MEDICAL NOTES.

Auckland Star, Volume LXIV, Issue 83, 8 April 1933, Page 8 (Supplement)

MEDICAL NOTES.

PROBLEMS OF RHEUMATISM

CAUSE AND REMEDIES. BEER AS A DRUG. ' • (By PERITUS.) Sixty-one per cent of incapacitating illness amongst' workers is said to be due to rheumatism (chronic, joint and muscular) and arthritis, and in England and America special clinics have been opened for the study and the cure of these conditions. The cause of rheumatic disease is obscure, for although acute rheumatism is definitely febrile and microbic, the chronic variety appears to be more toxic and allied to blood impurity. To saturate the system with sulphur or salicylic has such beneficial effect in chronic rheumatism that one is tempted to regard these internal anticeptics as true antidotes, but only modified reliance can bo placed in them. The prompt treatment of early pain and stiffness in the affected joints affords the best hope of cure and the prevention of the intense suffering and terrible deformity of late stages. It is probable that the natural fluids of the body are first affected, the synovial lubrication of joints being soon affected. Deposits in and actual thickening of the joints point to defect in normal nutrition, and it has even been said that nervous influences cannot be entirely exempted as a cause. The slight fever occasionally evident-may be due to pain which in moderate degree raises temperature. An Old Problem. For fifty years the profession has argued about cause and cure until patients have nearly lost the hopefulness which is so essential to recovery. The cramped and painful joints give warning long before deformity begins, and, like many serious illnesses, the prospect of cure is greater the earlier treatment is commenced. The author of a monograph on this disease says that he has seen much benefit follow the drinking (medicinally) of two pints of bitter ale daily, but I have not been able to discover anyone who has tried this rather pleasant remedy. The sedentary worker seems to require arthritis moro readily than the labourer, although it is well known, that exposure to damp cold increases liability to attack. The two worst cases I have seen were far advanced. The patients—one a schoolmaster and one a doctor —were hopelessly crippled and confined to bed. In both cases there were heart symptoms which caused one to suppose that acute rheumatism may have preceded the arthritis.

Need For Care. It is. obvious that a joint threatening future immobility should not be kept at rest, except when in a highly inflamed state. When a joint has been covered with muslin, and treated with very hot packs, and then dressed v with mesotan and oil (1 to 4) gentle massage, and'passive movement,' have restored mobility and relieved pain. . Steady continued attention to; elimination, flushing bowel and kidneys daily is "common-sense" treatment, with added care that strength and vitality are not lowered. The beer treatment mentioned above may have owed its benefits to increasing normal fluids intake. Hot mineral baths are recommended, but require more caution than is generally supposed, .because the sedative and "lowering" action have been.-known to have serious results. I knew a badly crippled woman who, returning from a course of treatment at Rotorua, able to walk freely and in comfort, and saying thankfully, "I a ma new woman," died of heart failure shortly afterwards. Medical supervision is therefore absolutely necessary. ' Miracles have been done at Rotorua, but there is an art union element in the treatment, as everybody is willing to admit. Dry Climates. Apart from constitutional methods surgery has been successfully practised, but this is the treatment of despair for most afflicted people, who cannot know that the clearing up of ono'joint has been most wonderfully followed by the spontaneous clearing up of another, untouched. In advanced cases every effort is made to reduce pain, which, as far as my knowledge goes, is all that can be done. There may be a history of gout in the family, and to this some cases have been attributed. Of drugs administered internally guaiacol (in capsules) is recommended, and reduces pain and swelling, but on the whole, it is the systematic cleansing of the secretions, and attention to improvement in diet, change to a dry, warm climate, and the use of mineral waters, to which we look with most hope. The hotter, drier parts of the world arc comparatively free from this painful disease, and in Europe, Madrid; in Egypt, the Upper Nile; and in Australia, the high inland part of Queensland, are localities suggested as remedial residences. One old doctor has prescribed "patience, persistence, and cod liver oil," and these are available to everybody. There is a form of joint trouble common in this country which sends many men to work limping on one foot, or with one wrist bandaged. This is usually rheumatism which has attacked a joint sprained or otherwise injured, and the pain is out of all proportion to the extent of the injury. If the painful part is bathed with hot water—until the surface is reddened —dried, and lightly rubbed with opium liniment, and afterwards covered with a flannel (all wool) bandage, the pain will soon cease. Do not tell the wife this is early arthritis and demand the beer treatment.