482 THE TREATMENT OF DISEASES. 



it would even effect a cure in cases in which the nocturnal exacerbation is not a 

 prominent symptom. 



We cannot leave the subject of rheumatism without saying a few words on 

 what is known as gonorrhoeal rheumatism. This affection consists of inflammation 

 of and about the joints, following an attack of the complaint from which it derives 

 its name. It differs from ordinary rheumatism in many important respects. In 

 from ten days to three weeks after the establishment of the primary disease, one or 

 more of the joints become stiff, painful, and swollen, possibly as the result of the 

 patient having got a chill from exposure to the weather, or from sitting in a draught 

 of cold air. At the same time the feet may be painful, there may be some 

 inflammation about the eyes, and there will be considerable fever, with dry skin, 

 and a furred tongue. The knee is more frequently affected than any other joint, 

 possibly because it is a large and complicated structure, but little protected by 

 muscles from atmospheric influences. The complaint occurs almost exclusively in 

 men, and after the first attack the patient is exceedingly liable to a recurrence. Each 

 attack is usually more virulent in its character than the preceding. After the first 

 visitation slight stiffness may remain for several weeks, and the result of several 

 attacks may be the occurrence of a permanently stiff and disabled joint, leaving the 

 patient a cripple for life. 



When the patient has reason to believe that he is suffering from this variety of 

 rheumatism, he should at once consult a medical man, and lay the whole facts of 

 the case before him. If the patient is foolish enough to suppress any part of the 

 history, he may pay a penalty of lifelong misery. 



When the complaint is vigorously treated at the very commencement of the 

 attack, its progress may sometimes be arrested. When there is much constitutional 

 disturbance, anti-febrile treatment will have to be resorted to, and it may even be 

 necessary to abstract a small quantity of blood from the arm by bleeding. Leeches 

 applied to the inflamed joints often aggravate the symptoms, and may do more harm 

 than good. The constant application of poultices or hot fomentations to the affected 

 joint, which must be kept absolutely at rest, will prove advantageous. The Turkish 

 bath may be resorted to with very great benefit, the pain often quickly subsiding 

 on the occurrence of profuse perspiration. Abstinence from meat and stimulants 

 is usually absolutely necessary. 



In chronic cases a combination of the iodide of potassium mixture (Pr. 32), with 

 the frequent employment of the Turkish bath, is most likely to do good. A capsicum 

 plaster applied over the painful joint, or one or two small blisters, about the size of 

 a shilling, may prove of service. When the patient is much pulled down, it may be 

 necessary to keep up the strength by a slight stimulating and tonic treatment. 

 When the pain and swelling have completely subsided, gentle friction with sham- 

 pooing may restore mobility to the affected joint. Sometimes it is necessary, in 

 order to restore motion, to manipulate the limb after the patient has been placed 

 under the influence of chloroform. 



In conclusion, we would say that gonorrhoeal rheumatism is not a complaint to 

 be trifled with, and no man is justified in endeavouring to treat it himself. 



