RHEUMATIC FEVER, OR ACUTE RHEUMATISM. 473 



can be advantageously given only in the liquid form. Milk is one of the best kind? 

 of nourishment which can be administered for the maintenance of the strength. 

 When it is not readily assimilated, and proves too heavy for the stomach, it may 

 be advantageously mixed with an equal quantity of soda water or with lime water. 

 Besides milk, beef -tea, mutton-broth, jellies, arrowroot, and other similar easily 

 digestible substances may be given. To allay the thirst, soda water, lemonade, 

 toast-and-water, or even plain iced water will be found useful Wine or brandy 

 is in young people seldom required, unless indeed there be much depression, as the 

 result of heart mischief. 



As the fever abates, a more generous diet may be allowed, commencing with 

 light rice or sago or arrowroot puddings, and gradually progressing to white fish 

 and fowl, and then to beef and mutton. The more the strength of the patient can 

 be maintained, the less tedious will be the recovery. 



A large number of different drugs have been recommended for the treatment of 

 acute rheumatism a fact which may be taken as an indication that we are at present 

 acquainted with no specific for the disease. 



The nearest approach to a specific for acute rheumatism will be found in salicine, 

 a substance obtained from the willow. It should be given in thirty-grain doses in an 

 ounce of water every two hours, according to Pr. 12. In very bad cases it may be 

 given every hour until the pain is relieved. Very much larger quantities have been 

 given without the production of any inconvenience. Given quite at the commence- 

 ment of the illness, it will sometimes quickly cut short an attack. In cases in which 

 it does good the beneficial action is usually apparent within twenty-four, and always 

 within forty-eight, hours of its first administration. In acute cases the relief of 

 pain and the fall of temperature usually occur simultaneously, but in sub-acute 

 cases the pain is sometimes decidedly relieved before the temperature begins to fall. 

 It has been claimed for salicine that it prevents the occurrence of heart disease, 

 but the evidence on this point is inconclusive. Although tliis drug proves beneficial 

 in the large majority of cases of acute rheumatism, it sometimes fails. In cases in 

 which benefit has been experienced from its administration, it should be continued 

 in twenty-grain doses every four hours for a week after the temperature has fallen 

 to the normal. The influence of salicine on the temperature in acute rheumatism 

 will be seen by reference to the chart given in the article on TEMPERATURE. 



Salicylic acid has also been used in the same way as salicine, but it is very 

 insoluble in water, is very nasty to take, and is not readily obtained pure. The 

 only advantage it appears to possess over salicine is that it is cheaper. 



Aconite has been highly praised by many eminent authorities in the treatment of 

 acute rheumatism, and there can be no doubt of its usefulness. In many cases, however, 

 it must be admitted that its administration appears to be ineffectual. It is especially 

 indicated when the fever is high and there are violent shooting or tearing pains, 

 worse at night, and aggravated by the touch. The most successful results are 

 obtained when it is administered quite at the commencement of the disease. The 

 aconite mixture (Pr. 38) may be used, the dose being a tea-spoonful every second or 

 third hour. This is not at all equal to the salicine treatment. 



Bryony may be given when the patient suffers from lancinating or stitching 



