Diel.—At the height of the fever: bouillon, milk, wheat bread, barley or oatmeal broth, or pap; at the same time plenty of fluid in the form of lemonade and soda water. When the temperature falls, vege tables, meat and eggs are permitted.
Salicylic acid is specifically effective for controlling the fever and the articular phenomena, and is best administered as salicylate of soda or aspirin.
Effective action against the invasion or severity of the heart compli cations is unfortunately not assured either by the above or by any other measure. At the outset not too minute doses should be given, to smaller children 0.25 Gm. (about 5 gr.), to larger children 0.5-0.S Gm. (7)-,-12 gr.) three to four times daily, as a powder or in aqueous solution. When, after the lapse of 1 to 2 days, the symptoms have vanished, the daily dose of 1 Gin. (15 gr.) for older children, and 0.5 Gm. gr.) for younger ones may be persisted in for 6–S days more, in order to avert another attack in the joints.
This medication is followed by more or less profuse perspiration. Other secondary effects hardly occur if the above-mentioned doses are adhered to, excepting ringing in the ears, which, however, is not an indication to discontinue the salicylate preparations.
lleubner observed nose bleeding in a few cases, and we have seen albuininura appear twice, which slowly vanished after discontinuing the salicylates. In case salicylic acid or aspirin prove ineffective, one of their substitutes may be successful, as phenacetin, antipyrin, salol, sahpyrin and lactophenin, in such doses as are appropriate for children. In these cases, which however, are rare, even the above-mentioned rem edies may fail, and it is then always well to reconsider the diagnosis. We may often he forced to conclude that we have a case of rheuma toid before us, or else one of those sad cases with a tendency to change into the severe chronic form, the treatment of which will he described on page 506.
In connection with the internal, a local treatment inay be required if the pains are severe. Simply enveloping with cotton wadding or
immobilizing in splints is often found to give great relief. By means of "mesotan" local salicylic treatment can be had in place of the internal salicylic doses.
.30.0. 5 M. D. S.-3-5 Gin. (i to one teaspoonful) painted over the joints. (One must be on the lookout, however, for dermatitis.) If after the acute stage has passed, swelling or stiffness of individ ual joints remains, inunctions with ichthyol-vaseline (10 per cent.) or Priessnitz compresses followed by massage may render good service. If there is the least suspicion of ensuing endocarditis, the measure most indicated and most important, though very difficult to carry out with children, is absolute bodily rest; with the customary application of icebags, it is important to avoid needless uncovering of the patient, or accidental wetting, lest a relapse of the joint symptoms be caused. With regard to art established endocarditis, pericarditis, etc., we refer to their relative sections.
Rheumatismus nodosus requires no special method of treatment. For a rheumatic involvement of the cervical portion of the vertebral col umn, it is advisable, if salicylic therapy does not bring speedy recovery, to resort to the applications of warm poultices and carefully conducted massage. For severe cases, some new methods of treatment which have been recently proposed may be briefly mentioned here: The intravenous (Mendel) or intra-articular (Bouchard) applications of salicylic acid; scarification and cauterization of the tonsils (Giirich); the use of streptococcic serum (Meyer, Menzer). Menzer expects, through his serum, to be able to reduce the frequency of cardiac involve ment. The value of these methods is up to the present time, as far as adults are concerned, open to discussion; their general application in the case of children would be therefore much less advisable.