In the year following that in which this method of treatment was brought under the notice of the profession, the leading medi cal journal in England thus referred to the subject: "There are few practitioners who have reported themselves as disappointed in the use of this drug; or, to put it at once strongly and carefully, more disappointed than in the use of quinine for ague. There has not been, in fact, such a consensus of medical opinion on any thera peutic question for many years, as on the power of this drug in one form or other to cure rheumatic fever" The experience acquired during the years that have elapsed since then has amply confirmed the favorable conclusions drawn from the earlier observations, and salicin and salicylic acid are now universally regarded as the remedies for acute rheumatism. The evidence, in deed, is now so overwhelming that no one calls in question the efficacy of these drugs, or their power to arrest the course of that disease. To get the full beneficial P ffeet S the drug should be given in full and frequent close—twenty to thirty grains every hour till the tempera ture falls and pain is materially diminished. It will generally be found that when the drug is given in this dose the pain and fever are materially allayed in eight or ten hours, and abolished within twenty-four hours from the commencement of treatment. It reads like an exaggeration, but it is a strictly accurate statement to say that treated thus by frequent large doses of salicin or salicylic acid the symptoms of rheumatic fever (pain and fever) are more completely relieved in twelve hours than under the old forms of treatment they used to be in three weeks.
The rapidity with which the cure is effected depends on the dose given; and the necessity for giving the drug in full and frequent close cannot be too strongly insisted on. Salicin and salicylic acid are rapidly eliminated from the system, and only by giving them in full and frequent dose can their action be kept up. In the early years
of this treatment many cases were reported in which these drugs failed to effect a cure. The failures were generally attributable to the inadequacy of the dose given. To give five or ten grains of salicin or salicylic acid every four or six hours is to do injustice both to the patient and to the drug. Large and frequent doses are necessary— thirty grains every hour till pain is relieved and temperature falls; after that the interval between the doses may be widened. But to guard against a recurrence of the symptoms it should continue to be administered for ten or twelve days after all pain has ceased.
It is marvellous how speedily the symptoms decline under this treatment. Relief of pain is the first indication of improvement, and this is generally marked before an ounce of the drug has been con sumed, often before half that quantity has been taken. It takes about an ounce of salicin or salicylic acid to completely allay the acute symptoms, and the sooner this is got into the system the better. The cases are few in which that quantity may not be given and pain and fever abolished within twenty-four hours of the commencement of treatment; in many cases this result is got within twelve hours. So rapid is the cure that it is often difficult to keep the patient in bed for more than two or three days. He should never be allowed to get up within a week ; for no matter how completely the pain and fever may be abolished, it must be borne in mind that the structures of the joints have been inflamed, and do not at once resume their normal tone on the decline of the inflammation; time must be given for the effects of the inflammation to pass off and the inflamed struc tures to return to their natural condition.
The following cases illustrate the good effects of the salicyl com pounds: