The physical treatment most frequently used for the hands in rheumatoid arthritis is the local paraffinwax bath. It was first described by Humphris (1919) and since then has been in general use. The standard textbooks of physical medicine and rheumatology refer to wax baths as being of value, but we have been unable to find any critical attempt to assess this. It is unusual for a patient with rheumatoid arthritis to be admitted to this hospital who has not received prolonged courses of paraffinwax baths at other hospitals, usually in the outpatient department. Wax baths are also extensively used at the Devonshire Royal Hospital, approximately 10,000 individual wax treatments being given each year.Although evaluating the effect of any form of therapy in rheumatoid arthritis is notoriously difficult, especially if dramatic results cannot be expected, it was decided to investigate the progress of the hands treated with paraffin wax, and compare them with those of an untreated series of patients.
MethodNinety successive in-patients with rheumatoid arthritis referred to the physiotherapy department for paraffinwax hand baths were divided into three groups, the choice being made at random by the department clerk. Group I received no local treatment to the hands, Group II had wax baths daily for 3 weeks, and Group III had wax baths daily for 6 weeks. The patients were unselected, except that subjects who had recently taken, or were taking, cortisone or ACTH were excluded from the investigation.All patients were taking calcium aspirin gr. 10-15 three times a day during their trial period. They received no other local treatment to the hands during the trial period, but they were all carrying out a general programme of physical rehabilitation linked with the activity of their disease.JThe method of applying the wax was by the patient dipping both hands into the bath of melted wax (at 110-115°F.) six times, so forming a glove of wax. The hands were then wrapped in a layer of greaseproof paper, and two towels, which were retained for 20 minutes. After this, supervised finger exercises were performed. Group I patients did no finger exercises, and Group II subjects discontinued them after the third week.Skin temperature measurements, using the Cambridge skin thermometer, were taken of the pulp of the middle finger and the skin of the dorsum of the third metacarpal head in six subjects, before, immediately on withdrawing the hands from the wax baths, and at 10-minute intervals for a further 60 minutes.When the hands were withdrawn from the wax bath the thermocouples were inserted under the wax into contact with the hand, and cooling curves plotted. The rise in temperature was similar in the same hand at both sites. The range of temperature rise was from 2 -9-9.5 C. (mean 5-8°). Skin temperature rapidly fell to initial values or below within a time range of 10-60 min. (mean 37). It is clear that with the technique employed a fair rise of temperature is obtained, but is not long maintained. AssessmentThe hands were examined by a...
