Physicians’ caution for Articular Rheumatism.—­Go to bed and remain there and do not get up too soon, for remember the parts are still tender when they may not be painful.

Local Treatment.—­1.  There must be absolute rest.  Remove the sheets from the bed and wrap woolen cloths or blankets about the patient and protect the inflamed joints from the weight of the coverings.  Cover the joints with gauze or absorbent cotton, after putting on the parts a thick coating of ichthyol ointment.

2.  Sometimes hot fomentations are helpful in relieving the suffering; sometimes cold cloths are best.

3.  The following is good.  Apply with cloths wrung out of it: 

Carbonate of Soda    6 drams
Tincture Arnica     10 ounces
Glycerin             2 ounces
Water                9 ounces

4.  Oil of Wintergreen 1 ounce
    Compound Soap Liniment 8 ounces

Mix.

Rub the affected parts with oil of wintergreen and then wrap the parts in cotton wool and soak with the solution.

5.  “A layer or two of gauze saturated with methyl-salicylate is wrapped around the painful joints and covered with paraffin paper, or other impervious dressing, held in place by a bandage.  This is renewed once or twice daily until the pain in all the joints is relieved.”

6.  Internal.—­Sodium salicylate or aspirin given until the pain and temperature are relieved; usually five to ten grains of sodium salicylate every three hours for an adult; or five grains of the aspirin every three hours.

7.  Dr. Hare recommends for the beginning in a strong, healthy individual, ten drops of the tincture of aconite at once in a little water, and follow it by a teaspoonful of a mixture containing fifteen drops of tincture of aconite and two ounces of water everyone-half hour, until perspiration on the skin betokens the circulatory depression through the action of the drug.  I use aconite in this disease very often, but not in such doses as the first one.  It seems to me that it is uselessly large.  I use about one-tenth of a drop at a dose everyone to two hours during the first twenty-four hours.

[Constitutional diseases 321]

Nursing.—­The nurse must have the patience of Job to attend a patient sick with this disease; but you must remember the suffering is awful.  The patient may be very restless and the pillows may need rearranging every few minutes.  Also be careful how you handle the patient.  It hurts terribly to be even touched.  A rough, hearty person has no business to care for such a patient.  I allow patients to say anything they wish, for this is a painful disease.  They may swear at me if they wish.  I know how it is, for I was there twice, the last time for six long weeks.  Have patience and courage and cheer your patient.  Do not look cross or scold.

Diet.—­Milk mainly, broths, gruels, albumen water, oyster or clam broth, milk toast, buttermilk, kumiss.  Do not give solid food.  Water, lemonade, vichy or carbonated water.