Therefore, the problem presented in the treatment of rheumatism, aside from certain general remedies at the outset of an acute attack, is to put the stomach and bowels in a healthy condition, and to give only such articles of food as admit of complete digestion and assimilation. Thus, the rheumatic element will not be furnished to the blood, the fermentation will not be excited, and the fever and inflammation will not return, unless the dyscrasy be an heirloom-a legacy from one's ancestors-or implanted on some other irremediable vice of the system. When, from my ill success in chronic cases of rheumatism, I had come to the conclusion that the primary seat of morbid action is in the chylopoietic viscera, I attempted, while giving certain specific remedies, to eliminate the products of fermentation by the skin, bowels, and kidneys, to correct the gastro-intestinal secretions, and improve the quality of the chyle. To do this, I prescribed laxatives, with or without calomel, as the case might be, until the secretions were corrected, and allowed simple, unirritating articles of food only. I avoided the tonic plan, and made the patient's strength to wait upon a more complete digestion and assimilation. I was forced to this course, as alcohol, iron, meat-broths, and everything else of a tonic, bracing nature, such as are used in other cases of convalescence, seemed to aggravate the disease, and renew the fermentation. Consequently, as the bloodless, nerveless patient gained little nutriment from gruels and farinaceous articles, and little strength from bitters and quinine, the recovery was always slow, the tendency to relapse always present, and a fresh attack always imminent. Since the use of milk with lime-water, however, as almost the sole article of diet in febrile affections, the void in alimentation and medication has been filled, and I have, while eliminating the uric acid from the system, been enabled to prevent its re-formation and supply the blood with all the elements of nutrition at one and the same time. The milk being unstimulating and very digestible, the gastro-duodenal mucous membrane returned to a healthy state, so that perfect chyle was elaborated; and, containing all the elements of nutrition, the assimilation regained its activity, so that the uric acid was no longer generated in excess. A healthful nutrition being thus established, and the blood and nerve forces sustained by a diet that is both food and medicine, the progress to recovery became steady and uninterrupted. What is more, the milk-diet not only obviated the tendency to chronic stiffness of the joints and muscles, but, also, the tendency to a recurrence of the disease. At the present time, with salicin to aid the alkalies, and vegetable acids in eliminating the materies morbi from the system, and milk to restore the digestion and assimilation, there seems to be no lack of means to secure a prompt recovery from acute or chronic rheumatism, and a long release from future attacks. In acute cases, I give calomel as a purgative, morphia as an anodyne, Rochelle salt in lemonade as a laxative and diuretic, and from ninety to a hundred grains of salicin daily until the fever and pain abate. This while, the patient takes six tablespoonfuls of milk, with one tablespoonful of lime-water, every three hours. That the gastro-duodenal mucous membrane may regain its healthy state, and the digestion be fully restored, every other article of diet must be rigidly excluded. Thus treated, the pain in three or four days leaves the joints, although the limbs still continue as swollen and motionless as at first. Now, all that remains is to regain the nervous power and the muscular force. This may be accomplished by gentle means, without any fear of relighting the disease; for the enemy has been routed from the system, and nothing remains but to repair the damage he has inflicted. When the above remedies, reinforced by quinine, have been used, as the occasion may demand, for some days; and when the milk, reinforced first by farinaceous articles, and later by fresh meat at dinner, has been taken for some months, I have seen the rheumatic element seemingly eradicated; at least there has been a long respite to persons who had previously been constant or frequent sufferers. E. B. had articular rheumatism when nine years of age. It began in the summer, and lasted three months. Eight years later it seized her in the winter, imprisoned her two months in her room, and left her weak, anæmic, and crippled. Her recovery was completed by the warm weather and country air. In the latter attack I was her attendant, and met with the average success. The 24th of October, 1877, she was confined with her third child, and the 6th of January following was attacked with a high fever and excruciating pain in the shoulder joints. Her sufferings were so severe, that morphia failed to afford her any relief the first forty-eight hours. During this time she took Rochelle salt freely, and nearly two hundred grains of salicin. R. Salicin. 3iijss; The pills were put up in capsules, and two given every two hours. The pain becoming more tolerable, and not forbidding the use of a bed-pan, I gave her a purgative dose of calomel. Subsequently, I reduced the salt and salicin, and eventually supplanted them with quinia and cinchonia. The pain and swelling in the shoulders rapidly extended to the other joints; but, what is peculiar, all the affected parts improved simultaneously, and none were attacked a second time. In less than a week there was neither fever nor pain; but the limbs were powerless and the joints swollen. In less than two weeks she was out of bed and hobbling about the room without inconvenience, further than that occasioned by her clumsiness. All this while she lived on milk exclusively; and, thereafter, for the eleven. months during which she continued to nurse the baby, she made it the main article of her diet. In less than three weeks the recovery was complete-a marked contrast to the previous attack in which salicin and milk were not employed. Mrs. B. is now nursing her fourth child, ten months old. She has taken three or four glassfuls of milk daily since its birth, is hardy and vigorous; weighs 127 pounds; does a good deal of hard work besides taking care of the baby, and has had no return of her old complaint. This is a great change from her former condition. Then her weight was never above 97 pounds; and lactation so reduced her as to necessitate the weaning of her first child when a few months old. Mr. A., æt. 78, has had the rheumatism hanging about him since his third year, when he had an acute attack; and he has, at various times, been confined to the house for weeks together. When I first saw him, November 3, 1879, his hands were swollen and useless, and his muscles and joints stiff and painful. Besides, he was affected with hypertrophy and valvular disease of the heart, enlargement of the prostate gland, frequent and difficult urination, and gastric and intestinal disorders. His food, which he relished and partook of liberally, had consisted of meat, bread, and potatoes almost exclusively. VOL. XXXI.-14 Proceeding upon the plan indicated above, this patient was able on the 18th of January, 1880, though he lived on a third story flat, and the route of the cars was two blocks distant from my house, to call at the office. At his second visit, the 22d of March following, when he came to consult me about certain dyspeptic symptoms which had begun to trouble him again, I found that he had, the previous two months, been out of doors whenever the weather permitted, and had been relieved, except a dull pain in the shoulders, of the rheumatic feelings. He had free use of his hands, and his health was far better than is common at his time of life. In this case the restriction of the dietary to milk, farinaceous articles, and acid fruits, except at dinner, when meat was allowed in moderation, neither impaired muscular power nor depressed nervous energy, even at his advanced age; but, on the contrary, so quickened the digestion and assimilation, renewed the secretions and excretions, and stimulated the nerves and arteries, that this old, decrepid man resumed active exercise in the open air, and passed his days and nights in comparative comfort. Certainly milk, qualified by lime, must be highly digestible and nutritious; even more so than all other articles combined, if it be capable of sustaining and strengthening the human frame after its vital mechanism has been nearly worn out by time and disease. H. O., ætat. 15, came under my care March, 1877. In her fifth year she had had intermittent fever, which, when eventually subdued, left her so weak and bloodless, that anasarca supervened. From this poverty of the blood, her recovery, as she grew up, was imperfect, her face remaining pale, her blood thin, her nutrition bad, her flesh flabby, and her vigor deficient; yet she ate heartily, consuming an unusual amount of animal food. Two years previous to my attendance, articular rheumatism showed itself, and, thereafter, continued to recur at longer or shorter intervals, with general excitement, and local pain and swelling. At all times there was stiffness of one or more joints, particularly of the ankles, and an imminence of a fresh relighting of the inflammatory symptoms. At one of these periodic exacerbations, that had recurred so frequently the previous winter as to confine her to the house most of the time, I saw her whilst in attendance upon her uncle. Her stomach and bowels were disordered, her strength and flesh reduced, and her digestion, assimilation, secretions, and excretions much in fault. She had been ordered a great variety of specific remedies, those supposed to be effective in the elimination of the morbific matter from the system, but allowed to follow her inclinations in the choice of her food, which was always rich and nutritious, and often oppressive and indigestible. Hence, as fancy and appetite were the only guides to the kind of material furnished to the blood, the fermentation went on, and the inflammation, every now and then, lighted its fires anew. At the start, I gave a purgative dose of calomel, and ordered. an exclusive diet of milk with lime-water. The mercurial having been repeated, in two or three days Rochelle salt and lemonade were prescribed for the double purpose of a laxative and a diuretic. In a few days, when the excitement had somewhat abated, crackers, bread, potatoes, and clam-broth were added to the milk; but meat and meat-broths were forbidden until the recovery should be well assured. Soon a change for the better was noticeable. The digestion became perfect, the movements natural, the urine clear, and the assimilation active. As the nutritive functions regained their sway, the pain left the joints, and the strength returned. For some months after recovery, her dietary consisted of milk, bread, oatmeal, or wheaten grits for breakfast; fresh meat, bread, potatoes, and fruit for dinner; and milk, bread, crackers, and gingerbread for supper. Any unusual appetite was appeased by milk in the forenoon and in the evening. Acid fruits were allowed at any time of the day. At this date-May, 1880-no relapse has occurred, not even rheumatic stiffness of the muscles, and her health is perfect in every particular, although she has the past two years paid little or no regard to dietetic rules. It would seem in this case as though a steady use of milk and vegetables had, by cutting off the supply of the rheumatic elements, revolutionized the system, removed the uric acid diathesis, and given a fresh start to the vital forces. |