The Treatment of Acute Rheumatism by the Salicylates

cause of therapeutics, by eliciting through discussion the opinions and conclusions of those who have had the largest experience of the salicylates in the treatment of acute rheumatism. All the speakers agree that the fever and the jointaffection are alleviated by the administration of the salicylates, and that so far this method is superior to other plans of treatment. On the question of relapses, of cardiac complications, of the dose of the drug which is most efficacious, the opinions are in striking contrast.?Dr. Broadbent, with Dr. Coupland and others, believes that relapses, as shown either by a renewed rise in the temperature, or by an acession of joint-pain, are perhaps even more common under the new than under the old method of treatment. The explanation is, however, to be found in the rapidity with which all the acute symptoms subside under the salicylate: patients are thus not so careful of themselves as when they have gone through the sufferings of an unalleviated attack. Dr. Coupland moreover belives that the withholding of the drug renders the patient more liable to relapses than if its administration be continued, while he finds that the relapses may occur in spite of tolerably large doses having been given; as many occurring under doses of sixty grains in twenty four hours as under smaller doses. Dr. Douglas Powell supposes that relapse will follow upon any exposure, exercise, or improved diet, so long as the tongue remains coated and the secretions disordered whatever be the treatment adopted. The joint inflammation and the pyrexia are not the essential features of acute rheumatism? any more than pyrexia and diarrhoea form the essential points in enteric fever. Dr. Broadbent and Dr. Fagge agree in anticipating that as the salicylates are brought to bear upon rheumatic fever in the first days of its existence, a notable diminution will occur in the proportion of cases in which cardiac lesions are manifested.