At the present time osteo-arthritis is usually an incurable disease. The cause is unknown, but doubtless it owes its origin to chronic poisoning. This may be from some local focus, such as pyorrhoea alveolaris or chronic constipation; or it may be due to the lack of something in the organism which controls the metabolism of the body. On this subject little is known, but thyroid insufficiency appears to be a possible cause of the trouble, since adequate treatment by adding the extract of the gland to the dietary often seems to alleviate, if not to cure, the disease.

It has been said, with some degree of truth, that victims of osteo-arthritis rarely suffer from other ills, unless indeed the disease can be traced to some definite cause. The disease, once the acute stage is over, is liable to become chronic in character and usually very prolonged. The pain in the swollen joints is often very acute, and they are therefore held rigidly in the position of maximum comfort. The result, only too often, is the formation of contractures.

When massage is invoked there should be several aims in view. First, the presumption is that some general toxic condition calls for remedy. General massage, particularly to assist the portal circulation, should therefore be given. Second, the possible cause should be sought for diligently, and everything that can possibly be done to assist in remedying any abnormality of function should be carried out. Thus constipation or indigestion should receive appropriate treatment. Third, every effort should be made to prevent the occurrence of contractures, as, once they are present, little can be done to remedy the defect without operation, the result of which is frequently disappointing. Mobilisation in all its forms should therefore be an essential part of treatment. Fourth, mobility should be restored with all possible celerity at all joints, for the very fact that one joint is maintained in a state of rigidity necessarily entails lack of mobility in neighbouring joints. If we accept the axiom that "movement is life," the reduction of movement in a normal joint may be presumed to lower its vitality, and thus it would be more liable to fall a victim to the disease. Fifth, much can be done to prevent the stiffening of the affected joints, and this may save the patient the very painful remedy of movement under an anaesthetic. Careful administration of relaxed movement is the best remedy at our disposal. Sixth, the evils consequent on enforced lack of exercise should be guarded against, and every effort should be made to maintain the nutrition of the muscles and to assist elimination of waste products. Seventh, and last, the psychical aspect of the case must never be disregarded, as the victims of this painful, crippling, and often incurable disease need all the moral and psychical support that can be lavished upon them.

As with most other ailments, the disease may be acute, sub-acute, or chronic. Also it may be mono-articular or general. The former can frequently be traced to some definite injury. Often enough, particularly in women after the menopause, both knees become affected as the first evidence of the onset of the polyarticular variety. The progress of the disease to the other large joints may be very slow. In another type of case the small joints of hands and feet are affected while the large joints apparently escape. Finally, there are cases in which the onset is acute and general, and the attack is often confused with rheumatic fever. The most terrible form of the disease is that which affects the joints of the spine (spondylitis deformans).

Treatment for the true mono-articular variety is very easily dismissed, though the results are not always gratifying. Massage of the whole limb should be given to assist the general circulation and local treatment to assist the nutrition of the wasted muscles. All the muscles which control the movement of the joint should receive attention, even though all are not wasted alike. Relaxed movement should be administered during the continuance of the massage, and, if the trouble is chronic, assistive movements should be given, and active movements prescribed as regular courses. Both should be begun tentatively, and progress should be graduated with care. Faradism will prove invaluable in restoring the strength of the wasted muscles. Bier's congestion treatment, the eau courante, and radiant heat baths all form valuable adjuvants.

Treatment of a similar character may be given to the polyarticular variety of the disease during its chronic stages. If the patient's activities are reduced, the treatment in all its forms should be general, special attention being paid to the abdomen. No matter how advanced the disease may be when we are asked to help - the patient may have only a bed-ridden caricature of a human body - still the treatment must be carried out in the same way with all patience and never-ceasing care. However hopeless to all appearance, no deformity can be so extreme but that it will become worse if left to run its course, while material improvement can usually be secured. The lightest stroking may be unbearable over certain points at first, and movement may be impossible. Treatment should be guided by the law so often quoted - any point that is tender or hypersensitive is the last that should receive attention. Similarly, any joint that is sensitive should have its dose of mobilisation postponed until the other joints have had their exercise. By their recovery of mobility it may be possible to restore some degree of vitality even to the most hopeless joint, though restoration of mobility will be regulated by the amount of bony deformity and of muscular contracture. It is well to remember that, in cases of marked osteo-arthritis of the joints of the foot, increase of mobility sometimes leads to increase of pain. A rigid painless foot is of more service than one that is mobile and painful. In very mild cases manipulation may relieve symptoms.