Of late a compound of salicylic acid, salicylate of methyl, has been mended for external use; it is a volatile fluid of an aromatic odor; the pure drug is preferable to wintergreen-oil, a veg etable extract employed by perfumers and containing a large percentage of salicylate of methyl. The affected joints are to be painted with the drug and enveloped with some impervious ma terial. Experience has shown that the salicylic acid contained in methyl-salic ylate is absorbed through the skin. It is also chemically demonstrable in the urine. It removes the pain and reduces the temperature of rheumatic fever.
Local application of salicylate of methyl used in different forms of rheu matism (acute, subacute, and gonor rhozal, etc.). The drug must be used in cases in which for any reason it is de sired to obtain a local effect, and when the ordinary remedies for rheumatism are not well borne by the stomach. Salicylate of methyl acts well in acute articular rheumatism, but on account of the difficulty of applying it to painful joints it must be employed in such cases only if the internal administration of remedies has failed. On the other hand, in subacute and chronic forms, in the painful paroxysms which occur from time to time in the different varieties of deforming rheumatism, local absorption of salicylate of sodium acts as well as salicylates taken by the mouth, often better. Lannois and Linossier (Med. Mod., Aug. 19, '96).
Following suggested as summary of the chief points in reference to the prophylaxis of rheumatic hyperpyrexia: 1. Cases in which the pyrexia shows a tendency to rise instead of decline under full doses of the salicyl-compounds, and in which no intercurrent condition can be detected which might account for the increasing pyrexia, should be treated at once by cold applications without wait ing for the onset of nervous symptoms or for other prodromata of rheumatic hyperpyrexia. 2. When delirium appears in a ease which exhibits pyrexia, and no intercurrent visceral complication can be made out which might account for its presence, the immediate employment of cold is called for. 3. Should delirium appear while the temperature remains normal, a mild form of cold application --e.g., an ice-cap to the head—should be employed, and on the appearance of pyrexia more vigorous methods ought to be adopted without waiting for any ex treme degree of pyrexia (e.g., 105° F.)
to be reached. 4. Cases in which the hyperpyrexia is, as it were, accidentally discovered to be present offer, of course, no field whatever for prophylaxis, but treatment by cold should be commenced at once without waiting for the appear ance of nervous symptoms or attempting to reduce the temperature by means of any antipyretic drugs. H. G. Langwill (Scottish and Surg. Jour., Feb., '99).
The hypodermic injection of tropaco caine, in the form of a Schleich infiltra tion, accomplishes therapeutic results not approached by any other method in the relief of the agony of neuralgias and myalgias of rheumatic origin. The in jection should be made in the area of greatest tenderness to pressure, and varies slightly in technique from that practiced for surgical purposes, inas much as it demands the injection of as large quantities of the fluid as possible, with a syringe capable of exerting pow erful pressure. The method is successful in acute, subacute, and chronic cases in which fibroid changes have not already taken place; furthermore, it offers a sign of diagnostic importance, since it offers relief only in the neuralgias of rheumatic origin. In rheumatic affec tion of tendons and joints it is available only in very light eases, with small amounts of exudation. R. Bloch (Med ical News. May 23, 1903).
As the long-continued use of salicylic acid is not without inconveniences, dif ferent other antipyretics have been tried as substitutes for it; such arc antipyrine, antifebrin, salol, phenacetin, malakin, analgen, asaprol, pilocarpine, etc. Each of these drugs has in some cases proved successful; none of them, however, has any chance of supplanting salicylic acid as the most ready and reliable remedy. Ten patients with articular rheuma tism treated by injecting the serum ob tained by bleeding patients who had recently undergone an attack of acute articular rheumatism. Reaction from the injection was variable, not only for each patient, but even for each injection. It cannot be said to have a specific thera peutic value, for all that in some cases the cure followed two or three injections of serum. In the majority it was neces sary to resort to the use of salicylates. J. Weiss (Revue de Then, No. 11, p. 325, '96).