474 THE TREATMENT OF DISEASES. 



pains, apparently affecting the muscles rather than the bones, and increased on the 

 least movement, but improved by rest. It may be given according to Pr. 49. 



When the pain in acute rheumatism is very severe it may be necessary to 

 administer opium. A small dose of laudanum may be given by the mouth, but in 

 the majority of cases a hypodermic injection of morphia will not only act more 

 quickly, but will be. less likely to upset the stomach. It must be remembered that 

 opium is merely & palliative, and in all probability exerts no influence on the progress 

 of the disease. 



Small blisters in the neighbourhood of the affected joints often prove efficacious 

 in relieving the pain. 



By some people the administration of nitre in rheumatic fever is supposed to be 

 attended with favourable results. As much as two or three ounces of the salt, dis- 

 solved in plenty of water, have been taken in the twenty-four hours without causing 

 any inconvenience ; but it must be admitted that there is no conclusive evidence to 

 show that these large doses do any good. A great objection to their use is that un- 

 less the perspiration is very profuse patients are unable to take the large quantities 

 of fluid in which the salt must, of necessity, be dissolved. 



Bicarbonate of potash has been frequently given in thirty-grain doses every four 

 hours. In many cases it relieves the pain, but it is unavailing in lessening the 

 intensity or duration of the fever. 



Large doses of tincture of perchloride of iron from twenty to thirty minims 

 every four hours are sometimes given, but we are at present unable to express any 

 definite opinion as to the value of this mode of treatment. 



In some cases benefit has been derived from the administration of lime-juice in 

 doses of eight ounces daily. 



Colchicum is useless in this disease. 



There can be no question as to the value of the cold pack in acute rheumatism. 

 When the pain is too great to admit of the patient being moved, the front only of 

 the body should be packed, and a cold compress, renewed every two or three hours, 

 should be wrapped round each of the painful joints. In cases in which there is a 

 prejudice against the cold pack the body should be thoroughly sponged with tepid or 

 cold water several times a day, using soap if the perspiration is offensive. There is 

 not the slightest fear of increasing the liability to heart mischief by the* adoption of 

 this method of treatment. 



It will be seen from what we have said that there is great discrepancy of opinion 

 respecting the treatment of acute rheumatism. Some doctors have even gone so far 

 as to assert that all remedies are useless, probably assenting to the dictum of a cele- 

 brated physician, who, when asked what was good for rheumatic fever, replied, "Six 

 weeks." It should be remembered, however, that that was before the days of 

 salicine. 



Individuals who have once suffered from rheumatic fever must be extremely 

 careful as to their clothing ; they should always wear a flannel vest and drawers, 

 which may vary in thickness at different periods of the year. The feet should be 

 kept dry and warm, and every precaution taken to avoid catching cold. 



In all cases of rheumatic fever the attendance of a medical man is necessary. 



