Newspaper Page Text
4E
What Causes “Rheumatic Joints” and How to Cure Thenr-
An Important Article Upon a Very
Prevalent and Painful Disease by One
of the Greatest Physicians of England
By Sir James Barr, M. D.
THERE <re few diseases In which greater
confusion exists as to their nature and
causation than those of the jointa, and
vet every writer seems to think that he, at
least, knows a’l about the subject If you read
any textbook Mealing with arthritis, you will
be a clever men if you know what the author
means, and, on the other hand, you may prob
ably consider that the writer does not himself
know. You wi’l find a whole series of diseases
inextricably m’xed up under the same name,
or different names applied to the same disease.
Inn find such names as rheumatoid arthritis,
Infective arthritis, toxic arthritis, arthritis de
formans. osteo-arthrltts, chronic rheumatism,
rheumatic gout. Indiscriminately applied to a
variety of affections of the Joints and to dif
ferent stages of the same affection.
Arthritis deformans is a common name for
the disease with which we are dealing, but if
vou wait for deformity before correctly diag
nosing the disease you may have td wait for
years until the patient Is becoming a hopeless
cripple Again, some call this affection an In
fective arthritis, and others call It a toxic ar
thritls without offering any proof In support of
their contentions.
Because certain cases of arthritis have been
associated with pyorrhoea alveolarls or an ul
cer In the rectum, and have been cured by a
vaccine, It has been promptly assumed that all
cases of rheumatoid arthritis are due to some
germ or other, or to its toxin But such evi
dence as this Is no proof whatever that those
easily remediable cases are similar or In any
way allied to the chronic polyarticular inflam
mations of the synovial membranes and pert
articular structures of the Joints which we
designate rheumatoid arthritis
Perhaps the most popular view of this af
fection In the present day Is to look upon It
as a toxic arthritis, due to one or more toxins
produced by the Intestinal flora, but no attempt
has been made to show the nature of the toxin
or Its special affinity for the Joints, or what
the liver has been doing to allow it to pass Its
portals.
Osteoarthritis Is frequently used as a syno
nym for rheumatoid arthritis, but really tho two
conditions are diametrically opposed The for
mer usually occurs at a later ago; the disease
runs a very chronic course without any exacer
bations There Is thickening of the synovial
membranes erosion of tho cartilages, ebuma
tfon of the ends of the long bpnes and the
formation of osteophytes It usually affects
many Joints, but one hlp-Jolnt may be the only
one Involved It Is true that the ieposltlon of
lime salts may take place In the flnad stages
of rheumatoid arthritis, but this only occurs
after the disease Is over and the deformity
left It is Nature's clumsy method of effecting
a cure
By a process of elimination I am now In a
position to define what I mean by rheumatoid
arthritis It Is a low, chronic, polyarticular In
flammation with frequent acute exacerbations
There Is thickening of the synovial membranes
and the periarticular fibrous tissue, with slight
serous effusion Into the Joints. Tho muscles
generally are wasted, Irritable and contracted;
the deep reflexes are Increased, and there Is
frequently neuritis, especially of the nerves sup
plying the Joint structures The Joints are at
first stiff, grating and painful on movement.
Tn my experience the large Joints, especially
the knees, shoulders and ankles, are first in
volved. and one Joint only may be at first as
fected. especially If It had been previously In
jured
In this stage of the disease. If recognized and
energetically treated. It rapidly disappears; but
unfortunateiy the disease Is not then usually
diagnosed, but Is called chronic or subacute
rheumatism and treated accordingly; or if it
be recognized, the patient la told that It will
eventually cripple her. and nothing can be done
except to try and delay its progress If the
disease be allowed to progress, as It practically
always Is, then you get the smaller Joints af
fected. such as the wrist Joints, carpus, meta
carpophalangeal and first phalangeal Joints and
the Joints of the toes You then get the char
acteristic fusiform swelling of the Joints, and.
of course, diagnosis can no long, r be delayed.
The further swelling of the Joints is accom
panied by Increased effusion, erosion of the car
tilages and rarefaction of the articular ends
of the bones from absorption of he limo salts
From the disorganization of the Joints and
muscular contraction you get well-marked ar
thritis deformans It Is still possible to cure tho
disease, but not the deformity If. however,
you keep hunting after the germ and Its toxin,
the patient as well as her Joints will become
a hopeless wreck.
In dealing with the nomenclature I have to
some extent referred to the etlolcgy. As I be
lieve with Newton that we should admit no
more causes of natural phenomena than such
as are both true and sufficient to explain their
appearance. 1 shall at once pass over the score
of causes which have been set down in text
books. and now state my own view as to the
immediate cause of the disease, and afterward
lay bare the foundations of my belief. The
proximate cause, in my opinion, is a mild
chronic acidosis, which extracts the lime salts
from the fibrous tissue, muscles, nerves, cartil
ages and bones
I thus look upon this affection as a general
disease, and the apparent localization in the
Joints is due to their structure and liability to
Injury. The extraction of the lime salts from
the fibrous tissue causes It to swell and its
vascularity increases, with the loss of the lime
salts the muscles get into a condition of Irrl
table weakness —they waste, readily contract,
cramp frequently occurs, all the deep reflexes
are exaggerated and even a state of rhythmic
tremor may be set up
There Is not much lime In the nervous tissue,
but Its abstraction leads to a marked result:
neuralgic pains readily occur, and even neuritis
Is easily established The patients frequently
complain that the pains are worse at night,
and this Is almost universally ascribed to the
heat of the bedclothes, but when the pat'ent
Is in bed In the daytime the pains subside,
though "the heat of the bedclothes" remalnt
the same The condition really Is that the
blood Is less alkaline at night; ft Is conse
quently capable of bolding more lime, which is
tasen up from the tissues The night pains
can usually be obviated by a drachm of sodium
bicarbonate and fifteen grains of lime carbon
ate In a class of milk at bedtime.
As more and more lime gets absorbed, you
get swelling of the periarticular tissues and
effusion Into the Joint, this serous effusion Is
often bloodstained, and inflammation in the
Joint" soon attacks the cartilages, from which
absorp'lon of *he lime salts takes place fol
lowed by their erosion and thinning The end
of ths bones in turn afflicted Jomts uro at-
-VI. AX.
tacked last, and absorption of the lime salts
with rarefaction takes place; these parts of
the hones are selected as they are easily dam
aged from use and become more vascular The
deposition of IJme salts readily takes place In
parts which aae’not functionating, and if you
wish to causal absorption you must see that
the function (of the part Is restored —for ex
ample. If you wish to decalcify rigid costal car
tllages. you must not merely use decalcifying
remedies, but you must also make the patient
take respiratory exercises
I frequently use decalcifying agents, bnt I
am always quite alive to the danger of produc
ing rheumatoid arthritis, and so such an un
toward-event has never occurred In my hands.
Perhaps some of my followers will accomplish
this, but It will not be without warning If
people were more careful In their diet they
would not require so much physic.
Women are much more liable to this disease
than men. There Is nothing In the constitu
tion of a woman which should make her spe
cially susceptible to this disease, but the very
same conditions which make her less liable
to arterio sclerosis render her more prone than
men to rheumatoid arthritis In the poorer
classes, whore this disease abounds, she Is
badly nourished. Ilves on tea. bread and but
ter and various carbohydrates which readily
undergo acid fermentation tn the stomach;
there Is a poor supply of milk and other pro
teins She gets very little lime and other al
kalles. while she Is liable to exhausting dis
charges, such as menorrhagia, leucorrhoea. ex
cessive lactation and mucous colitis, which rob
the system of its lime.
The thyroid gland is more active In women
than In men. and this leads to active calcium
metabolism. It is essentially a disease of de
bility, and nutrition la readily affected by
worry, anxiety, overwork, frequent childbear
ing. loss of blood, etc
Among the associated conditions which to
some extent stand in a casual relation must
be specially mentioned an almost Invariably
dilated stomach with deficient motor action
and obstinate constipation with occasional
diarrhoea. For the maintenance of the motor
function of the stomach and bowels a certain
amount of calcium and potassium salts are
necessary, while In these cases the supply of
both is deficient This leads to stagnation
with acid fermentation, and the production es
pecially of lactic and butyric acids; this tends
to Increase tho excretion of lime rather than
Its absorption. Tho late Dr. O. T Williams
showed how the insoluble lime soaps damage
the mucous ifiembrano, setting up mucous co
litis; but in this case they have the further
deleterious effect of robbing the system of lime.
The amount of lime taken up from the In
testinal tract when administered in the form
of food or medicine is very variable. In many
cases onlv a ■ mall fraction of that administered
roaches tho blood, while many individuals ab
sorb It freely and excrete It as rapidly. Apart
from Individual peculiarities, this to a large
extent depends on the form in which it Is
presented for absorption; tho tribaslc phos
phate is a very fixed salt and almost entirely
Insoluble, yet I have hoard a professor of
therapeutics assert that this salt cures the
toothache of pregnancy. Such childlike sim
plicity and therapeutic faith deserve a place in
the Kingdom of Heaven if there bo no retribu
tion for culpable Ignorance.
The sulphate Is rather insoluble, but it la
readily decomposed In the Intestinal tract, and
so presented to the mucous membrane in more
assimilable forms; the same can be said for
the carbonate. The chloride, the lactate, the
glycerophosphate, and the iodide of calcium
are all easily assimilable forms; the lodide Is
an especially active salt, but from Its stimu
lating effect on the thyroid gland it Is not al
ways advisable In this disease. The oxalate
of lltne Is very Insoluble, though It may be
decomposed In small amount by the hydro
chloric acid of the stomach; tho citrate of lime
Is fairly soluble, but the citric acid hastens
elimination Where sodium citrate is added
to cow's milk it splits off the fixed lime from
tne casein, and thus lessens the density of the
curd When the stearin and palmitin of beef
and mutton fats are decomposed by the lipase
In the Intestines, their saturated fatty adds
■'O' form Insoluble limo soaps; but. on the
other hand, the oleate of calcium Is easily as
similated
Lime exists In two states In the blood—first,
as a fixed albuminate of calcium, and, second,
as free lonizable calcium; the amount In both
states varies considerably, but especially In
A Belle of the Old South : : : By Genie Orchard Stovall
r-j-xHERE in the corner of the long porch nt
I White Sulphur Springs, lovingly called
by Southerners “The White.'' I found
the old General in his favorite seat. He was
quietly smoking an age tinted meerschaum with
a reminisix-nt look in Ids k<s-n gray eyes.
“As usual thinking." said I. "But how can
you become nbsorlied in deep thought with that
la'vy of lieauties over there In such tantalizing
proximity?”
Turning slightly and sweeping the gay scene
with calm eyes, he then for a moment gazed in
my face in silence.
"Ah. my dear friend." said he. “they do not
belong to my day. I'm an old fossil to those
modernites, with their bunny hugging, tango
trotting, grizzly bear sqms-zing. and and ah.
but I admit they're charming and Iv-witehing.
yet I never recall a season at this grand old
mooca of lotus eaters when there was not as
sembled all that is most attractive in the South.
Sitting erect witli shoulders thrust back he
grew voluble on his favorite topic the glorious
old days at The White.
"Yes." ho continued. “I’ve been thinking, and
it makes me feel pretty lonesome, as in fancy
1 s<s- the many friends who for successive gen
erations have gathered hen- and realize how
few are here to <ta\ 1 can look up tho length
of this porch and s<-e just as plainly as though
it were yesterday, women ami men who have
given to the South its reputation for beauty
ai.d chivalry.
"Rut am. ng the thousand fact's there is one
1 always see. wherever I look yea I can set"
her now standing (hero liefore me." And the
Did General with twinkling eyes glanced up.
"Beautiful, brilliant, soulful Mattie Duld. ah.
she was an enchantress, a born subjugator, a
HEARST'S SUNDAY AMERICAN, ATLANTA. GA.. SUNDAY. SEPTEMBER 21. 1013.
bi W I
■ .-U 'w s" g, t
Jr
- JBL
■ > ...v. v
u vMm
la
1 W i
i . r avll
X-Ray Photograph of a Hand, Showing
Rheumatoid Arthritis. Note the
Thickening About the Joints.
the latter. When the blood is very alkaline
the fixed limo Is fairly constant, but as the
alkalinity Increases the blood holds less free
lime and part of the free ionizable calcium is
thrown out Into the tissues or excreted by tho
bowels and kidneys.
The fixed lime In the form of large mole
cules of calcium albuminate Increases the vis
coslty of the blood, lessens the capillary veloc
ity, and diminishes transudation of albuminous
fluids, hence where tho blood Is well charged
with fixed lime you do not get any albumin
urla; on the other hand, with diminished al
kallnlty and the presence of acid salts with
an alkaline reaction the blood holds a consid
erable amount of lime, which Is readily ex
creted by the bowels and kidneys, and leaves
the blood ready to take up more lime from the
tissues or alimentary tract. So long as the
blood Is more or le<ss saturated with lime the
fixed calcium remains constant, but whore the
acidosis Is not completely saturated with limo
or alkalis tho fixed calcium may be split off
from the albumen, and then you readily get
transudation. Hence, in tho early stages of
rheumatoid arthritis the urine Is usually free
from albumen, but in tho later stages or during
acute exacerbations when the fixed lime is
lessened you get albuminuria, and also effusion
into the Joints and tissues.
Dr Sidney Ringer made experiments on the
swelling of laminaria when Immersed In water,
and he found that sodium and potassium chlor
ides retarded, but did not lessen, the amount
of fluid taken up; on the other hand, even
minute traces of the chloride or other soluble
salt of calcium greatly and persistently re
stricted the swelling of laminaria. Among the
causes of dropsy the presence of sodium chlor
ide in excessive amount must he recognized;
and in the treatment of this affection Widal
and many others have recommended a salt
free diet; but I have shown that In many cases
this is not enough; you must to some extent
replace the sodium salts in the tissues with
calcium salts. In rheumatoid arthritis there
Is usually a deficient supply and excessive
excretion, though, of course, the activity of the
process is an ever varying quantity.
We have already referred to the dilatation
of the stomach, deficient motor function, acid
fermentation and intestinal stasis; when the
latter is very marked and persistent you get
pigmentation of the skin with dark lines round
tho eyes. The function of the liver and pan
creas are Impaired, and the patient is usually
troubled with flatulence. There is anorexia,
but very rarely vomiting. As was originally
pointed out by Kent Spender, there Is a mod
erate tachycardia, and this is associated with
excessive function of the thyroid, which 'leads
to excessive calcium metabolism, fibrillar
tremor, myotatic Irritability, and rather free
action of the skin.
There Is general muscular wasting, muscular
coquette, who made slaves and fools of more
men than any woman since the days of Cleo
patra. 1 swear I mean that, yes. yes. Mattie
Duld could capture ami entrance the heart ami
senses of men of all ages and conditions, ami
make jump-jacks of them just us that elilbl
out there dances her toy clown. I've seen the
most stately and severe jurist dams' attendant?
on her witli the enthusiasm of a college fresh
man.
"She |Hissessed a certain Insight into men's
dispositions, an exquisite tact in discerning
their vulnerable points. She treated the old
beaux, and. In fact, all her ancient followers,
with gay despotism and wayward playfulness,
leading them for the time to believe they were
young gallants in whom she was well pleased.
"That woman pours rejuvenation .in my brain
and makes me feel as I did when a young col
lege swain." said the erudite L. C. Q. Lamar to
me one day.
“I have heard her discuss theology with tho
Bishops, lowering her eyes with mute and
adroit reverence. The next moment she was
giving to some gay sports the pedigree of the
noted blooded racers ami hunting-hounds. She
could tell about every thoroughbred since the
days when racing started in Virginia.
“Ah, yes, and such a horsewoman you never
saw. Iler mount was that of an Arab. I can
see her now as she sat on “Black Charger,”
Mart Gary’s blooded ra-'er, there under the big
oak tree. On one side was Clary, on the other
his rival. Pierce Young, all ready for a race.
T recall the words of Valentine the sculptor,
as he watched her flexible, graceful mount.
Said he, nodding his head toward Mattie Duld:
"I would ask for no more Inspiring model for
an equestrienne statue than that."
"Yes General I’ M. B. Young was her ardent
follower and worshiper. He was dashing.
EnbSSt z'. W . WgregEpffiaS
?f iff-- - wßrrfi 1 WSO
wi
I9B'
I iSfe
IWQa
, 4 ’■&
a/i,
I 4 ’ - !
I 1 j I
The numbers 1 to 7 Illustrate the ancceaafva
rhinxm In the nerve-cclla affected by rheuma
toid arthrltln.
The cells undergo reduction In alr.ei the Nlanl
bodies being replaced by yellow pigment stain
ing black with Marchl's fluids the nucleus
ahrfnkm, heeomes Indistinct, and eventually dls
"ppenrsi (he processes get thinner and break
otl. nnd ultimately h m mall mama of granular
pigment remains.
Irritability and contraction, frequently spasm
and cramp, and at later stages neuritis with
atrophy of the interossei and muscles of the
thumb with deformity of the hands. The neu
ritis and symmetry of this disease have led
many to imagine that it is of nervous origin,
but as Sir James Paget pointed out, the decay
of a leaf is symmetrical without any nerves.
The quadriceps extensor fetnoris and deltoid
are frequently much wasted. The muscular
wasting leads to weakness, fatigue and weari
ness, but although there is usually general
emaciation and malnutrition, the existence of
the disease is quite consistent with the pres
ence of a considerable amount' of adipose tis
sue There Is a slight effusion into the joints,
swelling of the periarticular tissue, and the
Joints become fusiform in shape, stiff and
tender. The skin over the Joints becomes at
tenuated and glossy.
All the deep reflexes are exaggerated except
brilliant and gallant—he and Butler were said
to lie the two handsomest officers in the army.
Young was the youngest Major General in
either army. My friend T. C. DeLeon, the
Louisiana author, called him 'the Murat of the
Virginia lines.’ Now this fearless fighter, the
idol of men. and no less popular with women,
was the slave of Mattie Duld, and I know as
a fact she was the only woman whom he wor
shiped until the hour of his death. They were
engaged to marry, some misunderstanding
arose, of course the result of her eoipietry
Here the Old General paused and his eyes be
came misty. “Tlie saddest of all, said he, “she
loved Young with the absorbing strength and
passion of her nature, and yet the failure of a
reconciliation shadowed both lives. The fact
was both were too hard headed and proud to
explain.
"A very amusing incident occurred that Mat
tie use to fell on herself. It was during her
engagement to Young. One evening while in
her father's library, her head resting on her
lover’s shoulder, her father, the dignified stiff
laced old judge entered unexpectedly. Shocked
and indignant he approached P. M. B. when
he was appeased by his daughter’s ready wit.
‘Oh, father dear, she cried, ‘it’s nothing. It is
not the first time an Duld head lias been put
on Young shoulders.’ Yes. her wit was as ready
and as keen as a Spanish stiletto.
“But I must tell you.” he went on, how on
another occasion she put a dignified dining
party in a roar of laughter.
"Two Richmonders who sought her hand in
marriage were among those present, one
CamplH'll. tho brilliant attorney, ami the other
a popular clubman, familiarly known by his
friends as Nat. The witty and erudite Colonel
Bacon, who sat next to Mattie, teasingly asked
her in a low voice which of her two suitors
r\w non®.niffinw
nMIb ill
V W W P 18/
I\f I B
\h \l \I I I
nil M &i! II M
Diagram IlluMtratingr the ProKreag of Rheumatoid Inflammation of the Jolnta. Flrat, the
Knee Joint. Second, the Synovial Remhrane Inflamed. Third, the Inflammation Increaaea, Afreet-
Inc the siervem and Reducing the Circulation About the Joint, " bleb Hecomea Greatly Swollen.
Fourth, the Joint Ronea Become ••RaifKed.” the Muaclea Steadily Diminished. Gnat, the A* hole
Bone Stiff and I aeleani the Muncies Are Gone.
. <| ? i- -Av,
A Photograph of the Knees of a Patient Who Has Undergone the Progression
Shown in the Above Diagram.
where the action Is limited by the stiffness of
the Joints. There is often much general pain
and tenderness from effusion into the sheaths
of the muscles, and the presence of sarcolactlc
acid; these pains, as well as those of the
Joints, are worst at night. There are fre
quently, acute exacerbations with intermittent
pyrexia. At such times the affected parts feel
hot. and there is rather profuse perspiration.
Increased muscular weakness, and general
lassitude. At other times the extremities may
be cold and somewhat livid, or the fingers may
feel “dead and numb.”
At a later stage a radiogram shows wasting
of the cartilages and rarefaction of the articu
lar ends of the bones; this leads to more or
less irreparable deformity. The lungs are not
affected; the muscle of the heart may be weak
and Irritable, and the blood pressure is low,
but any valvular lesion which may be present
is due to other causes, or may be induced in
Nature's methods of cure.
The brain is not involved, except so far as
the irritability of the patient’s temper may be
considered evidence of such involvement. At
any rate, the patient is never stupid nor men
tally lethorgic. though migrane is not uncom
mon; there is often slight anaemia. The
urine is usually clear, amber, acid (except from
the effects of treatment), deposits urates dur
ing febrile attacks, contains an excessive
amount of lime and phosphates, occasslonally
a trace of indican, and a little albumen in the
later stages.
The earlier the recognition of the disease the
more successful the treatment. Our attention
should be first directed to the prima via, the
teeth should receive scrupulous attention and
all sepsis should be eradicated; the acid fer
mentation in the stomach should be eliminated,
and this is most readily accomplished by cut
ting off all saccharine and farinaceous articles
of diet, and placing the patient for a few days
on an abundance of red meat with plenty of
hot water. Red meat produces ammonia,
which neutralizes the sarcolatic acid In the
muscles; then milk, to which some sodium bi
carbonate and chalk or lime water have been
added, Junket and cream.
The sour milk craze In this disease has
she preferred. ‘Oh, I'm straining at a nat,
but I may swallow a camel.’ she laughingly
replied and was heard by all present.
"Another very funny thing she said,” con
tinued the Old General "wfis when Professor
Wheat, the Richmond organist, informed her
with gusto that the stork had the night liefore
left a little new Wheat in his home. Where
upon she exclaimed. ‘Oh, but remember this lit
.tle Wheat wilt have to be thrashed and cradled
liefore it is any good.’
"But I must not forget Mart Gary, who was
another of her assiduous worshipers. Whv
Gary didn’t fear the devil. He has charged in
the fiercest battles, and it’s recorded he was
never known to surrender to a foe. but believe
me old Mart was completely subjugated In
fills brown-eyed girl, who gave to the art of
coquetry something really powerful in its j.o
tent exercise. Yes. beyond doubt Mattie Ould
was tin- cause of this brave ‘old Courser’ dying
a disappointed nnd lorn ly bachelor.”
"Yes," my friend said the old General sigh
ing audibly, “this place has venerable history
and many memories of brilliant, beautiful wo
men, since the days of the stately Dolly Madi
son, but so long as this old resort stands it will
be redolent with no sweeter, more enchanting
memory than that of Mattie Gwynne Ould.
But there is a sting and a pain to know that,
because of her power to capture and entrance
the brain and heart and senses of men. many
have gone to their graves with a stone for a
heart.
“Gallant Young, splendid, daredevil Gary,
are but two of many.” Here the Old General
paused and looked at me with the saddest
eyes I have ever seen.
In a moment I read the life secret of this
grand old cavalier. He, too, had a stone for a
heart.
fizzled out. Afterwards green vegetables and
farinaceous food, except oatmeal: a fair amount
of fat should be given, especially olive oil or
cod liver oil; at least an ounce of one of these
oils should be given every night at bedtime.
Bacon gravy, fat bacon, cream, butter or mar
garine are valuable adjuncts, but beef and mut
ton fats had better be eschewed.
The patient should take a liberal allowance
of table salt with meals. All acids and acid
fruits, rhubarb, tomatoes and asparagus should
be avoided. When saccharoses are considered
permissible, glucose and honey are better than
cane sugar or Jams, but perhaps a little marma
lade may be occasionally allowed.
When the patient Is Improving, grapes,
bananas, nuts, stewed prunes and figs may be
allowed; saccharine Is better than sugar, more
especially if the urine has become alkaline
under the treatment, and tends to deposit phos
phates.
Regarding drink, there Is nothing better than
pure water, especially when hot, weak tea, milk
and soda water (containing about 30 grains of
sodium bicarbonate to the pint), plain barley
water, and raisin tea. Avoid all sweet and
acid drinks, wins and malt liquors. Regarding
alcohol,, I think the patient ir better without
any, but if for any particular reason a little Is
ordered It should be in the form of whiskey,
gin. brandy, sloe gin, or liquor cognac.
To correct the acid fermentation and improve
the motor function of the stomach a good com
bination consists of 30 grains of sodium bicar
bonate, 10 grains of potasslmu bicarbonate, and
15 to 30 grains of aromatic chalk in a glass of
milk about half an hour before meals, and a
double dose at bedtime; often smaller doses
suffice. An excellent stomachic of calcium
chloride, hydrochloric acid, and minute doses
of the perchloride of iron is very useful after
meals; a small cholagogue pill should be regu
larly administered to keep the bowels open;
for this purpose an excellent mixture can ba
made with the sulphate, bicarbonate and sali
cylate of sodium and liquorice.
The pancreas 13 also usually at fault, and to
Improve its action I often prescribe a capsule
of holadin and bile salts about two hours after
meals. In these cases the thyroid gland Is
usually too active, and so all preparations of
iodine and thyroid should be avoided. Pos
sibly suprarenal gland and pituitary extract
might do good, as Dr. Blair Bell has shown
that these secretions tend to retain the lime
in the system, whereas the thyroid increases
Its elimination, but personally I do not care to
i prescribe such powerful drugs when milder
- remedies may suffice. It is imperative to get
lime into the tissues and to lessen its elimina
tion, but herein lies our difficulty, as no matter
how much is administered by the mouth it
may be as rapidly excreted as it is absorbed,
and so none may reach the tissues; but on the
other hand, the acidosis in the blood may ba
taking lime from the tissues as well as from
the intestinal tract.
In order to get the lime Into the tissues there
must be a liberal oral supply, and the blood
must be kept very alkaline. For this I pre
scribe freely chloride of sodium and potassium,
sodium bicarbonate, chalk, lactate of lime, and
calcium glycerophosphate. If it be desired to
get calcium rapidly Into the tissues it may bo
given In a very dilute form subcutaneously, say
a pint of sterile normal saline solution with
0.05 per cent of calcium chloride, and 3 per
cent of syrup of glucose. If the calcium chlor
ide be administered hypodermically in a con
centrated form, It may readily produce gan
grene of the skin and adjacent tissues. Iron
Is best administered in the form of underdone
red meat, and yolk of eggs; arsenic, potassium
lodide, guaiacol, and a host of remedies com
monly prescribed are worse than useless.
Leucorrhoea should be treated with inden
tions, and any infection of the urinary tract
should receive attention. Here vaccines will
often prove useful, and the same may be said
for pyorrhoea alveolarls.
General massage and the Alx douche improve
nutrition, and are highly beneficial; the hot
air and electric light baths applied to affected
Joints often give much relief, but can scarcely
be looked upon as curative agents.
When you have cured your patient you can
send her or him to Egypt, Timbuctoo. or any
health resort. Encourage the patient to take
a fair amount of exercise short of fatigue when
the disease has subsided, and to live a godly
righteous and sober life in this present world.’