When the combined plan is employed, the usual practice, as already described, is to combine soda bicarbonate with the salicylates, but there is no reason why the potash salt may not be similarly administered as in the following mixture: R. Sodii Salicylat is 3iv.
Potassii Biearboiuilis 3vj.
Liquor. Morphi na Hydrochloe. 3iss. Aqiue Camphorce ad 5xvj. Misce.
Fiat inistura. Ca piat 3i. pater in die.
Or, as already mentioned, the Bicarbonate may be given in the form of a strong aerated potash water (3o grs. to so oz.), to which the salicylate is added just before swallowing, or 3o grs. of the bicarbonate may be added to half a tumblerful of soda water, in which zo grs. of the salicylate have been dissolved.
Or the following plan may he adopted: 11. Polassi Bicarbonalis .1quee ;5"xij. Misce.
uiiNliuya. " of the powders (i.e., 20 ges. Salicylate of Soda) to be dissolved in lien tablespoonfuls of this mixture?, after which a tablespoonful of Lemon nice is to be added, and the whole to be taken during effervescence every four holies." Garrod's method of treatment consisted in a combination of alkalies with full doses of Quinine.
Rees's treatment by Citric Acid or Lemon juice alone has fallen into disuse, but when combined with alkalies the resulting potassium or sodium citrate is a most valuable agent as administered in the above recipe, and the amount of lemon juice may be doubled without diminishing the alkaline effect.
The newer antipyretics—Antipyrine, Phenacetin, Exalgin, etc.— speedily reduce fever and relieve the joint pains considerably, hut by common consent their employment as routine agents has been abandoned, owing to the profuse sweating, depression and sometimes collapse which often follow full doses.
Hyperpyrexia, which is so liable to supervene in acute rheumatism, should never be combated by these antipyretic drugs, neither should salicylates or quinine be depended upon. The only way to save life in this grave complication is to r :sort to the cold pack or cold bath, and since movement of the painful joints usually prohibits the bath, the best plan is to place the patient upon a wire mattress protected by a mackin tosh with a sheet around him and pour cold water over this till the hyper pyretic temperature has been reduced.
The old routine of administering Opium has entirely given way to the salicylates, but occasionally it will be found necessary to resort to opiates for the relief of unusually severe pains and restlessness or of insomnia.
The latter condition cannot be relieved by the simple hypnotics, since the sleeplessness is nearly always due to pain, and hence opium or morphia should be given in one full dose at bed-time along with the last dose of the salicvlate.
The treatment of the cardiac complications, whilst mainly that of the primary condition, will be found detailed in the articles on Endocarditis and Pericarditis.
Serum Treatment.—Various attempts have been made of late years to treat acute rheumatism by a serum prepared from various strains of streptococci. Thus Menzer, obtaining cultures from the organisms existing in the fauces in the so-called rheumatic sore throat, has injected animals with these in increasing doses, and he maintains that the serum from these immunised animals has a powerful curative influence in acute rheumatism. Vaccines from Streptococcus rheumaticus have been employed, and Sherman reports most favourably on the results. Others have employed cultures of staphylococcus and of Bacillus coli.
The initial dose of the Wimpole Institute Streptococcus rheumaticus vaccine is to,000,000 organisms. Until the causal organism of rheumatic fever has been isolated and placed beyond the possibility of doubt the methods of serum and vaccine treatment may he regarded as a groping in the dark, though it can hardly be doubted that the streptococcic vaccine has proved of great value in the treatment of some of the complications of the disease.
The dose of Menzer's serum is 5 to to c.c., but much larger doses have been administered. It seems almost certain that this serum really functions as a vaccine, since marked exacerbations of the arthritis and pyrexia supervene after each injection.
and Schichhold maintain that the primary focus of infection in all cases of acute and subacute articular rheumatism is situated in the tonsil, and the last-mentioned authority carries out as a routine the entire removal of the tonsil. He slits up the lacuna; and proceeds to remove the portions of the tonsillar tissue between the incisions till the whole gland is excised. This he claims to have done in 7o cases with great success. Not only do the symptoms of joint trouble rapidly disappear, but he claims that this method of treatment prevents relapses or return of the attack, and so complete is the disappearance of all the usual evidences of the disease that salicylates are not necessary.