Colchicum, has been much used in the treatment of rheumatism; but there is no valid evidence of its exercising any beneficial action. Garrod, who regards its power to subdue gouty inflammation as be yond doubt, says that "it possesses no influence in checking the progress of rheumatic fever." To give relief to the pain of rheuma tism it requires to be given in quantity large enough to cause depres sion of the heart's action ; and that is a condition which cannot safely be induced in the course of an ailment which tends specially to the heart.
Guaiacion has long enjoyed considerable reputation as a remedy in rheumatism. Originally introduced by Dr. Dawson, it found its chief advocate in Fowler, who regarded it as useful in all stages of the disease. It is nowadays prescribed chiefly in the chronic forM. Any good effects which it produces are probably due to its stimulant action on the skin.
Nitrate of potassium was at one time a good deal used as a diuretic and refrigerant in febrile ailments. Brocklesby recommended it in acute rheumatism. He gave as much as two drachms dissolved in some diluent three, four, or five times a day. Given thus, there was got both a diaphoretic and diuretic action. This treatment was re-. vived by Dr. Basham, who not only gave the nitre internally, but also applied it locally to the inflamed joints. The results of this treatment seem to have been as good as those of any other.
Other remedies, aconite, veratrine, digitalis, acta racemosa, etc., have enjoyed a passing reputation, and had their claims advocated by different observers. But not one of them has stood the tests of time and investigation.
About the time that bleeding went out of fashion, new views began to be entertained regarding the pathology of rheumatism. This was all but inevitable. If bleeding was wrong the pathological view on which that treatment was founded was also likely to be erroneous. If to take blood not only did no good, but even did positive harm, then were there grave reasons for questioning the soundness of what. was generally believed regarding the nature of rheumatism. Doubts were started, investigation was stimulated, the symptoms of the mal ady were subjected to fresh scrutiny, the opinions of the older writers were regarded with a healthy scepticism, and by and by new views began to be ventilated. The question began to be discussed whether rheumatic inflammation was not altogether peculiar, and due to some special poison circulating in the blood, rather than to the operation of cold. The acid condition of the secretions attracted early and
prominent attention, and was regarded as a possible cause of the rheumatism. Prout made the definite suggestion that lactic acid was the rheumatic poison. Ably advocated by Todd, Fuller, and others, this view was soon generally accepted. Altered views of causation led to altered treatment. If lactic acid were the rheumatic poison it was plain that the proper treatment was to promote its elimination and to counteract its effects.
It is probable that the materies morbi in rheumatic fever is lactic acid or some analogous agent. We know that the natural emunctory of this is the skin. Many chemists maintain that it will also escape by the kidneys; and if it ever does so, perhaps this is more likely during rheumatic fever than at any other time.
"Again since vitiated digestion is apt to produce it in undue quan tity, and it, therefore, is formed abundantly in the stomach, there is every reason to think a certain proportion of it may be carried off through the alimentary canal. The indications are, then, to promote the action of the skin, the kidneys, and the bowels; to use antacid remedies; and to give large quantities of fluid for the free dilution of the materies morbi, and to supply the waste caused by the drainage from diaphoresis and diuresis" (Todd).
The acid theory naturally led to alkaline treatment, and that con tinued till very recently to be the treatment for rheumatism. "If the materies morbi be indeed an acid or an acidulous compound—if it be lactic acid, for instance, as there are cogent reasons for believing it to be—then will its neutralization be effected, its irritative property probably diminished, and its elimination promoted, by a free exhibi tion of alkalies and neutral salts" (Fuller).
The alkaline salts chiefly used have been the bicarbonate and acetate of potassium, given in the close of fifteen to thirty grains every three or four hours. The evidence adduced by Fuller, Garrod, Basham and others in support of this treatment is sufficient to dem onstrate its superiority over any which preceded it. But the sanguine anticipations of its earlier advocates have not been realized; for it has been found in practice that alkalies may be given so as to render the urine alkaline without diminishing the joint pain or allaying the fever.