442 SPORADIC DISEASES. 



repeated once or twice a dfiy. To prevent its constipating action 

 on the bowels, the opium may be combined with calomel, but 

 calomel should not be given until the bowels are " set " after the 

 purgative. If the pain is not excessive, aconite and the nitrate 

 of potash are more suitable than opium, and in all cases the nitrate 

 of potash is to be freely administered in order to alter the character 

 of the blood, to act upon the excretory organs, and to influence the 

 vascidar system. I am of opinion that the nitrate has a more 

 powerful influence on the disease, and is less debilitating than 

 the bicarbonate of potash or the liquor potassJB. In combina- 

 tion with the nitrate, colchicum has a faivourable effect, and in 

 cases where debility is not great, it should bfe substituted for the 

 aconite about the third or fourth day. If the sufferer be strong, 

 young, and in good condition, a moderate bleeding is usually 

 prescribed ; as a rule, however, the conditions do not warrant the 

 abstraction of blood. Indeed, it is now generally agreed that 

 although bleeding, by relieving congestion, may give temporary 

 relief, it enhances future suffering and danger, by increasing 

 the irritability of the heart, and consequently predisposing it to 

 rheumatic inflammation. 



Local treatment. — If the pain in the inflamed parts be very 

 great, it may be advisable to endeavour to relieve it by warm 

 fomentations, and the application of a liniment, containing some 

 of the extract of belladonna, opium, or aconite; but valuable 

 time should not be wasted if these afford no relief, and blisters 

 are to be freely applied to or near the inflamed parts. The treat- 

 ment by blistering is called that of elimination, and those who 

 advocate it most strongly use it only. According to Dr. Herbert 

 Davies, physician to the London Hospital, the action of blisters, 

 by promoting a serous discharge from the blistered surface, 

 affords a ready means of exit to the rheumatic virus. 



The success of this treatment depends upon the amount of 

 vesication produced by the blister ; and in oiuer to promote the 

 free flow of serum, the blistered parts are to be subsequently 

 covered by linseed meal poultices. According to Dr. Davies, 

 the blister treatment causes a speedy diminution in the frequency 

 of the pulse, rapid subsidence of the joint affection, and lessens 

 the liability to cardiac inflammation. Within twenty- four hours 

 after the removal of the blister, the urine is stated to become 

 alkaline in reaction. 



