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It has been sought to attain this end by the daily administration of the salts of quinine, of the salicylates, and of the tincture of eucalyptus, each and every one tried in turn. But the salts of quinine are dear, exercise a prompt, though very transient anti-malarial action, and, when administered for a long time, disturb rather seriously the functions of the digestive and nervous systems.
I am a little melancholy now and a little rheumatic; it is time to take salicylates and to go out and work in the garden a time for meditation and for long stories, for watching the flames as they flare upward under the chimney piece upon the hearth. I commend myself to the event. It is dark outside, but the door of my house stands open. Whoever will, be he life or be he death, let him come in.
The salicylates, when well prepared, are rather dear, and there is as yet no proof that they possess prophylactic powers against malaria. Possibly. But it is very certain that it possesses no efficacy in places where malaria is severe. It will suffice to prove this to recall the two epidemics of fever which afflicted the colony of the Tre Fontaine, near Rome, in 1880 and 1882.
This is caused not only by the rheumatism, but also by the salicylates. The surface of the body should be sponged with cold, lukewarm or hot water, depending on the temperature, especially of the skin.
This is liable to be mistaken for rheumatic fever, from which, however, it differs in that there is no real migration from joint to joint; there is an absence of sweating and of cardiac complications; and no benefit follows the administration of salicylates. In exceptional cases, tuberculous joint disease follows an acute course resembling that of the pyogenic arthritis of infants.
The general treatment is concerned with the diet, attention to the stomach, bowels, and kidneys and with the correction of any gouty tendencies that may be present. Remedies such as salicylates are given for the relief of pain, and for this purpose drugs of the aspirin type are to be preferred, and these may be followed by large doses of iodide of potassium.
Except in large doses, salicylates probably do not depress the heart. In pericarditis it is perhaps well always to administer an alkali in some form unless otherwise contraindicated, whether or not the cause is rheumatism. A diminished alkalinity of the blood would always increase the likelihood of an augmented amount of pericardial or endocardial inflammation.
As soon as all acute symptoms have ceased, rheumatic or otherwise, and the temperature is normal, the amount of food should be increased; the strongly acting drugs should be stopped; the alkalies, especially, should not be given too long, and the salicylates should be given only intermittently, if at all; iron should be continued, massage should be started, and iodid should be administered, best in the form of the sodium iodid, from 0.1 to 0.2 gm.
If the child has had a rheumatic inflammation of the heart, or has had rheumatism without such a complication, it is considered by some clinicians wise to give a week's treatment with salicylates at intervals of three or four months, for two or three years, perhaps. It is hard to determine how much value this prophylactic treatment has.
The pain is relieved by salicylates, but most benefit follows weight extension, the induction of hyperæmia by the rubber bandage and hot-air baths; if the joint is greatly distended, the fluid may be withdrawn by a needle and syringe.
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