Etiology

This disease represents a perverted state of nutrition. Its victims belong to the gouty diathesis. They are almost invariably eaters of large quantities of starch--great bread-eaters. Workers in damp places; those whose work is in basement; those who live in damp houses, on low, marshy ground, in sections of the country which are not drained, are inclined to develop this disease.

Symptoms

Stiff joints are always in evidence. The subjects of chronic rheumatism find it difficult to get around when they first get up in the morning. The knee joints, ankle joints, and other joints of the body complain very bitterly when they are moved; but, after being up for a few hours, the patient becomes more comfortable. if, however, he lies down during the day for a nap, or sits down for any length of time, he will get up stiff and sore.

These people are supposed to be barometers. They can tell when there is to be a change in the weather. If they cannot tell, they think they can; so it does not matter, for they have pain in season and out of season. Some of the joints will be tender to the touch, and a little swollen, but there will not always be any redness. The rule is that more than one joint is affected, but we meet with a great many cases where the disease is confined for years to one shoulder, or one particular point in the back, or to the hip, or to one knee. The general health of such people is not badly impaired; they always have a good appetite, and are especially fond of sweets. The disease is not recognized as serious; yet some cases do develop heart complications. These patients are very inclined to develop arteriosclerosis, seldom live to be very old, yet may live to be sixty or seventy.

After the rheumatism becomes chronic there is seldom, if ever, any fever. In the early stages fever may run very high, up to 103 or 104 degrees. A patient in this condition should not have anything but hot water until the pain and swelling are all overcome.

Treatment

The diet must be corrected. It is impossible to build chronic rheumatism without improper diet, improper clothing, improper bathing, improper housing, etc. No two cases require exactly the same treatment--every case is a law unto itself. If there is constipation, it must be overcome. All bad habits must be put aside; no coffee- or tea-drinking; and, of course, alcoholics are never to be thought of by those afflicted with rheumatism. The use of tobacco must stop.

Breakfasts should never be more than an apple or an orange. Until the rheumatism has been entirely overcome, these patients get along better by using such fruits as apples, pears, and peaches, and leaving out the citrus fruits. Anything in the starch line--bread, potatoes, beans, etc,--should not be eaten oftener than once a day; meat two or three times a week; cooked, non-starchy vegetables and a combination salad always being preferred in these cases. The amount of food must be limited until the condition has been entirely overcome. At no time so long as there is any rheumatism should one eat what would be called a full meal.