CHRONIC ARTICULAR RHEUMATISM. 



539 



private practice it is difficult to conduct the bath-treatment with the 

 necessary care and prudence ; hence it is generally better to send 

 patients, whose means permit, to one of the above-mentioned warm 

 springs. Baths of 95 100 are sufficiently warm, and are probably 

 to be preferred to those of higher temperature ; at least, according to 

 my experience, Russian vapor-baths do less good in chronic rheuma- 

 tism than warm-water baths. The same observation has been made 

 elsewhere. The erection of a Russian vapor-bath, at a place where 

 there has formerly been none, usually pays very well the first and 

 second year, for most persons with chronic rheumatism crowd to it, ex- 

 pecting to be cured ; but the third and fourth years the number of 

 customers is usually much less, and this is certainly not because the 

 persons with rheumatism have all been cured, but because their hopes 

 have been disappointed. From the experience at Wildbad, Leuk, 

 and elsewhere, it seems advisable to gradually extend the duration of 

 the bath, and, toward the end of the treatment, to let the patient 

 pass an hour or more in it. It is very important for them to avoid 

 taking cold after bathing, and it would be well to give them a blanket- 

 sweat. It is customary to give about thirty warm baths in succession, 

 and if this number proves insufficient, it seems better to stop their use, 

 and take up the treatment again a few months later. In " cold-water 

 cures," patients with chronic rheumatism, especially old cases, are not 

 usually cured. I know not a few cases of this class who left the cold- 

 water cure establishment, after a sojourn of several months, sicker 

 than when they entered. In recent cases, on the contrary, hydropathy 

 appears to have a favorable effect. Among the "anti-rheumatic" 

 medicaments, tine, colchici sem. ( | ss), with extract, aconit. ( 3 ss), 

 and tine, opii ( 3 ss), in doses of 15 20 drops four times daily, has a 

 great reputation, and is probably the most common prescription in. 

 chronic articular rheumatism. Unfortunately, we do not yet know in 

 which cases colchicum (which is certainly not altogether inactive) is 

 indicated, nor when we cannot expect any thing from it. Ammo- 

 niated tincture of guaiac. and the antimonials, which formerly had the 

 reputation of being active anti-rheumatics, are little used of late. In 

 some cases of chronic articular rheumatism, and, as it seems, chiefly in 

 those cases where the ligaments are mostly affected, iodide of potash 

 in large doses (3j 3 j daily) appears to be very serviceable. Im- 

 provement ordinarily begins with the appearance of slight iodism, and 

 it is advisable to increase the dose until the effect of the medicine is 

 observed on the skin, or the mucous membrane of the nose. In recent 

 cases, and in young persons, the regimen of the patient must differ from 

 that in old cases, or patients of advanced age. While, in the former, 

 especially after improvement has begun, we should advise a careful 



