Treatment of Chronic Rheumatism

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Sep 8, 1910

Treatment of Chronic Rheumatism

THE diet is of first importance, and the popular notion that a fruit dietary is to be strictly avoided in rheumatism has no foundation in fact. For many years the writer has practised placing rheumatic patients upon a strictly fruit diet whenever evidences of autointoxication were marked. Not infrequently the patient is required to eat exclusively fresh apples, grapes, or any other seasonable fruit for several days in succession.

A fruit diet is certainly incapable of increasing the accumulation of uric acid, as it does not furnish the necessary material for the production of this toxic element. It is not sufficient simply to withhold flesh meats in cases of rheumatism. The patient must be furnished

with an ample supply of easily digestible foods which he can relish, and which will furnish to the body the needed nutritive elements with the least outlay of vital energy. If dyspepsia be present, which is true in many cases, cereals must be used in a dry and well-dextrinized condition (zwieback and other cereal-food products dextrinized by heat). Mushes must be carefully avoided, also starchy vegetables. Purees of peas and beans may be eaten in moderate quantities, but the skins of these legumes must be excluded. Mustard, pepper, and condiments of all sorts must not be used; the use of tobacco in any form must also be strictly prohibited for the reason that the nicotine not only depresses the heart, but greatly taxes the liver and kidneys,—first, in the work of oxidizing and destroying the poison; and, second, in eliminating it.

Water Drinking Essential

To the great thinning of the blood which follows copious water drinking, is due the remarkably increased activity of the kidneys, skin, and bowels. Examination of the urine not only shows that the quantity is increased by water drinking, but that the urea and other solid constituents are increased in amount. By the continued employment of this measure, the tissues may be thoroughly washed free from accumulated waste, and to such an extent that uric acid, urates, and a number of other products of imperfect oxidation may be reduced to almost imperceptible amounts. The quantity of water taken should be from two to three quarts daily. Distilled water is preferable to mineral waters of any sort. Distilled water, or water containing the smallest possible amount of mineral, is most readily absorbed. In most cases it is best to take the water at the ordinary room temperature. Deluging the stomach with hot water relaxes the organ, and lessens its digestive power. Hot-water drinking is to be recommended only in cases of gastritis accompanied by a profuse secretion of mucus, and in cases of hyperpepsia.

The Value of Exercise

Next in importance to diet and water drinking is exercise. Every chronic rheumatic must be made to perspire daily. It is not well to produce constant and profuse perspiration, but the highest activity of the skin short of actual sweating may be maintained with benefit. The skin ordinarily eliminates from an ounce to an ounce and a half of liquids an hour. In profuse sweating, this amount may be increased to from fifty to sixty ounces hourly. Such an increase for a short period is highly beneficial. Rheumatics generally do better in a warm, dry climate, and suffer less in clear, dry weather, than at other times, as activity of the skin is promoted under these conditions.

Rheumatics need exercise more than almost any other class of persons. This is one of the most efficient means of burning up wastes. Vigorous exercise increases the amount of oxygen absorbed, and the output of carbon dioxid.

This is evidence of the improved oxidation of the nitrogenous wastes. Although rheumatic patients need exercise more than any other class, they are unfortunately so crippled that general active exercise, such as walking, horseback riding, etc., is out of the question. Exercise is also likely to be followed by an exaggeration of the pain. Rheumatics suffer from other embarrassments in relation to exercise, among which may be mentioned shortness of breath and general muscular weakness. These difficulties must be overcome by carefully graduated muscular work, beginning, if necessary, with the more gentle forms of massage, gradually increasing the vigor of the manipulation. As soon as able to do so, the patient must be encouraged to take active voluntary exercise. The amount of exercise to be taken each day should be increased as the patient's capacity for muscular work increases. The outdoor gymnasium, affording an opportunity for exposing the body to the air and sun, is of the highest value in cases of this sort. Sand baths are particularly helpful. The patient should be very careful to avoid chill from evaporation after exercises which produce perspiration.

Hot Baths

The value of hot baths in rheumatism, both chronic and acute, has been recognized from the earliest ages. There are, in various parts of Italy, the ruins of many ancient Roman baths, in which the rheumatic and obese gourmands of the degenerate days of ancient Rome were daily subjected to hot-water baths, as well as vapor and hot-air baths, followed by massage and exercise, for the purpose of combating the effects of their luxurious living.

All forms of hot baths are beneficial in rheumatism; but the hot-water bath, the vapor bath, and the electric bath, especially the latter, are to be preferred, for the reason that these are the quickest and most efficient means of securing an elevation of bodily temperature, and thus increasing nitrogen oxidation.

But hot bathing alone is not sufficient in this disease. Hot baths of all sorts are attended by the inconvenience that they produce a decidedly depressing effect. All the vital processes are depressed; the heart action, in particular, is diminished in vigor. The relaxed condition of the blood-vessels of the skin, produced by the hot bath, exposes the body to danger from rapid loss of heat, resulting in chill. These several inconveniences may be wholly avoided by a proper cooling procedure immediately after the hot bath. The method must depend upon the various circumstances. If a hot-bath immersion has been administered at a temperature of one hundred five degrees to one hundred eight degrees (about the proper limits), the temperature of the water may be lowered, within one or two minutes, to eighty degrees. The patient may be kept in the tub with gentle rubbing for from two to five minutes, by which time the temperature of the skin should be sufficiently lowered to make it safe to remove him from the bath, wrapping him in a Turkish sheet and woolen blankets, and permitting him to lie quiet until his skin is thoroughly dry, and the equilibrium of the circulation restored.

The hot-blanket pack may be followed by a short wet-sheet rub, the vigor of which may be gradually increased from day to day by lowering the temperature of the water employed, starting at sixty-eight degrees, and lowering the temperature one or two degrees daily to fifty-five degrees, and by increasing the duration of the application from one-half minute at the beginning to two or three minutes later on. In very feeble cases, the cold-towel rub or cold friction may be employed.

Local Applications

Chronic as well as acute rheumatism is a general rather than a local disorder; hence comparatively little need be said respecting applications to the diseased joints. There are valuable measures, however, whereby the local curative process may be hastened, and pain and other symptoms greatly mitigated. The most important of all local applications is heat, which may be employed in the form of the fomentation. The dilatation of the vessels by heat leads to an accumulation of the blood in the part, and it is the blood that heals. These hot applications may be applied with advantage twice daily, and should be followed by a heating compress. The heating compress consists of a folded linen cloth or a moderately thick layer of cheese-cloth wrung dry out of cold water, and wrapped around the joint. This compress is covered first with oiled muslin or rubber sheeting, and then with several thicknesses of flannel, so as to retain the heat. Thus the superheating induced by the hot application is maintained.

Another measure of great value is local massage. When tenderness exists, much care must be used. The first manipulations should consist of a light stroking or friction movement; later, digital kneading should be employed about the joint in such a way as to follow the natural contour of the bones.

Joint movements should likewise be employed in connection with massage. If the movements of the joint are limited, the first attempts at flexion and extension should be applied with great care; only a moderate amount of force should be used. From day to day, the latitude of the movements should be increased until the greatest degree of mobility possible is established. Gentle massage and joint movements may be best administered after a hot pack or fomentation, or some other hot application, which has been followed by a very short cold application to prevent chilling by evaporation.

The building up of the general health is a matter of primary importance in chronic rheumatism. Every effort must be made to improve the general physical condition of the patient.—Modern Medicine.