GENERAL DISEASES OF THE JOINTS. 309 



Rheumatic disease is characterised by its tendency to move 

 from joint to joint or muscle, by its aggravation under the in- 

 fluence of cold and damp, and improvement under warmth and 

 sunshine, and by its indisposition to suppuration. Glanders, 

 farcy, plugging of the vessels, etc., are distinguished by the 

 presence of the coexisting disease in other parts. 



General Treatment — In severe cases secure immobility in 

 the joints by placing in slings, and, if necessary, by the appli- 

 cation of a smart blister around the articulation. In the absence 

 of the blister apply cooling or soothing lotions as for inflamma- 

 tion of bone, and follow this up by blisters or firing when the 

 inflammation has in the main subsided, and the heat and 

 tenderness disappeared. In the slight, subacute, and chronic 

 forms the counter-irritants may be applied at the first. When 

 anchylosis threatens it is sometimes advisable to favour it by 

 active blistering and rigid immobility of the joint. If ulcer- 

 ation of the joint surface occurs the hot iron usually gives the 

 best results. If suppuration has ensued the pus must escape 

 by an external opening, and our efforts must be thereafter 

 directed to limiting the inflammation as far as possible, and 

 obviating death by the general fever, or uselessless, by destruc- 

 tion of the joint. 



In the severer forms a purgative should be given at the outset, 

 and this may be followed by a soft laxative diet (mashes, roots, 

 green food) and diuretics (carbonates or acetates of potassa or 

 soda, colchicum, etc.), especially "When there is reason to sus- 

 pect any rheumatic complication. In some cases of this, as of 

 bone disease, in which there is imperfect assimilation and the 

 passage of an excess of phosphates in the urine, a course of 

 bitters and iron tonics is demanded. 



Tuberculous disease of the joints demands similar treatment 

 with due attention to the general health to correct, if possible, 

 the unhealthy state. 



