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15
sociological studies and the modification in the patient's
environment that should be carried out.
We have introduced new pharmacological methods as
the use of prostigmine for the relief of pain and muscle
spasm in rheumatoid arthritis. We have learnt that the
numbness, tingling, and uselessness of the hands and fingers
which we meet so commonly in the middle-aged women who
come to the Rheumatic Clinic are often just one sign of
their chronic fatigue. This is the result of excessively heavy
duties and household work necessitated by the war. Their
muscles are atonic, their shoulder girdles have fallen, and
some branches of the brachial plexus are caught between
the arms of a vice formed by the clavicle and the upper
chest wall. A period of rest from all domestic work is of
more value than intensive physical treatment in the relief
of these symptoms.
Rheumatic people can do a great deal to help themselves
by using simple physical remedies in their own
homes. We have started to give our patients some instruction
along these lines.
Mrs. Butler has visited several of our patients in their
own homes, and has been able to give them appreciable
help both in their domestic troubles and in their dietetic
and housing difficulties. Sister Reed, in spite of the smallness
of her staff, has run the clinic most efficiently and
has somehow managed to find time, space and staff for the
physical treatment of our rheumatic patients.
During the year we have tended to concentrate our
physical treatments rather more on the younger patients
who are referred to us, and we have limited the length
of treatment which we have given to our older patients.
We give them one or two courses of treatment, and then
keep in touch with them and they report to be seen by
me at stated intervals."