Since the introduction of the Salicylic treatment its literature would fill a small library, and volumes might be made up of statistics attempting to prove its efficacy or its failure in influencing the duration of the disease and its effects upon preventing or determining cardiac complications. It cannot be denied that the salicylic treatment affords the most certain and speedy means by which all the arthritic symptoms of acute rheu matism may be relieved, but it must be granted that it still remains to be proven that this treatment has the power of cutting short the actual duration of the disease to any considerable extent. As regards the effect upon the cardiac complications likely to occur during the attack, it must again be admitted that clear proof is still wanting to demonstrate that it lessens to any appreciable degree the occurrence of endo- or peri-carditis, though these complications are undoubtedly relieved by full doses as long as the arthritic manifestations and fever still continue.
By closely watching the cases long after recovery, the writer believes that it may be possible to prove that of a number of patients who have suffered from rheumatic endocarditis, a smaller percentage of those who had received salicylic treatment will eventually develop permanent valvular mischief than of those subjected to expectant or other methods. This is obviously a very difficult point to settle, but of late years the results of hospital and private cases (but chiefly the latter) have led the writer to gravitate towards a conclusion in favour of the permanent benefit arising from the salicylic treatment and of the drug possess ing some degree of specific action in neutralising the toxins of the disease.
These remedies do not appear to prevent relapses, and indeed it would seem upon the contrary that relapses are, if anything, more frequent than when the Alkaline treatment is alone used. This is, however, owing to the patient indulging in exercises or movements whilst the pains are in complete abeyance under the influence of the salicylates before the attack has run its normal course.
The drugs embraced under the general term of Salicylic remedies include Salicylate of Soda, Salicin, Salicylic Acid, Oil of Wintergreen, Salol, Aspirin, Diaspirin, Novaspirin, Benzosalin, Salacetol, Saloquinine, Salophen, and other new salicylic derivatives.
Mitclagan recommended Salicin, some still adhere to the Acid, but the great majority of physicians rely upon the Salicylate of Soda, and, upon the whole, it is from many points of view the drug best suited to the great bulk of cases. Salo] in full doses is dangerous, owing to its high percentage of carbolic acid and its slower excretion.
Since Charteris isolated a substance from the artificial acid and its soda salt, and experimentally demonstrated it to be the cause of certain toxic effects noticed after large doses of these drugs, the sodium salicylate treatment has become universally accepted as the best. Only the " physiologically pure " acid or its soda salt should be used in medicine, and much larger doses than those formerly employed may be given with perfect safety.
One dose of 3o grs. of the purified salicylate of soda may be given as soon as the patient comes under observation, and 20 grs. may be given every three or four hours afterwards. In twenty-four hours after the inaugura tion of this treatment sometimes all fever has disappeared, and the joint trouble may be noticed to have entirely given way. In the writer's wards the students complain that they never see " rheumatic fever," as the symptoms of the disease are, as a rule, entirely removed by the salicylic treatment before they get a sight of the patient.
Some physicians prefer to give 15 grs. of the soda salt every hour for four or five doses, then every three or four hours, but each case may be treated upon its merits, and as the temperature falls the amount and frequency of the dose may be diminished. The best plan will be to proportion the size of the dose to the length of time from the commencement of the patient's illness till he came under observation. Thus, given a patient ill for several days with many joints affected, it will be well to save time by giving 3o grs. of the soda salt immediately, and 20 grs. every two or three hours, according to the effect upon pain and temperature. i5-gr. (loses three times a day should be given for a week after the subsidence of the pain and fever.
It is a significant fact that in rheumatic fever patients the total excretion of salicyl is markedly less than in non-rheumatic cases, showing the probability of a chemical neutralisation of the salicylate by the toxin of the disease. Lees regards the salicylate of soda as a specific in acute rheuma tism if given early and in full doses. He insists upon the necessity of combining with it twice its weight of Sodium Bicarbonate in order to pre vent respiratory symptoms; he.gives 20 grs. of the salicylate every 2 hours during the day and every 4 hours during the night. This dosage works out at about i8o to 200 grs. in 24 hours, and half this amount he gives to a child 6 to so years old, and increases it in severe cases to the adult dose.