5. ARTHRITIS AND RHEUMATISM

If some friend of yours has complained recently about an attack of rheumatism or arthritis, he is one among some 11 million companion sufferers in the United States. Nor is his complaint new. It is probably age-old.

If we want to dip back into American history for other sufferers, we might go back to the autumn of 1804 and the famous Lewis and Clark Expedition which was camped at the site where Bismark, North Dakota now stands.

The party was prepared to winter there among the Mandan Indians. But not in comfort, as is revealed by a notation in Clark's journal, dated October 22: last night at 1 oClock I was violently and Suddenly attacked with the Rhumetism in the neck which was So violent I could not move. Capt. (Lewis) applied a hot Stone raped in flannel, which gave me some temporey ease.

The attack lasted for several days, and on the 25th he added in the journal:

R. Fields with Rhumetism in his neck, P. Crusat with the Same complaint in his Legs—the party other wise is well, as to myself I feel but slight Simptoms of that disorder at this time.

If they had been further west, Indians might have suggested switching nettles against the affected parts of the body, or taking hot and cold baths, alternately.

In a village of the Shoshone tribe an old man watched as a fire burned down to coals. His squaw waited stoically. Be­side her was a pile of freshly cut juniper boughs.

When the coals were at the proper heat, the old Indian nodded. The squaw spread the juniper boughs upon the coals in a thick mattress, and then helped the Indian to stretch painfully out on the boughs. As the heat began to steam up through the juniper, the squaw fed him tea made from the leaves. Thus was he treated for rheumatism, and possibly received some temporary relief through the heat.

Midwest pioneers sometimes followed a two-stage treat­ment. Externally, the patient might be treated with rattlesnake oil, goose grease, or bear oil. Internally, a mixture of calomel, tartarized antimony, cayenne pepper, and gum camphor was advised. Another internal mixture was composed of a tincture of butterfly weed roots or ripe pokeberries in French brandy.

The Aztec Indians resorted to nettles, as the West Coast Indians did, but with refinements. The following translation, obviously concerning arthritis, is from the Badianus Manu­script, a 1552 Latin version of an Aztec herbal:

"Against pain in the joints prepare a plaster of cuauhtzitzicaztli, tetzitziccaztli, colotzitzicaztli, patlahuactzitzicaztli and xiuhtle-maytl, and these are herbs (four varieties of nettles), and of the small serpents, the scorpion, and the milliped, which are to be ground in water and well cooked. Besides, that part which has' become stiff is to be pricked with a bone of an eagle or lion; then it is to be anointed with the above-mentioned plaster together with honey. But if the arthritic or joint-patient has moderate pain, there is no need to have any part pricked."

In England the dandelion was used rather extensively in the treatment of arthritis, while wintergreen was suggested for acute rheumatism; agrimony, burdock, dandelion, and chickweed for chronic rheumatism.

Liniments long have been associated with arthritis and rheumatism. A typical "liniment for man and beast" described in Secret Nostrums and Systems of Medicine compiled by Charles W. Oleson, M.D. and printed in 1890, is composed of: powdered myrrh, powdered aloes, balsam fir, and plenty of alcohol.

Sol Tetherow, "Wagonmaster of an Expedition to Oregon— 1845" inscribed his specific liniment for rheumatic problems. Doubtlessly the liniment was used by many settlers in the West:

Rheumatic Liniment

take 1/2 pint of the Seads (seeds) jimpsan (Jimson) weed pulv. 1 pt. (pint) Brandy or alcohol. V4 oz. spirits turpentine. Bathe 1 to 3 times heat in.

Heat, as demonstrated by Clark during his attack in North Dakota, has been used consistently and still is in efforts to relieve the pains of rheumatism or arthritis. Hot springs al­most everywhere in the world have won recognition of one sort or another in this capacity. Sometimes minerals in the waters have been credited with healing powers.

Of more recent attention in the realm of folk medicine and arthritis is, of course, Dr. D. C. Jarvis' Arthritis and Folk Medicine. The book follows out the general suggestions in his previous book, Folk Medicine: Referring to his experi­ences and observations as a Vermont doctor, he emphasizes the use of vinegar, honey, and Lugol's solution (iodine) and some dietary practices to control a tendency toward "alka­linity" which, suggests Dr. Jarvis, is the underlying cause of most diseases, including arthritis.

In a book report from the Arthritis and Rheumatism Foundation, New York—the recognized health agency in this field—R. W. Lamont-Havers, M.D., the Foundation's Medical Director, has this to say about the Vermont doctor's book: "Much of the theory concerning disease and its treatment expressed in this book stems from fallacious reasoning based upon observations made on animals, or made on simple household procedures. It should be noted that these same theories expressed in the book 'Folk Medicine' have been unfavorably commented upon by outstanding men in the field of medicine in the Journal of the American Medical Associa­tion and in a number of lay magazines.

"The Federal Trade Commission has issued a complaint against the publishers of 'Folk Medicine' for advertising and representing the book as an effective treatment which would arrest the progress of, or correct the underlying cause of, a number of diseases, including arthritis. It requires only a healthy skepticism, even with little or no scientific knowledge, to realize that the regimen outlined in this book could never have an effect on the arthritic disease process whatever else the patient thought it was doing."

Dr. Lamont-Havers also is highly critical of two books by Dan Dale Alexander—Good Health and Common Sense and Arthritis and Common Sense-—-as well as Victory Over Arthritis by Rasmus Alsaker, M.D.

The two books by Alexander apparently concentrate on Alexander's theories that the relationship of free liquids to the oil bearing foods and water in a diet affects the health. Dr. Alsaker obviously believes that the key to health is alkaliniza-tion—directly in opposition to the acidification idea suggested by Dr. Jarvis. Of Dr. Alsaker's book, Dr. Lamont-Havers says:". . . it cannot be recommended as supplying authorita­tive and factual information concerning the arthritic and rheumatic diseases."

As a matter of fact, the literature concerned with arthritis and rheumatism is rather extensive, and probably will con­tinue to be until a cure is discovered for arthritis and other rheumatic disorders.

Probably more familiar treatments—medically accepted as home treatment that may bring a measure of relief for ar­thritis and rheumatism sufferers—are those described by Dr. John E. Eichenlaub in his authoritative book about a Minne­sota doctor's home remedies.

Many of Dr. Eichenlaub's suggestions are medically fa­miliar across the country. Undoubtedly, many sufferers of rheumatism or arthritis will testify to the value of the paraffin dips he suggests, or warm flannel wrappings, rest, and his homemade liniment of wintergreen, camphor and soap lini­ment. As many experts do, he also advises the use of aspirin.

Most of us probably have had aches and soreness, twinges, and muscular pains at one time or another. Usually they dis­appear after a time. When arthritis develops, it may be a much more memorable occasion than that marked by a vagrant muscular ache.

Probably everyone who is intimately associated with the Arthritis and Rheumatism Foundation is acquainted with the story of its chairman, Floyd Odium, who was top executive of the Atlas Corporation, and key man in the Office of Produc­tion Management during the war.

At two o'clock one morning in 1944, he awoke with an excruciating pain in his right ankle.

He was in a Kansas City hotel and had been working hard. He had retired at midnight, and now the pain more than had him wide awake. He called a doctor who managed to get him to sleep again. Within a few days, Floyd Odium was on a plane to the Mayo Clinic in Rochester, Minnesota.

The Mayo doctors succinctly diagnosed his case: "You have rheumatoid arthritis. If you want to get well, quit work."

From that moment on a series of events began to take place that eventually may result in an answer to arthritis long before it might otherwise have come about, with resulting relief to millions who might have faced intense suffering for years.

Odium found it necessary to resign from the Office of Pro­duction Management, and he sought help for his physical condition. The disease was beginning to show in his fingers.

For a time gold injections seemed to work like magic, but he received an overdose and spent 6 months in bed and then a year in a wheel chair.

Subsequently, he experienced most of the new treatments that were being developed, including aid from newly devel­oped steroids.

In the 16 years since he had his first attack, he has learned to live with arthritis and has become virtually an expert on the subject.

When he learned in 1949 that only some $40,000 was being spent yearly in research and study of the disease, he went into the "do-something" action for which he long had been noted.

He went to the American Rheumatism Association, and with the aid and the help of other interested persons, the Arthritis and Rheumatism Foundation was established.

In 1950 he helped persuade Congress to set up, at the National Institute of Health in Bethesda, Maryland, a separate arthritis project. In 1959 more than $8 million was spent in such research.

But again, as in the case of so many other diseases, scien­tists say they must find the cause before they can find the cure.

Furthermore, as we have found in cancer, while the scien­tists work surely and competently toward a solution, thou­sands of arthritis and rheumatism sufferers become victims of quacks who are cheating their victims of more than $250,-000,000 each year.

The methods used by the arthritis swindlers run the gamut of "cures" that are almost astounding in their scope.

Let us take the case of Mrs. Sarah Johns, 72, wife of a "hard-rock" miner in a Western mining city. Richard Johns, her husband, was a short, wiry man. He moved gingerly despite his age, and he was very solicitous as he helped his wife into the waiting room that had been made from what was once the shack-like office of a mine.

A bus had let them off at the highway, five miles away, and a station wagon from "The Uranium Mine" had picked them up. This was part of the $50 treatment.

At a desk a middle-aged, smooth-talking man had a brief interview with the old couple. He seemed to be more inter­ested in their financial status than in the arthritis which had gnarled and crippled the old lady's hands.

"Don't worry," Mr. Johns said, testily. "We c'n pay. We've saved a bit 'ere 'n there. Fifty dollars, we 'ear? Right?"

"Fifty a treatment. One hour. But it won't take many, Mr. Johns. It's a miracle the way the uranium in the mine works. Fifty-two patients yesterday. Twenty-two already today and seven on your bus. Lots come by car."

" 'Ow many treatments would 'e say her should 'ave?" Richard Johns asked in his heavy Cornish accent.

"Hard to tell, Mr. Johns. Maybe one—maybe more. I'd say, offhand, six or eight should help a lot."

The old man tried to hide his consternation as he mentally figured the cost. Six treatments would be $300 plus the bus fare. The savings were not as much as he would like this man to believe. There was exactly $526 in the savings account. There had been so many other cures they had tried for Sarah, and they had all cost money.

There was the doctor in California who had used the elec­trical stuff that hadn't helped. That had cost almost a thou­sand dollars. There was the special electric blanket that had cost $175. It hadn't helped. There were all the drugs they had sent for. The ones that had cost $2 a bottle, the ones that had cost $15. There was the vibrating couch thing. That had cost almost $600.

In ten years they had spent a lot of money for Sarah; the gadgets, and drugs, and "doctors" who weren't like regular ones.

And he had been forced to quit the mines at retirement age. They had his social security money and that was about all now. They owned the house, but taxes were so high. The savings, carefully hoarded over the years, were almost gone. But anything was worth it if only Sarah could be rid of the terrible pain!

"If Mrs. Johns is ready, that will be fifty dollars in ad­vance," said the man behind the desk.

"She's ready," said Richard Johns. He pulled out a worn billfold and carefully counted out the money in the crisp ten-dollar bills he had drawn from the bank that morning. "I 'ope it 'elps 'er."

"Don't you worry about that, Mr. Johns! Sure-fire! Ask some of our patients who are cured. Now you'd better stay here and wait, while the attendant takes Mrs. Johns into the tunnel with the others. It's warm in there, with nice chairs to sit in."

"One hour?"

"That's right, Mr. Johns. One hour per treatment."

The old man watched them lead his wife away with the other "patients" and wondered what they meant by "radio­active" and all the rest of it. He knew about hard-rock mining, and how to drill a round, and blast, and get the ore out. He knew copper ore when he saw it, and lead, zinc, silver, and antimony. He had even worked in a gold mine once. But he didn't know much about uranium and radioactive things. He only hoped that whatever it was in that mine, it would cure Sarah's arthritis. Even if it took all of the $526. Even if they had to sell the house.

The cure did not help but, fortunately, a neighbor per­suaded Mrs. Johns to seek, once again, the help of an ethical doctor. He was able to aid her considerably.

Several hundred "patients" were not so fortunate and the operators of "The Uranium Mine" were richer by a small fortune before a growing unsavory reputation drove them out of business.

Subsequently, when geologists checked the mine tunnel, they found that radioactivity in the mine was almost negligible.

But no arthritis victim need seek a uranium mine, or strange electrical equipment to become victims of fortune hunters building quick returns through deception.

Probably hundreds of "arthritic remedies" or "cures" have been sold at outrageous prices when they were little more than common aspirin, which, of course, is one of the recog­nized reliefs for disease.

Thus it is not uncommon for a victim to pay $10 or $15 for a' bottle of a "revolutionary new relief for arthritis" which may be nothing more than ordinary aspirin—frequently ob­tainable for as little as ten cents—possibly coated with some disguising substance of no medicinal value. Almost invariably the disguised aspirin remedy will be sold under another name as "temporary relief."

Another field of exploitation of arthritis sufferers has been in the so-called "nutritional" field. To quote the Arthritis and Rheumatism Foundation in reply to the question if certain foods or vitamins can cause arthritis, the answer is clear and positive: "It has never been scientifically proved that the lack or presence of any foods or vitamins will either cause or cure the disease."

When alfalfa seeds were being touted as a dietary remedy

for the disease, Dr. Howard Weinstein, director of clinical research for the U. S. Food and Drug Administration, an­nounced: "There is no scientific evidence that alfalfa seeds would be beneficial in the treatment of any disease."

Quite recently, in a talk entitled Arthritis Quackery—Our Common Enemy, Dr. K. L. Milstead, director of the division of regulatory management bureau of enforcement for the FDA, had this to say: "Nutritional quackery and arthritis quackery are closely associated."

Russell L. Cecil, M.D., as medical director of the Arthritis and Rheumatism Foundation, in 1956, was confronted by Look magazine with the following statement and question: "A recent popular book claims that 'you can eat your way into arthritis—and you can eat your way out again.' Is that true?"

Here is Dr. Cecil's answer. "That's ridiculous. Any person making such a claim not only knows nothing about arthritis but is also ignorant of the chemistry, anatomy and physiology of the human body. Extensive research has failed to show that the absence or presence of any food or vitamin will either cause or cure any form of arthritis. The one exception may be gout, which can be controlled in part by diet."

When asked about claims that persons can prevent or cure arthritis by eating certain foods that contain oil needed for lubricating the joints of the body, Dr. Cecil's answer is cryptic: "That's nonsense."

Meanwhile, as stated above, millions of dollars are being spent yearly in intense, highly scientific efforts to solve the problems of arthritis and rheumatism.

What are the problems? What, as a matter of fact, is ar­thritis? Rheumatism? What causes them? Are there cures? Can relief be found for them?

When we begin to answer these questions, almost immedi­ately we come to the revelation that has spelled the nemesis of many of the old folk medicines and early treatments for human ailments.

Here, again, we are not dealing with one disease or dis­order.

As a beginning, let's look at rheumatism first. The Arthritis and Rheumatism Foundation has one definition which is prob­ably as clear as any:

"Rheumatism is a term used to describe a variety of aches and pains which may or may not be caused by joint disease. Relatively few people go through life without at least one attack of a painful stiff neck, lumbago, bursitis or simply the stiff aching muscles physicians call fibrositis."

Let's carry this a few steps further. Dr. Ronald W. Lamont-Havers, medical director of ARF, in an interview printed in Today's Health, March, 1959, explains that when a person says he has rheumatism, "He may have any one of a number of rheumatic diseases—ailments marked by pain in the joints or muscles and which are inaccurately lumped together as rheumatism or arthritis."

The doctor goes on to explain that of every 100 patients complaining of "rheumatism" and seeking medical aid, ". . . about 40 may have rheumatoid arthritis, 30 may have osteoarthritis, 15 may have muscular rheumatism, neuritis, and sciatica. The rest may have traumatic arthritis, gout, rheu­matic fever, or other forms of the disease. Of the more than 100 different forms of rheumatic disease, the most painful and disabling by far are rheumatoid arthritis and osteo­arthritis."

Thus, we can assume that "rheumatism" refers to many dis­orders that result in aches and pains, stiffness and soreness.

For some of these pains, the familiar home and folk treat­ment undoubtedly brought relief.

For instance, Harry Thomas, 47, a heavy construction worker, back in 1910, came home one winter evening with a sore and aching back.

"I think it's lumbago," he told his wife. He was a thick, stocky, heavily muscled man of great strength. In a previous bout with a "sore back" a doctor had diagnosed the ailment as lumbago.

"Oh, Harry—not again!" his wife sympathized. "Shall we try the heat like we did last time?"

"He taped me then. But maybe if we just used bath towels

"Let's try it."

Thomas went into the bedroom and stripped to the heavy winter underwear he wore. He stretched out on the bed, face down. In a few moments his wife came in with thick towels, which she spread over his back.

"I've got the irons on the stove," she told him.

"It sure aches, Jenny," her husband complained. "I never had a back ache as bad as this."

"You said the lumbago was the worst you ever had," she reminded him.

"Well, this is as bad. I guess it's the same. Aren't those irons hot enough yet?"

This was before electric irons were common. Mrs. Thomas went into the kitchen and returned with a flatiron. Carefully but firmly, she began to iron her husband's back through the protecting thickness of the towels.

"Feels good," he finally grunted. "Feels real good, Jenny."

Harry Thomas continued to have his sore back for about a week. Each night his wife applied heat with the irons, which, he said, brought him a great deal of relief. When the soreness began to go, it seemed to disappear almost as quickly as it had come.

Over the years, such homemade improvisations for heat and comfort have been practiced, apparently with a measure of success, for some of the vagrant aches and pains that appear.

They have not been so successful with other disturbances, such as rheumatoid arthritis, which is the most ravaging form of arthritis and plagues approximately 4 million Americans.

RHEUMATOID ARTHRITIS—Rheumatoid arthritis is de­fined as a generalized disease of the entire body that produces an inflammation of the joints. It is a long-term disease. Some­times it appears suddenly, but usually the onset is gradual. First signs of the disease are fatigue, weight loss, general weakness, stiffness of the joints and muscles.

As it progresses, one or more joints become swollen, in­flamed and painful. From 15 to 25 per cent of all arthritics become progressively disabled and invalided—hence its dubi­ous distinction of being called "the great crippler."

The disease attacks persons of any age, even children. It attacks three women for every man, although rheumatoid arthritis of the spine more frequently strikes young men, four for every woman.

As yet the cause, or causes, of rheumatoid arthritis are not known. Nor is there any specific cure for the disease. How­ever, with proper treatment and care most patients can be greatly helped. There appears to be no certain way to prevent rheumatoid arthritis. It is seldom fatal, but its crippling and other effects tend to weaken the body, making it more sus­ceptible to other diseases.

The accepted treatment is to control pain and inflammation, maintain the best range of motion in the joints, and preserve the strength and use of the muscles.

Dr. Lamont-Havers emphasizes that, as yet, there is no drug that will permanently arrest rheumatoid arthritis. "The best that drugs can do at present is help control the ailment and relieve the major symptoms—pain and inflammation of the joints—thus making it possible for the arthritic to under­take physical therapy."

Scientists are certain that someday there will be a drug or medicine to cure arthritis. In the meantime these drugs are most commonly used, according to Dr. Lamont-Havers.

"Aspirin, one of the oldest and most widely used drugs in arthritis, is mainly a painkiller and is safest for long use.

"Injected gold compounds may actually curb development of the disease temporarily in a number of cases; but their use may produce potentially dangerous side effects.

"The steroid hormones such as cortisone and its various chemical cousins are important in reducing inflammation and swelling of the joints, but they sometimes produce unwanted reactions.

"Chloroquine and related compounds may be effective in some cases if administered over a period of months. But, like others, they may cause undesirable reactions."

Scientists are working ceaselessly to find new drugs and improving existing ones.

Physical therapy helps patients to maintain or improve the range of motion in arthritic joints, prevents the joints from permanently locking, and heads off atrophy of muscles. Physi­cal therapy usually includes hydrotherapy, heat, and a super­vised program of exercise.

OSTEOARTHRTTIS—Osteoarthritis is defined as a form of arthritis that attacks the bone and the cartilage in the joint. Most frequently associated with aging, it usually attacks those joints that undergo the greatest wear and tear.

After the age of 50, anyone is likely to suffer from the disease. It is sometimes labeled "everybody's disease." Al­though no definitive cause for osteoarthritis is stated, it is in some way associated with advancing years and wear and tear. More accurately, it is called degenerative joint disease.

It is sometimes crippling, especially when knee or hip joints are involved. Symptoms usually are aches and soreness of the joints, usually following too much physical activity. Overactivity will increase the severity of the disease in most instances.

There is no known cure for osteoarthritis and it is consid­ered to be an incurable disease in the sense that the basic damage, which is defined as a destruction of cartilage, is prac­tically beyond repair.

The disease is treated by physiotherapy, dietary regulation and drugs—such as aspirin—and sometimes by surgery. Over­weight is a factor in osteoarthritis and sometimes a loss of weight will greatly relieve symptoms of the disease. Foot dis­orders may also contribute to aggravation of the condition. Therefore, improvement of foot mechanics and wearing properly fitted shoes sometimes help relieve pain due to osteoarthritis.

Physical therapy is probably more effective in osteoarthritis than in any other form of rheumatic disease, according to ARH experts. However, each procedure must be selected and prescribed by a physician to suit the needs of individual joints and muscles (which also occasionally experience pain radiated from involved joints).

Surgery sometimes can be most helpful. Improved ortho­pedic techniques in surgery enable skilled doctors to bring long-lasting relief to many sufferers.

RHEUMATIC FEVER—Rheumatic fever kills about 20,000 persons each year. Its victims usually are between the ages of 5 and 15. Furthermore, it causes more long-time crippling illness in children than any other disease. It is especially dangerous in another way because it is a "repeater" and a child can get it more than once. With each attack there is a new chance that there may be serious injury.

Rheumatic fever is denned as an inflammatory disease that can either be acute or chronic. It may affect almost any part of the body, including the heart, joints, blood vessels and the brain.

Probably the most serious danger from rheumatic fever is the effect it can have upon the heart. Damage to the heart may be very serious or even fatal, but effects on other parts of the body usually are temporary.

In adults, rheumatic heart disease, which is a result of rheumatic fever, is an important cause of illness, disability, and premature death. Adults, too, may be victims of rheu­matic fever, but in a large minority in comparison with child victims. During World War II more than 40,000 men in the armed forces were attacked by the disease, to one degree or another.

No immediate cause for rheumatic fever is known. How­ever, it usually follows nose and throat infections caused by a particular streptococcus germ. Three such common infections are "strep" sore throat, tonsillitis, and scarlet fever. Usually rheumatic fever starts about two to four weeks after the "strep" infection disappears. However, only a small percent­age of such infections are followed by rheumatic fever.

While there is no specific cure once the disease develops (certain drugs such as aspirin, cortisone and others may shorten the course of it), prompt and adequate treatment of a strep infection by a physician with penicillin and other drugs can prevent the development of rheumatic fever, and doses effective over a 10-day period may forestall the disease from taking hold later on.

Prevention is the watchword in this instance.

Johnny Martin, 9, came home from school on a Wednesday afternoon complaining of "not feeling well."

"What's wrong?" Sally Martin, his mother, asked anxiously. The boy's face did look flushed.

"It hurts when I swallow."

"Did it this morning?"

Johnny shook his head. "This afternoon."

"Is it kind of tickly, Johnny? Sort of itchy?"

"I don't know. It just kind of hurts to swallow. I feel hot, too."

"I'm going to take your temperature," the mother decided:

Ten minutes later she was dialing the family doctor, a worried frown on her forehead, her eyes glancing into the bedroom where she had put Johnny to bed.

"Dr. Wills, this is Sally Martin. Johnny's ill."

"What's wrong, Sally?"

"He came home from school complaining about a sore throat. It looks sore to me, too."

"Fever?"

"That's what really worries me. It's almost one hundred and three."

"Hmm. Did it come on suddenly?"

"Yes."

"Hurts when he swallows?"

"He says so."

"Head ache? Sick to his stomach?"

"No, I don't believe so."

"You don't know if he's been exposed to scarlet fever?"

"I haven't heard of any in the neighborhood or the school."

"Sally, go and press under the angle of the jaw. See if the glands there look swollen, or feel swollen. If they are, it probably will hurt him when you press. I'll wait."

A few moments later Sally Martin returned to the tele­phone.

"I'm positive they're swollen," she said.

"I'll be by in about an hour," Dr. Wills said.

Johnny was examined by the doctor. The sore throat was diagnosed as "strep" and Johnny was given penicillin and he made a complete recovery in a short time.

The chances of Johnny's contracting rheumatic fever were thus reduced to about an absolute minimum.

In another part of the city, another child, Margaret Whit-more, 12, had been complaining for some time of vague muscle and joint pains.

"Growing pains," a neighboring housewife assured Mrs. Whitmore. "All children have them."

"But she seems to be running a fever so often. And she's so tired all the time."

"She should eat more," said Mrs. Clay, the neighbor. "That's what's wrong with girls these days, Agnes. They don't eat enough."

"But she never seems to have an appetite, and she's always so pale. Besides, she has those nosebleeds."

"You mean she's still having them?"

"Yes, and I'm worried. I told Mike last night that—"

Mrs. Clay interrupted with a matronly nod of sudden decision.

"Agnes Whitmore—I think you'd better take that child to the doctor. Those nosebleeds and all. There's something wrong with Margaret. Mark my words!"

"That's what I was about to tell you, Mrs. Clay. Mike and I decided that's what we'd better do. I'm going to take her to Dr. Jackman tomorrow afternoon, even if I do have to keep her out of school."

Mrs. Clay nodded again, thoughtfully. "You know, Agnes, she never did quite get over that siege of sore throat she had a while back. I guess maybe you'd better see the doctor."

"Maybe I should have had a doctor then. Only it didn't seem much more than a cold or whatever all the children seemed to be having then. But her throat was awfully sore. . . ."

Dr. Jackman's examination and diagnosis bore out Agnes Whitmore's misgivings about not having earlier medical at­tention for her daughter. Margaret was suffering from rheu­matic fever.

Unfortunately the girl's heart was permanently damaged by the rheumatic infection. Usually such damage is the result of inflammation of one or both valves on the left side of the heart. The infection frequently leaves the valves scarred, roughened and, occasionally, deformed. They fail to work properly, which affects the blood flow at the heart.

New surgical techniques, even the use of plastic substitutes, have accomplished a great deal in the last few years in enabling these cardiac cases to live normal lives.

With Margaret Whitmore, months of bed rest were neces­sary. Fortunately arrangements could be made so that she could continue her school studies at home.

Immediate attention, when she had what probably was a strep sore throat, quite possibly might have prevented the onslaught of rheumatic fever.

Unfortunately, Margaret will have to be very careful about a repeat attack of the disease. She should have regular check­ups from her doctor. He may possibly give penicillin or sulpha drugs continuously as they have shown good results in pre­venting rheumatic fever from striking again.

The danger of repeated attacks is great. Statistics reveal that only about three per cent of strep infections in normal persons are followed by rheumatic fever. For those who have previously had rheumatic fever, the figure jumps to 50 per cent.

GOUT—Probably no description of the onslaught of an attack of gout will ever be more dramatically written than the one written by Thomas Sydenham, a famous English physician, in 1683. The doctor suffered from the affliction for more than thirty years, so he wrote from experience: . . . The victim goes to bed and sleeps in good health. About two o'clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle, or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them.

Then follows chills and shivers, and a little fever. The pain, which was at first moderate, becomes more intense. With its intensity the chills and shivers increase. After a time this comes to its height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments—now it is a gnawing pain, and now a pressure and tightening.

So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of the bedclothes nor the jar of a person walking in the room.

The night is passed in torture, sleeplessness, turning of the part effected, and perpetual change of posture; the tossing about of the body being as incessant as the pain of the tortured joint, and being worse as the fit comes on.

Over the centuries the treatment for gout could be almost as excruciatingly painful as the disease. One drastic remedy was the employment of moxa, which Oliver Wendell Holmes attributed to the Japanese, but which possibly was practiced by the ancient Chinese and Egyptians. The practice embodies lighting cones of combustible material and applying the burn­ing cones over the affected parts of the body. (It is still used, and some patients received moxa treatment after the atomic bombings of Hiroshima and Nagasaki.)

The more familiar practice of acupuncture was also used. This is the Chinese practice that entails sticking needles in the body to counteract pain. Authorities observe that Chinese literature about acupuncture contains much sound anatomy and many modern Chinese today are examining acupuncture with seriousness.

One fallacy about gout is that it is always caused by "high living." This is not true.

Gout is defined as a chronic disorder with recurring attacks of joint pains. In many cases the great toe is the first joint affected, but not always. Frequently several joints are affected.

It is caused by an inherited chemical fault that involves the production and excretion of uric acid. In the gout victim, uric acid that would be excreted from the kidneys in normal persons, is deposited in the tissues, especially of hands and feet, in the form of a chalky substance. Inflammation and intense pain can result.

Frequently gout is triggered by an injury, overeating and drinking, or a surgical operation. The attacks tend to recur.

As yet there is no cure for gout in the strict sense, but the disease may be controlled by drug therapy.

Probenicid, a comparatively new drug, is useful in cutting down the abnormal amount of acid in the body over a period of time. It is not of particular value in acute attacks, which are dramatically relieved by colchicine—a drug dating back centuries to early Moslem medicine.

For the intense pain of the acute attack, one of the most effective drugs is a muscle relaxant called zoxazolamine which was developed by researchers at the National Heart Institute in Bethesda, Maryland.

OTHER FORMS OF ARTHRITIS AND RHEUMATISM—

There are a number of other forms of arthritis that occasion­ally attract comment and attention.

Rheumatoid spondylitis is a form of spinal arthritis which usually attacks young men.

Lupus erythematosus is a "collagen disease" related to rheu­matoid arthritis, and particularly attacks young women, in­volving many of the vital organs besides the joints. It can be fatal, and frequently is.

Bursitis is an inflammation of a sac which lies between muscle and bone, or between two muscles, as a cushion be­tween moving surfaces. The sac is called a bursa.

Bursitis may be caused by wear and tear upon a joint in the nature of work or unusual exercise, or from an injury. Most frequently it involves the shoulder.

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