R. Sodii Salicyl. gr. cccxx.
Sodii Bicarbonatis Siss. Syr. Anrantii Igor. -3ss. .1quee Chlorofornti ad 3xvj.
Ft. inistura. cpt. at dicta.
The writer has never ventured to push the drug in the above heroic doses. Poynton, who considers that the salicylate should he administered as a routine for the relief of the arthritic manifestations, apart from the consideration of its specific action, recommends that 20 grs. salicylate with 15 grs. bicarbonate of soda should be given every 2 hours for 6 doses, every 3 hours for 4 doses, and then every 4 hours. This dosage works out at about 200 grs. during the first 24 hours if given during the night, and 120 grs. on the succeeding days, and appears to be a safe limit for a strong adult as long as the joint pains are severe, provided the administration is not continued during the night.
The salicylate of soda may be prescribed in zo-gr. doses as a powder to be taken in effervescing Potash water. The advantages of this plan are obvious—it is more palatable, and it combines the salicylic treatment with the alkaline. The drug should be stopped or suspended for several hours as soon as its full physiological effects as buzzing in the ears, giddiness, deafness, etc., are established, but such results are now seldom witnessed when the pure salt or acid is employed.
Pure Salicylic Acid is advocated by Latham, who insists that the natural and not the synthetic product should be used. He gives too grs. daily and sometimes 15o grs., often combining Calomel with it, and he main tains that it is a true antidote to the rheumatic poison and that when the temperature falls 5o grs. daily may produce cerebral symptoms.
In the writer's experience of the disease he has never seen a case where the new-fangled plan of giving salicylates by a vein was indicated or necessary. The same remark applies to the intra-muscular injections of Magnesium Sulphate. Salicin may be given in cachets in doses of 2o grs. every 4 hours; it is less depressant but certainly less analgesic in its action.
Aspirin, though invaluable in chronic rheumatism and rheumatic neuritis, is not well borne in the acute disease, and there is great difficulty in saturating the blood with it owing to its interfering with the functions of the stomach, through which it is supposed to pass unchanged. If
prescribed with bicarbonate of soda it is decomposed at once into sodium salicylate and acetate.
Saloquinine is the tasteless quinic ester of salicylic acid, and its salicy late—Rheumatin—which is also tasteless, may be given in 15-gr. doses every 4 hours; both these substances are valuable in the treatment of the acute rheumatism of children when the unpleasant taste of the soda salt is strongly objected to. A child of 7 years may get 5 grs. They may be advantageously employed in adult cases during the later stages of the attack.
Alkaline Treatment of Acute Rheumatism.—This was the routine before the introduction of the salicylates, and though founded upon a probably incorrect idea of tho pathology of the disease, nevertheless it still maintains its priority in every case where, from cardiac depression or other cause, salicylates cannot be pushed. The almost universal practice of the best authorities is showing a return to the old method of treatment by com bining alkalies and salicylates, and with our present knowledge this must be accepted as the most satisfactory and safest plan for dealing with rheumatic fever.
When the alkaline treatment alone is pursued tilt Bicarbonate of Potash is the salt generally selected, and it should be given in doses sufficient to rapidly render the urine alkaline. 3o grs. may be given every 3 or 4 hours, and after the effect upon the renal secretion has been thoroughly established, 15 or 20 grs. four or six times a day may be given for many days, or even for several weeks, till the disappearance of pain and fever indicates that the disease has exhausted itself. The addition of Citric Acid or fresh Lemon Juice to each dose of the alkali in no way diminishes its good effects, and where a more decidedly alkaline action is desired the Tartrate or Acetate of Potash may also be given.