ACUTE ARTICULAR RHEUMATISM. 



533 



the convalescents are usually very anaemic, and we may hear false 

 murmurs in the heart and great vessels, which, on careless examination 

 and insufficient attention to the general state of the patient, may be 

 confounded with valvular aifections. 



TREATMENT. For acute articular rheumatism all kinds of antiphlo- 

 gistic remedies have been used, particularly general and local bleed- 

 ing, nitrates of potash and soda, tartrate of antimony in small doses, 

 and many have thought it possible to shorten the course of the disease, 

 and to prevent the complications, by energetic antiphlogistic treatment. 

 From what we have said of the varying course and duration of the dis- 

 ease, it is evident that it would be very difficult to prove any such 

 suppositions. On the other hand, if energetic antiphlogosis did have 

 a beneficial effect in some cases, the fact that the disease has often 

 persisted for weeks and that heart-affections have often developed in 

 spite of it, speaks against its infallibility. Hence, in recent times, the 

 treatment by repeated bleeding, by large, and even dangerous doses 

 of saltpetre, as well as the systematic use of tartar emetic, has been 

 abandoned, and we now employ other remedies which may, perhaps, 

 be as uncertain, but are, at all events, less dangerous. Nitrate of 

 soda, in moderate doses ( 3 i j to vi of water, a tablespoonful every 

 two hours), has alone maintained its position in the treatment of acute 

 articular rheumatism, and is prescribed by most physicians, without 

 any great expectations from it, just as it is given in pneumonia and 

 other febrile diseases. Since this remedy can hardly prove injurious 

 in small doses, and since its antiphlogistic action has not been dis- 

 proved, and is not at all improbable, and, finally, as we know no other 

 remedy that will certainly arrest or shorten the course of acute articu- 

 lar rheumatism, we have nothing to say against its employment. Per- 

 haps it has been wrong to follow JRademacher's advice, and prescribe 

 nitrate of soda instead of nitrate of potash, which is probably more 

 active. Recently, great authorities recommend a return from cubic 

 nitre to common nitre (Kohler). The next most popular remedies are 

 colchicum (tinct. or vin. sem. colchici f ss, tinct. opii 3 ss, 15 20 

 drops every three hours), lemon-juice ( f ss three times daily), iodide 

 of potassium ( 3 ss 3 j dissolved in 3 4 oz. water, during the day), qui- 

 nine and the narcotics, especially opium and morphine We cannot, 

 with our present experience, give any special indications for the em* 

 ployment of colchicum, lemon-juice, and iodide of potassium, which 

 seem to have proved serviceable in some cases, but most generally 

 have no effect on the course of the disease. In very obstinate cases, 

 with frequent relapses, we will employ these remedies, slight as is the 

 hope of benefit from them. Quinine is no more a specific in acute 

 articular rheumatism than in pneumonia, typhus, and many other dis 



