As regards drug treatment it therefore appears from the published results of the last-mentioned authorities that the best routine in all cases of rheumatoid arthritis is to persevere with full doses of Guaiacol Car bonate, changing from time to time to Benzosol or Saloquinine in similar amounts when better effects can be obtained.
There is no doubt that Sulphur and Guaiacum Resin as in the Chelsea Pensioner Electuary and also Ichthvol often afford considerable relief to the wearying joint pains, probably acting in a manner similar to the guaiacol and benzosol treatment by neutralising the toxins in the blood. Arsenic, Iodine, Iron and Quinine will always find a place in a chronic ailment where anemia and debility continually manifest their presence.
Fibrolysin injections have been strongly recommended on the same grounds as they have been advocated in chronic rheumatism or fibrositis, with the view of dissolving nodular growths. This method should always have a trial in those rare cases where an important joint like that of the jaw becomes locked and where surgical interference is clearly indicated.
Vaccine treatment has been resorted to with doubtful success, hut it should have a trial in those desperate cases of acute rheumatoid arthritis which constitute one of the most serious ailments that can affect the human subject, rendering him absolutely helpless for life by locking all the joints in the body and condemning him to drag out a miserable existence in bed. The Polyvalent Antistreptococcic Vaccine should be injected in doses of 25 to so millions of the killed organisms. Sherman advocates the injection of a mixed vaccine containing roo millions each of Staphy lococcus aureus and .5. albus, given alternately each week with doses of 3o millions of streptococcus. The hope of dealing effectually with the grave type of acute case lies in the possibility of the preparation of an autogenous vaccine from the joints, as everything points to the prob ability of the pathology of these examples of the disease being an infection by an acute septic micro-organism and not the result of a toxmia arising from intestinal fermentation. Crowe, who has studied exhaustively the bacteriology of the disease, affirms that the Staphylococcus defornians, which he found in go per cent. of acute cases in the urine, is the true
causal factor, and believes that a vaccine prepared from it gives every hope of a successful treatment of the disease.
Local Treatment.—For the relief of pain anodyne applications innumer able are in constant use, nearly every physician haring his own favourite liniment. Any of the local analgesics mentioned under Rheumatism may be employed; the writer's routine is Methyl Salicylate gently rubbed into the tender joint either in its pure state or with Menthol as in Methysal Balm of Martindale or as the odourless methylester—Mesotan—which must be diluted with twice its bulk of olive oil. Bannatyne recommends Guaiacol mixed with olive oil or with Tincture of Iodine.
Every known form of counter-irritation and every counter-irritant drug have been tried, from Chili Paste and Iodine to Cantharides and the cautery iron.
As regards the milder counter-irritants and anodynes it is probable that a considerable degree of their benefits is attributable to the friction necessary for their application.
in the case of acute rheumatism, the accumulated evidence regarding the value of blisters has led to the use of these agents in two very different methods. Thus in one a marked general or spinal effect is obtainable according to Midelton without applying the vesicant to the affected articulations. Ile applies a series of blisters 4 x ti inches along each side of the spine over the lumbar and sometimes over the cervical enlargement, and keeps the blistered surface raw by dressing it with a mixture of Savin and Resin ointments. This treatment is supposed to act like Plarkin's and Caton's plans, but probably the good effects, of which in some cases there can be no doubt, are, as the writer believes, to be attributed to some antiseptic action of the absorbed cantharidin. The other plan is to blister the affected joints one by one; by both methods pain may be considerably relieved and often the swelling is lessened and the range of motion increased. The thermo-cautery lightly passed over the affected articulation is also useful as a pain reliever.