As a last resource, in the case of older children only, when the heart shows sig nal signs of failure, when the first sound becomes short and feeble, and the pulse small and irregular, hypodermic injec tions of liquor strychnim, combined with brandy or digitalis, are valuable. Cheadle (Treatment, No. 5, '97).
Rheumatic fever most successfully treated by giving a combination of a salicyl compound with an alkaline bicar bonate. For an adult 20 grains of so dium salicylate and 30 grains of potas sium bicarbonate should be given every two hours until the pain is relieved and the patient is fully under the influence of the salicylates. when the same quan tities should be given every four hours till the temperature has fallen to nor mal. Afterward 15 grains of the salic ylate and 20 grains of the bicarbonate are to be given every four hours until all the joint symptoms have disappeared, and then three or four times a day until a fortnight has elapsed from the com plete disappearance of joint symptoms. During the whole of this course of treat ment absolute rest in bed must be en forced. A. P. Luff (Practitioner, Jan., 1901).
Nothing certain is known of the man ner in which salicylic acid and its com binations influence the rheumatic tion; possibly it has a specific action on the microbes; it is a reliable, but not an infallible, remedy, and some cases are rebellious to its action. Some patients do not tolerate it, vomiting being in duced. It may then be administered by inunctions (ride supra) or enemata.
An aqueous injection should first be given patient to evacuate intestines, and the solution should be heated to a temperature equal to that of the human body.
Following formula given preference: P Salicylate of soda, to 2 drachms.
Water, ounces.
Tincture of opium, 1 V, drachms.
Best instrument for giving this enema is the ordinary injection-syringe of 3 V, ounces' capacity, joined with an oesoph ageal sound, which may be made to pene trate about eight inches into the large intestine. It is important that the in jection be retained as long as possible in the intestines. Erlanger (Deutsches Archly f. klin. Med.„ vol. iii, '93).
Methyl-salicylate used in eighty-five cases of acute and subacute rheumatism internally, starting with doses of 15 to 30 minims a day, and increasing the daily doses up to 2 or 2 V, drachms. For
mula used: H. Methyl-salicylate, 2 drachms. Gum-arabic mixture, 5 ounces. Rum, Syrup. of each, 6 drachms.
To be taken during the twenty-four hours.
Amyl-salieylate is the equal of sodium salicylate as an antipyretic and analge sic, and is better borne by the stomach. Some cases, however, showed the follow ing untoward effects: Noises in the ears, headache, vertigo, dryness of the throat, nausea, vomiting, burning in the stom ach, etc. Its absorption is very rapid; in most cases salicylic acid can be dis covered in the urine within twenty-five minutes after the administration of the drug. Corma (Le Bull. Mo'cl., p. 909, 1900).
Salophen, a drug which in the bowels decomposes into salicylic acid and phenol, has been recommended as a substitute for salicylic acid. It is especially useful when given late in the course of the disease, when the acute fever has been mastered by the salicylic acid. Salophen is well supported even under prolonged use. The daily dose is 1 to 1 drachms.
Salophen recommended in acute rheu matism in doses of 15 grains every three hours, in conjunction with sodium bi 1() grains three times a day. W. II. Flint (N. Y. Med. Jour., July 30, '92).
It is in the acute variety of articular rheumatism that the good effects of salophen are manifested. It should be administered at the outset in daily amount of 90 grains taken in six doses in starch-wafers. It is always well borne; there is no malaise, nausea, ver tigo, or ringing in the ears. In equal dose it is a little less rapidly efficacious than sodium salicylate. 1\1. L. Gaillard (La Presse Med., No. 56, '97).
Salophen in forty cases of rheuma tism, giving 15 grains six times daily. It has a good effect in acute and chronic articular and muscular rheumatism. Klimenko (Ther. Monats., July, '98).
Excellent results obtained with salo phen. It is best administered in wafers, or simply dropped on the tongue. It passes unchanged through the stomach, and, in the intestines, it separates into salicylic acid and acetyl-paramidophe nol, the latter having antipyretic and analgesic properties, and supplementing the action of the salicylic acid. The sep aration is probably very gradual, as the salicylic acid which is formed causes no untoward symptoms whatever. H. A. Rielly (Buffalo Med. Jour., Feb., 1901).