Henry Baird Favill, AB, MD, LL.D., 1860-1916, a ... - University Library

MEDICINE AND PUBLIC HEALTH 137
times by local attention ;
warmth, counter-irritation, immobilization
are, singly or combined, indicated.
Whether to irritate by blister, liniment, or cautery,
will depend upon the type of the case in hand, though
generally speaking, the cautery'' is most efficient. It is, on
the whole, not often that such measures are necessary.
Warmth to the parts involved, and reasonable attention to
the general warmth of the patient, must be regarded as
indispensable. So far as I am informed, the new process
of extreme dry heat is not of value in acute febrile conditions.
As a rule, immobilization of a joint, even in the acute
stage, will afford appreciable relief. Plaster of Paris is
our best agent, because of its permanence and cleanliness,
though not at all times practicable. Being not a familiar
resort, its use in such circumstances is rather slow of adoption,
but its value is undoubted.
Much of the acute rheumatism has not severe pain, and
in most cases it is relieved within a few days. The conditions
then become asthenic and pursue a tedious course,
wherein the bodily depression is gradually augmented by
an anemia of toxic origin, while the local manifestations
are likely to be complicated by more or less trophic change.
From this point the treatment is full of perplexity. The
insidious effects of the specific toxemia become indistinguishable
from the autotoxemia, which I regard as more
or less constant.
The low fever, the grumbling joints, the deteriorated
blood form a familiar picture to which are added various
irregular manifestations of toxemia, as urticaria, erythema,
renal complications, etc., and not infrequently at this stage
an outbreak of the disease afresh, in the heart. What to
do as these phases pass along, to prevent or mitigate the
dangers which we know to exist, is always a problem.
Intestinal foulness is a constant feature of this stage ; hepatic
torpor is an important factor in determining this foulness.