478 THE TREATMENT OF DISEASES. 



In many cases local applications prove of service. In the early stages, when 

 there is tenderness and swelling of the joint, temporary relief may be obtained by 

 the application of a blister. When the affection has become chronic, and blisters 

 have effected all they are capable of accomplishing, the application of narrow strips 

 of plaster, one over another, so as to support the joint, may do good. Simple spirit 

 lotions or belladonna liniment well rubbed in will sometimes ease the pain. Friction 

 is usually not only serviceable but grateful. The joint may be well sponged with 

 strong brine, and then rubbed dry so as to cause the salt to be absorbed. 



Baths are very useful, especially when the skin is sluggish in its action, but care 

 should be taken that they are not repeated sufficiently often to produce debility. 

 The Turkish bath is often of the greatest service in these cases. The cold, or in 

 winter tepid, douche may be played for about two minutes on the affected joint, 

 which should then be rubbed till it is quite warm and dry. The use of hot sulphur 

 baths often proves of service in chronic cases. An arsenic bath is sometimes 

 employed. It is made by adding to the water four ounces of common washing soda 

 and twenty grains of the salt known as arseniate of soda. 



Respecting the diet little need be said. The patient should, if possible, live 

 generously, and beer, wine, or spirits may be taken in moderation. For people 

 whose pecuniary circumstances will admit it, a frequent change of air and scene is 

 to be advocated. Prolonged mental exertion is hurtful, and all causes of anxiety 

 should as far as possible be avoided. A removal to a moderately warm, dry, 

 bracing climate during the winter months is to be advocated. There can be but 

 little doubt that as a rule many of the foreign saline and alkaline waters, such as 

 those of Carlsbad, Wiesbaden, and Yichy, do more harm than good. The springs 

 most adapted for the subjects of rheumatic gout are those which contain iron in 

 some easily digestible form. 



RHEUMATISM, CHRONIC. 



Chronic rheumatism is a complaint with which few elderly people are altogether 

 unacquainted. It is sometimes the sequel of rheumatic fever, but more frequently 

 a separate constitutional affection coming on quite independently of any previous 

 acute attack. There is at first only slight constitutional disturbance, but the 

 sufferer is constantly annoyed and his existence at length rendered miserable by 

 wearing pains, causing him many a restless night, and destroying all comfort during 

 the day. 



The joints which are most frequently the seat of the pain are the knees, ankles, 

 hips, and shoulders. Redness is seldom present in chronic cases, but stiffness and 

 swelling of the joints are common accompaniments of the complaint. In many 

 cases pain is for a long time the only symptom, and even this may be latent unless 

 the part be moved. In some instances the pain is worse at night, being aggravated 

 by the warmth of the bed, but in others warmth affords the greatest relief. It often 

 exhibits great tendency to shift from joint to joint, often subsiding and then re- 

 curring. It is usually aggravated by vicissitudes of weather, and especially by the 

 prevalence of east winds and cold and damp states of the atmosphere. 



Chronic rheumatism is most common after thirty, and is especially prevalent 



