In subacute cases, when there is little or no fever, a somewhat more varied diet may be prescribed. Milk should, if possible, form the basis of the food of such patients. In addition to it, farinaceous articles may be used, but they should not be sweetened. Soft-boiled rice, arrow-root, cornmeal, oatmeal, cracked wheat, milk-toast, farinaceous puddings, blanc mange, custards, and broths may all be eaten by such patients, but never in large quantities at a time. If necessary, the number of meals per day may be increased. So much food should not be given at any one time as will tax the digestive and motor powers of the stomach, always limited in these cases.

The same foods are suitable for those who are convalescing from attacks of acute articular rheumatism.

In all cases of rheumatism, alcoholic beverages should be forbidden. It is universally admitted that they are detrimental in this ailment. Tea, coffee, cocoa, and chocolate should also be excluded from the bill of fare. When the heart is weak, clear coffee, without sugar and cream may be given as a stimulant, but it should be used only in such cases.

Albuminous foods must be used abstemiously both during convalescence and during the chronic stage of the disease. It may be necessary to prescribe them to a limited extent, especially when patients are anemic, as is frequently the case after an attack of acute articular rheumatism. The albuminous foods best adapted to the use of patients suffering from rheumatism are eggs, fish, oysters, sweetbreads, and the white meat of pigeon and chicken. Such patients may also be permitted to take a variety of the simpler green vegetables; for instance, peas, string-beans, spinach, boiled celery, asparagus, lettuce, and a mealy baked potato or mashed potato. Very starchy vegetables and those that are most likely to ferment in the gastrointestinal canal should not be eaten.

Of fruits, oranges can be eaten without harm. Many patients can eat a baked apple with comfort. It should not, however, be sweetened. The very acid fruits, such as strawberries, gooseberries, currants, and cherries, must be avoided. Preserves of all kinds are too sweet to be permitted to those who suffer from acute or subacute rheumatism, though small quantities can occasionally be taken as a relish by those whose joints are chronically stiffened by former attacks of rheumatism. If used too freely, however, they are liable to derange digestion and to place the patient in a condition which makes him particularly susceptible to a renewed attack of his trouble.

During the acute stage of the disease, food should be given every two or three hours. When convalescence is established, it may be given at gradually lengthening intervals and in somewhat larger amounts at a time.

It is desirable in all cases to prescribe the copious use of water to promote as perfect elimination by the kidneys as possible.

Persons suffering from acute or subacute rheumatism should be kept in large, well-ventilated rooms. They should be bathed daily with warm water, for they are likely to perspire so copiously that their clothing becomes saturated and their skin sour.

Woolen clothing should be worn next to the skin continuously. So long as patients are confined to the bed they should he between woolen blankets.

In order to avert injury to the heart, which so often occurs at this time because of the strain which is put upon it even by very moderate exercise, rest in bed must be enjoined in all cases of acute rheumatism until convalescence is thoroughly established. It is therefore best to keep patients in bed for at least two weeks after fever and pain have disappeared.

Those who are prone to attacks of rheumatism should, if possible, avoid a changeable damp climate during the most inclement portions of the year.

Recurrence is the rule among those who have suffered from acute articular rheumatism, each attack increasing the susceptibility of patients to further recurrences, and each attack being likely to aggravate the cardiac lesions which are usually started early in the course of the disease. It is therefore of the utmost importance that every precaution be taken to avert repeated attacks. The utmost care should be used, first, to prevent digestive disorders, and if they occur, to correct them; second, to avoid exposure to great changes in temperature, particularly when they are associated with dampness. Those who are liable to rheumatism should live upon a dry soil, well drained, and in a climate where there is a maximum amount of sunshine. Woolen or silk should be worn next to the skin at all seasons of the year. Its thickness may be adapted to the 17 temperature of the season. It is also well for patients who have made a successful recovery from an attack of rheumatism to train their skin to resist the effect of exposure to cold and dampness by taking daily a dry rub with a rough towel; or, better still, a cold or tepid shower, followed by a brisk rub. In this way the blood-vessels of the skin can be taught to react to chilling, and the patient will become somewhat less susceptible to cold and dampness.

Mineral springs are often resorted to advantageously by rheumatics, who are helped both by the drinking of such waters and by bathing in them. It does not seem probable that the chemical constituents of these mineral springs play a very important part in effecting the relief which suffereres from rheumatism so often experience. Without doubt it is through the copious use of water, the dilution of the blood and tissue fluids, and the increased elimination of the soluble toxins by the various emunctories, particularly the kidneys and the skin, that the most good is accomplished. Those who are young, stout, and fairly vigorous often obtain good results by drinking the stronger saline waters which are purgatives and diuretics. If salines are taken by emaciated or very nervous patients, they are apt to increase the feebleness and the nervousness, and are, consequently, counterindicated. Hot water is to be preferred for such patients; either the natural hot water to be found in many springs, or water that has been artificially heated. Hot water taken by the mouth, and hot baths are very useful in such cases. The hot springs possessing the most reputation in the United States are the Hot Springs of Arkansas, the Virginia Hot Springs, and the Glenwood Hot Springs of Colorado. In very many other localities springs of hot water are found which possess a local reputation for the cure of rheumatism. Those patients who suffer from rheumatism in its subacute form, with stiffness or some swelling of the joints, and slight or moderate atrophy of the muscles, are frequently greatly helped by drinking and bathing in sulphur waters, such as the waters at Richfield Springs in New York, and Mount Clemens in Michigan. Of late much of the good effect of treatment at mineral springs has been ascribed to the radio-activity of some of these waters, but that this plays any part in the successful treatment of patients has not been proved and is only surmised. A sojourn at a spa it must be remembered produces results in other ways than by the waters - freedom from care, a change from the sickroom, the hopefulness which a change produces, all help to restore the patient to health. Bathing is particularly beneficial when there is no fever; but when joints are still swollen or stiffened, relief comes most rapidly if massage is combined with bathing. Oftentimes, in addition to the bath, a stream of water thrown forcibly upon the affected joints will produce of itself a degree of massage which is of value. Spout baths of this kind at the Virginia Hot Springs have become quite noted, and are also to be found in many other well-conducted hydrotherapeutic establishments.

Many patients suffering from mild sub-acute rheumatism are helped by electric light sweats or by sweating provoked by dry heat in other ways and followed by gentle massage and manipulation of the effected joints. Such treatment should be followed by a rest in bed of at least an hour or if possible the treatment should be had before retiring to bed at night.

Mud baths are also useful ways of applying heat to the effected, stiff joints and often also provoke more or less general diaphoresis.