Internal treatment, though mentioned last, is of equal importance, and is to be carried out concurrently with local measures. It is to be pursued upon antirheumatic and eliminatory principles.
Salicylates are the most frequently employed of all internal remedies. Before resorting to them the writer's routine in all severe cases is to administer a wineglassful of unsweetened Gin made into hot punch after the patient has been put into a warm bed between blankets; this dose sometimes succeeds in cutting short the attack with promptitude. 20 grs. Sodium Salicylate, grs. Aspirin, to grs. Salol, to mins. Methyl Salleylate, 15 grs. Salicylic Acid, 20 ars. Salicin, I; ar. Salacetol, to grs. Salophen, or to grs. Novaspirin may be given thrice daily.
Rarely will Morphia internally be necessary to combat pain, and before resorting to it local anodynes and the coal-tar analgesics should be tried. When urgently indicated 13 grs. Dover's Powder or gr. of the hydro chloride hypodermically may be administered.
Diaphoretics and diuretics are always useful, but as all the salicylates act in these ways other emunctories are seldom employed. Mindererus Spirit, Citrate of Potassium in large doses with Spirits of Nitre or small doses (5 grs.) of Nitrate of Potassium may be used alternating with the
doses of salicylates, or the hot-air or thermoelectric bath may be resorted to in order to excite free skin action.
Colchicum in combination with full doses of Iodides is most valuable in gouty subjects; Dr. S. B. Coates has obtained excellent and speedy results in the ordinary rheumatic type of lumbago by administering Tincture of Iodine, and many physicians still adhere to the use of 3o-min. doses Tincture of Aetna Racemosa.
In chronic cases Guaiacum still holds its place, and a course of the Chelsea Pensioner which contains Sulphur and Nitre in addition is a favourite remedy. Arsenic occasionally does good, and Quinine Salicylate in debilitated subjects may he advantageously employed.
The bowels will require free purgation by salines with an occasional previous dose of Calomel or Blue Pill, and the diet should be such as is suitable for gouty and rheumatic subjects with a sparing allowance of red meats and purins. Active but not fatiguing muscular exercises should be regularly indulged in after convalescence to minimise recurrence of attacks.