The analysis of the pattern of pain has shown that often in rheumatoid arthritis the pattern is alkaline, while in osteoarthritis, it is acid. Comparison of variations in pain intensity with changes in urinary surface tension helps to determine the pattern. However, with urinary surface tension values used as a guide both for agent and dosage, favorable clinical results have been obtained in cases resistant to other therapy. Arthritis, painful for many months, was controlled in many instances with several doses of heptanol or of sodium thiosulfate with epichlorohydrin and more recently with propionic aldehyde or sulfurized tetralin. The simplicity of treatment, total lack of undesirable side effects, and the long period of improvement after even brief treatment in some cases, indicates that this method is worthy of further investigation. Some illustrations of the results are contained in the following observations:

Case #1

Mr. M. R., 63 years old with a long history of arthritic pains. Four years ago he was obliged to stay in bed for three months for severe pains in the right sacroiliac region. Two years ago he was again bedridden for a month and a half because of the same type of pain. A year ago, pain started again in the same sacroiliac region, to be followed by a very severe sciatica which kept him in bed for two months. Repeated X ray examinations showed advanced arthritic lesions in the lumbar spine and around the sacroiliac articulation. About ten months ago, he suffered another similar attack, with severe pain, in the same region. Urine analysis made at this time showed an offbalance of the type D with low surface tension, low pH and high specific gravity. The blood serum potassium was high (5.3 mEq.). The patient was treated with agents of the group D—1 mg. of heptanol and 30 mg. butanol three times a day. The patient remained free of symptoms for four months, when similar severe pains were again present. This time analysis showed an offbalance of type A, with high urinary surface tension, high pH, low specific gravity and low blood serum potassium (4.0 mEq.). For this reason, different medication of the group A—5 mg. epichlorohydrin and 50 mg. sodium thiosulfate—were administered. The response was as rapid as previously and pain disappeared within a few hours. Since then the patient has been taking 5 mg. epichlorohydrin and 50 mg. sodium thiosulfate twice a day whenever the slightest pain appears. The clinical results are excellent, the patient being now able to move about entirely free of pain, as he has not been able to do for many years.

Case #2

Mrs. F. R., 60 years old, was bedridden for one and a half years about six years ago, with lumbar and sacroiliac arthritic pains. X ray treatments, short wave, ionization with histamine and ultrasonic treatments appeared entirely ineffective. The administration of urolytic agents had helped at this time. The pains recurred repeatedly in the last three years keeping the patient in bed for from one week to three months at a time. For the past eight months, the patient has been under treatment using medication of the group A or D, according to the urine analysis. With this treatment the pain has been completely and rapidly controlled, never lasting more than a few hours.

Case #3

Mr. N. K., 55 years old, suffered for many years with generalized and very painful rheumatoid arthritis. Prior to coming under our care, he had been bedridden for six months, entirely immobilized with severe pain in arms, back and legs. The patient was entirely incapacitated, unable even to feed himself. Treatments with different cortisone preparations, ACTH, gold, etc., provided practically no relief of the severe pains. He came under our care, entirely immobilized and in severe pain. According to the analysis which showed a low urinary specific gravity, and pH, high surface tension and a low blood serum potassium, the patient received medications of the group A, sodium thiosulfate, epichlorohydrin and heptyldiselenide. Under this medication the patient made a most dramatic recovery. Within a few days, the patient was out of bed without pain, walking normally and with full functional capacity of his arms and legs. While still under treatment the patient went back to entirely normal activity. He gained 35 lbs. in the last months.