavicle which is supplied by the first four dorsal nerves.
These methods are not to be confounded with the practice of employing blisters as mere counter-irritants to the inflamed joints for the relief of pain as advocated by Davies and many others, but the above considerations seem to prove that when blisters are employed in this latter manner they may effect far-reaching results and should be resorted to more frequently than is generally practised. Osier recommends passing the thermo cautery over the skin of the joint for the relief of pain.
Another method of relieving the joint pains practised by Stromeyer is to apply the ice-bag, and Lees strongly recommends this agent for the relief of the cardiac pain and distress in acute rheumatism of the cardiac type.
The convalescent period requires prolonged rest almost as rigidly enforced as in the acute stage of the disease. The importance of this has been already dealt with in the articles on Endocarditis as the most powerful factor in the prevention of permanent valvular lesions, and it is a significant fact that the period of rest after the attack has passed off is being steadily lengthened till some authorities have recommended that more or less complete rest should be maintained for six months, This must, however, be considered unnecessary in simple cases, though it is clearly indicated where the heart has been seriously engaged, and in most cases occurring during childhood.
Massage, electricity, hydropathy, passive movements and the internal administration of Iodides in full doses should in most cases be kept up during the first month or six weeks of convalescence. A change to a dry inland residence is most desirable when practicable.