RHEUMATOID ARTHRITIS, Chronic.
Arthritis I kformans, Osteo-arthritis, Rheumatic Gout, Chronic Rheumatic Arthritis, Arthritis Sicca and Arthritis Nodosa are some of the synonyms of this obstinate affection which is essentially distinct from either rheumatism or gout.
The disease is too often regarded as invariably progressive and incurable, but if taken in its early stage unquestionably arrest in its progress is sometimes possible, and some observers are satisfied that a cure may be accomplished, though others regard the cured cases as instances of mistaken diagnosis.
The progress of any scientific treatment of the affection is necessarily retarded by the diversity of the views held about its pathology. Whether the diseased condition of the joints is to he regarded as the local manifes tation of a microbic infection or of a toxaemia arising in the intestinal canal or is simply the result of retarded eliminatory action or perverted nervous function, all authorities agree upon cold and damp as being power ful etiological factors in the production of the disease.
Clothing and climale consequently become important preventive agents as they also arc by far the most important considerations to be attended to in the treatment of the disease once the symptoms justify a diagnosis, as no improvement need lie expected unless the patient can be completely removed from his surroundings and transported to a drier atmosphere, where the variations of temperature are less marked than in this changeable climate—a warm, dry, equable climate being acknowledged on all hands to be an essential factor in successful treatment.
As a winter resort Las Palmas, Algiers, Egypt and South Africa are suitable, whilst in summer Seville and other Continental resorts are popular. In connection with these places the baths are of great impor tance, but these will be mentioned later on. As a rule inland resorts are preferable to seaside places.
As regards clothing, the body should be encased in light woollen gar ments, worn if possible next the skin, but over-clothing is to be avoided. The writer recommends a thin flannel vest and drawers, with a piece of wash-leather inserted inside the fabric next to the skin over the large joints, as at the shoulders, elbows and knees. The practice of piling on
garment over garment, so as to keep the patient always in a state of per spiration, is to be condemned. The foot-covering is not to be neglected, and cork insoles or overshoes are essentials in wet weather. As pointed out in the author's " Practice of Medicine," the monarticular cases are especially liable to be made worse by excessive clothing, as it seems certain that by keeping the other joints deeply enveloped in woollen fabrics the resistance of the exposed articulations is reduced and the hands become soon affected seriously. All undue exposure to cold and damp, or drying east winds, it is needless to say, should be avoided.
If the patient's residence is upon damp, cold clay, he should be strongly advised to change it for one on a dry, sandy, elevated well-drained soil, and when this is impossible he should be advised to sleep and live as near to his attic or as far from the ground level as possible. The worst cases are observed in Ireland amongst individuals who live mostly on the ground story of farmhouses with earthen floors.
' Diet.—As regards diet, everything which tends to improve nutrition must be freely given. No matter which of the various views of the pathology of the affection may be accepted, there is always evidence of serious impairment of nutrition, and this calls for the most liberal and varied dietary. Mixed food—fresh meat and plenty of fresh vegetables— with a very limited supply of malt liquor, or none at all, should form the basis of the dietary. A Koumiss or fermented milk diet is often beneficial.
Celery, eaten raw or stewed, is a popular remedy, and experience proves that there is some truth in the belief, though the writer thinks that the Spanish onion is the best of all vegetabes for constant use by the victims of this affection. In Ireland, where the disease is so very common, it is supposed that the excessive use of ill-cured bacon has something to answer for in inducing the disease.