534 DISEASES OF THE ORGANS OF LOCOMOTION. 



3ases in which it is, nevertheless, an important remedy. But it is one 

 of the most powerful antipyretics, and it should be used when the 

 fever is high. It is customary to give a scruple or half a drachm during 

 the day, and it is best to give such large doses, for, according to my 

 experience, it is only from large doses that we can expect any decided 

 effect on the bodily temperature and frequency of the pulse. After 

 the experiments of Weber and Billroth, there can scarcely be any 

 doubt that the quality of the blood in fever patients decidedly favors 

 inflammatory disturbances of nutrition. If this be so, an antipyretio 

 treatment has also an antiphlogistic action, and quinine as well as 

 other antipyretic remedies would answer not only the symptomatic 

 indications, but also the indications from the disease, particularly in 

 acute articular rheumatism, where, while the fever continues, new 

 joints are continually becoming affected. At all events, quinine de- 

 serves a full trial in acute rheumatism, when there is any great in- 

 crease of bodily temperature. Most of the narcotics can be dispensed 

 with ; but opium and morphine are not only invaluable remedies for 

 moderating the sufferings of the patient, but it also seems as if their 

 exhibition prevented the inflammation in the joint reaching so high a 

 point. I shall not attempt to say whether they shorten the course of 

 the disease, as some observers claim they do ; but I can affirm that, 

 even where there is great fever, large doses of opium or morphine are 

 well borne. Where the pain disturbs the night's rest, it is advisable 

 to give the patient a grain of opium, or one-quarter of a grain of mor- 

 phia, in the evening ; and, when the pain is uncommonly severe, we 

 may order this dose every two hours, till relief is obtained. In the 

 treatment of most cases of articular rheumatism, I limit myself to the 

 exhibition of quinine and opium. Among the external remedies, warm 

 and cold compresses, leeches, blisters, as well as numerous narcotic and 

 irritant lotions and liniments are recommended. As might be sup- 

 posed from their number, these remedies have, on repeated trials, been 

 of less service than was claimed by the person proposing them ; we 

 must acknowledge that external remedies also usually have no effect 

 on the course of the disease, and are at most only palliatives. Any 

 physician in good practice will not deny that cases of acute articular 

 rheumatism, coming under treatment at the commencement of the 

 disease, often resist all external or internal treatment for three to 

 six weeks or more. 



In cases of moderate intensity, it is well to envelop the affected 

 joint in wadding ; where the pain is severe, cool evaporating lotions 

 are best, parli'jularly as ice and cold-water compresses are popularly 

 considered as bad antirheumatics and are consequently used irregularly, 

 ^hlorttre ( 3 ss 3 j, lightly rubbed in), as recommended by Wun 



