Recent Advances in the Treatment of Rheumatism

DR. KERSLEY, after welcoming his guests, commenced his talk with a short history of Bath and of the Royal National Hospital for Rheumatic Diseases. He then emphasized the importance of arthritis to industry and the country. In 1953 it cost industry 28,000,000 days and cost the country £80,000,000. It was second only to mental disease as an expense to the nation, coming before that of tubercle, bronchitis, psychoneurosis and accidents. In addition it was the greatest home wrecker, often destroying the value of two lives, not one, owing to the need for home nursing and care extended over many years. The theme of the Royal National Hospital was team work, under the supervision of the physician, the maintenance of a broad view without fads, and the recognition of the patient as a person, who must be taught what is good or bad for him and how to live both physically and mentally with his disease. Co-operation from outside was needed to select those cases requiring special treatment, to follow them up and arrange aftercare, to minimize relapse after treatment and to utilize the partly disabled to the best of his ability. This involved the use of resettlement boards, the application of aids and gadgets, and transportation arrangements. These points were illustrated by a demonstration of gadgets (see p. 10), reference to Dr. Clemmesen's rehabilitation scheme at Copenhagen and trade testing experiments at the Robert Brigham Hospital at Boston and the Treborg Institute at Copenhagen. Dr. Kersley then proceeded to summarize very briefly the current views on treatment of various arthritic conditions. In rheumatoid arthritis, a biochemical problem with internal and external factors, the need was for mental and physical rest, attention to the general health, the aspirin type of analgesics, physical treatment and, in selected groups, the use of gold, steroids or butazolidin. Osteoarthritis, with again internal and traumatic factors, consisted of a generalized type mainly depending on the former and an oligarticular type where trauma played a large part. Saving joints from traumata, with mobilizing and strengthening exercises, was the main theme of treatment, coupled with treatment of muscle spasm and " fibrositis" and often some reassur-