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The Types of Treatment.
The various forms of electrical treatment and massage are carried out in the department of physical medicine,
which, as mentioned before, is not directly attached to the department though under the control of the physicianin-charge.
The essentials for a clinic such as this comprise radiant heat and infra-red lamps, diathermy, ultraviolet
light (general and local) and electrical apparatus for faradism, galvanism and sinusoidal baths. Most of
these were already in the department of physical medicine before the rheumatism clinic opened. Since then the
General Inductance Company have, through the Empire Rheumatism Council, kindly presented a new and
effective infra-red lamp. The department, however, still lacks an ultra-short-wave diathermy, a modern innovation
which is daily proving more valuable in the relief of pain.

A number of photographs are included in this report which illustrate some of the various forms of treatment
enumerated above. It might also be of interest to discuss the indications for some of them.
Injection of Gold and the Application of Plaster Splints.
These may be considered together, for it is in the treatment of rheumatoid arthritis that they are both almost
exclusively used. The features of this distressing malady are familiar to most; the thin pale patient, usually a
female, often attacked in the prime of life, with painful swollen joints, particularly those of the hands and fingers,
which sooner or later if untreated will become bent and deformed. Until recently little could be done for such
patients ; no known way existed of arresting the disease. During the last few years, however, treatment by the
injection of gold salts has been introduced, and in a great number of those patients on whom this drug has been
tried the disease process has been damped down and even stopped.
The application of plasters hitherto used by surgeons only for fractures and other injuries has proved of
considerable value when used in a modified way in the treatment of rheumatoid arthritis. If used judiciously they
relieve inflammation, lessen the swelling and correct the deformity, provided that the case comes up for treatment
in the early stages of the disease. Above all, by use of plasters a great proportion of the appalling deformities so
commonly seen in the past can be prevented. These points serve to emphasise the importance of treatment in
the early months of the arthritis. It might also be added here that gold is more likely to be effective at this early
period.
It is perhaps in the treatment of rheumatoid arthritis that some of the most satisfactory results have been
obtained in the last few months in the department of chronic rheumatism. One case illustrates this particularly
well. A woman of 47 came up in August with an arthritis of such severity that she had to be brought by relatives
with great difficulty in a taxi. Her knee was put in plaster and she was given a course of gold ; no other treatment
was tried. She is now able to come up to hospital unaccompanied and by underground railway.
In all, twenty-one patients have been treated with gold and of these fourteen required plasters of this type.
Injection of Novocaine.
During the last two years a considerable amount of work has been done on the subject of muscle pain. It has
been found that a small area of inflammatory tissue in a muscle may give rise to pain of great severity, not
necessarily at the site of the trouble, but often some distance away. Thus, for example, an inflammatory nodule
situated in the shoulder may give rise to severe pain down the arm and even in the fingers. It is obvious therefore
that careful search has to be made for such a place so that treatment can be directed there rather than in the
place to which the pain has been referred. It has been found furthermore that if this place is located with extreme
accuracy permanent relief may follow injection of a local anaesthetic (such as novocaine in saline) into it.
Injection of Histamine.
A painful condition of the knees commonly occurs in women in the late forties. This, if allowed to go
untreated, is apt to lead to a chronic arthritis ; but in the earlier stages the trouble is for the most part outside
the actual joint, and if an attack is made on the extra-articular structures much good can be done. It is in cases
of this nature that injections of histamine have proved of value. The method of giving these is illustrated.
In view of the high cost of running a department of this type efficiently we have appreciated the publicspirited
action of several important firms in presenting the Empire Rheumatism Council with considerable supplies
of their products for the use of our patients. These include Messrs. Pharmex for Diuromil Granules and Ralgex
solid liniment, Messrs. Bengu6 for supplies of their balsam, and Messrs. Smith and Nephew for Elastoplast and
Cellona bandages. Reference has already been made to the gift of an infra-red lamp by the General Inductance
Company.
Various preparations of gold have been tried, and Messrs. Schering kindly supplied us with Neosolganal.
Recently research work has been undertaken into the therapeutic value of a new preparation of gold which it is
hoped will prove an advance upon the ones at present in use. For this purpose Messrs. Bayer's medical
department have placed an unlimited supply at our disposal for the period of a year. This investigation is under
the control of the Kensington clinical assistant and will be reported upon in due course.