nectiori. There is nothing therapeutic about rest except insofar as it may avoid flare-ups of the disease process. A certain measure of activity is not only possible within these same limits but must be insisted on. From the timidity with which activity is permitted at times and the repeated caution to avoid pain or soreness in exercising the part, the process of rehabilitation might be a long one indeed. Not only is it important that there be an exerciserest balance,17 but as Hill and Holbrook -a have noted the term tolerance must be carefully explained to the patient so that he will not stop the exercises with the onset of pain. So far as the hand program is concerned, our patients expect pain and discomfort during the exercise or use period. If the pain does not persist for several hours or increased discomfort does not result from performing the same activities the succeeding day, the patient is urged to disregard such symptoms. By insistence on increased pain tolerance, transient flare-ups of increased activity have been weathered without halting the rehabilitation efforts.The use of the assistive device described, even in its present crude form, has met with immediate acceptance by the patient. Several patients have made their own devices, which attests not only to the simplicity of construction but also to the factor of motivation, which is so important in the treatment effort. The device may be laundered with ease, the only precaution being to insure against wrinkling in drying. Two patients have objected to wearing the cotton glove in public but have been quite satisfied to utilize soft suede gloves under these circumstances. Initially the tension may be tolerated for 30 to 60 minute periods only. No effort is made to exceed these limits at any one time, but it is soon established by the patient that he is able to tolerate the tension for increasingly long periods before becoming aware of the joint soreness. All patients thus far have increased the range of tolerance for hand activities within one month after incorporating the assistive device principle into the treatment program. SUMMARY 1. A hypothesis is advanced to explain the mechanical basis for the hand deformity of ulnar deviation of the fingers at the metacarpophalangeal joints, flexion at the metacarpophalangeal joints, hyperextension of the proximal interphalangeal joints, and flexion of the distal interphalangeal joints seen late in rheumatoid arthritis.2. Physical medicine rehabilitation measures are described that can readily be incorporated into the home activities of the average patient.3. The use of a simple assistive device is described whereby hand function in a more nearly normal position is possible. 4. The concurrent employment of pain-relieving, reaction-blocking, and nutrition-supplementing mechanisms as necessary parts of the treatment program is emphasized.Perforation of the interventricular septum following myocardial infarction is a rare complication. Since 1845, when Latham 1 first described this phenomenon, few reports have ...
