As time advanced and facts accumulated it became evident that the alkaline treatment did not materially shorten the natural duration of acute rheumatism, or decidedly diminish the tendency to heart complications—the two advantages which have been specially claimed for it.
We have already seen that the theory on which that treatment is based is untenable, and that lactic acid is not the rheumatic poison, but only one of the results of the rheumatic process.
The theory on which the alkaline treatment was founded being erroneous, we are not surprised to find that treatment fail to produce the good results which its early advocates anticipated.
Impressed with a sense of the failure of this mode of treatment physicians looked about for something better. Owen Bees used lemon. juice, and got from it results which were at least as good as those which followed the administration of alkalies. Some gave up all medicinal treatment and simply kept the patient warm in bed, gave him a light simple diet, and administered some placebo. Dr. Flint published in 1863 an account of thirteen cases treated on this plan with good results. Two years later an equally good report was given by Dr. Sutton of forty-one cases treated in Guy's Hospital and which got medicinally only mint water.
This expectant plan of treatment was adopted by many with re sults as satisfactory as those got from more active measures.
" I am quite certain," says Sir Alfred Garrocl, " that many cases even of severe rheumatic fever get rapidly well without the admin istration of drugs ; and on simply colored or camphor water the im provement is often so quick and satisfactory that had not the nature of the treatment been known great virtue would surely have been ascribed to it." This expectant plan of treatment is really that which was recom mended and practised by Sydenham in the later part of his career. To treat a patient by mint water, is practically the same as treating him by whey, which Sydenham did two hundred years ago. It is curious to find the physicians of the nineteenth century going back to the same plan of treatment which was recommended by the father of English medicine in the seventeenth.
Sir Russell Reynolds, dissatisfied with the alkaline treatment, tried in acute rheumatism a remedy which had proved serviceable in some forms of spreading inflammation, the tincture of muriate of iron.
His results were as good as those got by any other treatment; though his cases are too few to be of statistical value.
Dr. Herbert Davies, reviving an old practice, had recourse to free blistering of the inflamed joints, with very satisfactory results.
Such are the chief remedial measures which had been adopted in the treatment of acute rheumatism up to the year 1876. Antiphlo gistic treatment, the alkaline treatment, and expectant treatment, are the only ones which have met with anything like general ap proval.
Antiphlogistic treatment was practised, not because of the proved excellence of its results—for two hundred years ago these were re garded as unsatisfactory by Sydenham, and have frequently. since then been called in question by others, but because such treatment was the legitimate outcome of the views then held regarding the nature and mode of production of rheumatism.
The alkaline treatment was adopted, not because it has been proved to be specially beneficial, but because such treatment was a thera peutic sequence of the generally accepted acid theory.
The expectant treatment was the practical expression of the opin ion which had gradually been gaining ground, that the results of the alkaline treatment were not satisfactory. It succeeded the failure of the alkaline treatment in the nineteenth century, just as in the hands of Sydenham it succeeded the failure of the antiphlogistic treatment in the seventeenth.
A study of the natural history of acute rheumatism led us to the conclusion that the disease is of miasmatic origin, and that the poison which gives rise to it, though specifically distinct, is generically allied to that which cases ague. The ague poison is a minute parasitic organism which finds the nidus necessary to its reproduction in the blood of man. Its morbid action and the symptoms to which it gives rise are a result of this reproduction. The rheumatic poison is a minute parasitic organism which finds its nidus in the muscles and fibrous structures of the joints and of the heart, and the symptoms of acute rheumatism result from its reproduction in them.