[Illustration:  FIG. 161.—­Arthritis Deformans affecting several Joints, in a boy aet. 10.

(Dr. Dickson’s case.)]

Treatment.—­Treatment is for the most part limited to the relief of symptoms.  On no account should the affected joints be kept at rest by means of splints or other apparatus.  Active movements and exercises of all kinds are to be persevered with.  When pain is a prominent feature, it may be relieved either by douches of iodine and hot water (tincture of iodine 1 oz. to the quart), or by the application of lint saturated with a lotion made up of chloral hydrate, gr. v, glycerin [dram]j, water [ounce]j, and covered with oil-silk.  Strain and over-use of the joint and sudden changes of temperature are to be avoided.  The induction of hyperaemia by means of massage, the elastic bandage, and hot-air baths is often of service.  Operative interference is indicated when the disease is of a severe type, when it is mon-articular, and when the general condition of the patient is otherwise favourable.  Excision has been practised with success in the hip, knee, elbow, and temporo-mandibular joints.  Limitation of movement and locking at the hip-joint when due to new bone round the edge of the acetabulum may be greatly relieved by removal of the bone—­a procedure known as cheilotomy.  Loose bodies and hypertrophied fringes if causing symptoms may also be removed by operation.

When stiffness and grating on movement are prominent features we have found the injection of from half to one ounce of sterilised white vaseline afford decided relief.

The patient should be nourished well, and there need be no restriction in the diet such as is required in gouty patients, so long as the digestion is not impaired.  Benefit is also derived from the administration of cod-liver oil, and of tonics, such as strychnin, arsenic, and iron, and in some cases of iodide of potassium.  Luff recommends the administration over long periods of guaiacol carbonate, in cachets beginning with doses of 5-10 grs. and increased to 15-20 grs. thrice daily.  A course of treatment at one of the reputed spas—­Aix, Bath, Buxton, Gastein, Harrogate, Strathpeffer, Wiesbaden, Wildbad—­is often beneficial.

In some cases benefit has followed the prolonged internal administration of liquid paraffin.

On the assumption that the condition is the result of an auto-intoxication from the intestinal tract, saline purges and irrigation of the colon are indicated, and Arbuthnot Lane claims to have brought about improvement by short-circuiting or by resecting the colon.

Residence in a warm and dry climate, with an open-air life, has been known to arrest the disease when other measures have failed to give relief.

The application of radium and the ingestion of radio-active waters have also been recommended.