This section is from "Scientific American Supplement Volumes 275, 286, 288, 299, 303, 312, 315, 324, 344 and 358". Also available from Amazon: Scientific American Reference Book.
By ALFRED STILLÉ, M.D.
The treatment of simple acute articular rheumatism may be abandoned to palliatives and nature. Apart from complications, such cases nearly always recover under rest and careful nursing. Try and disabuse yourselves of the idea that their cure is dependent upon medicines alone; to help nature is often the best we can do. No treatment was ever invented which stopped a case of acute articular rheumatism. It cannot be stopped by bleeding, or sweating, or purging, by niter, by tartar emetic, by guaiacum, by alkalies, by salines, by salicylic acid, or by anything else. The physician can palliate the pain and perhaps shorten the attack, can control and perhaps prevent complications and stiffness of the joints, but he cannot arrest the disease. Where rest, proper diet, and warmth are enjoined, most cases will get well just as soon without as with the use of medicinal methods. Dr. Austin Flint, Sr., of New York, in support of this statement, subjected some patients, a number of years ago, to the expectant treatment, and found that they made just as rapid and just as complete recoveries as did those cases under the most active medication. Purgatives have been used in all ages in the treatment of this disease, because it was thought to be a fever. We are all but too ready to put our necks into the yoke of a theory. In old times they thought that the system ought to be reduced. Before the time of purgatives depletion was employed. This mode of treatment I will not even discuss. There is no evidence of which I am cognizant in favor of purgatives. There are very good reasons indeed why they should not be used: (1) Because they cannot possibly cure; (2) because they oblige the patient to make painful movements; and (3) because they expose him to the dangers of cold. A celebrated London physician had all his patients packed in blankets, and did not allow them to move a finger. This was going to the other extreme. There are certain cases in which purgatives are alleged to be of use, viz.: Those in which the bowels are constipated, and there is a bitter taste in the mouth. I have never seen such cases except in habitual drunkards, and in such cases a purgative does more harm than allowing the effete matter to remain in the system. Opium was once vaunted as a specific, and it was claimed that it diminished the tendency to complications in the course of the disease. Dr. Corrigan, of Dublin, said that large doses of opium were well borne--say from four to twelve grains in the course of twenty-four hours, or sometimes he advised giving as much as one grain every hour. Opium so employed does not produce narcotism, and does not constipate the bowels. More recent experience has shown that opium, of all remedies, is the most likely to cause heart complications. Some have recommended colchicum, arguing that because it does good in gout, it must, therefore, do good in rheumatism. But colchicum is not a remedy for rheumatism. Many years ago it was very much the custom to administer large doses of powdered Peruvian bark. The rationale of these large doses was founded upon their sedative effect. Haygrath, Morton, Heberden, and Fothergill were the first to employ this method. Later still, a number of noted French physicians, among them Briquet, Andral, Monerat, and Legroux, renewed the use of this medicine in the form of quinia, but gave it in smaller doses, seeking only its tonic effect, from five to fifteen grains being administered in the course of twenty-four hours, and then it was still continued in smaller doses. Still more recently, quinia taking the place of Peruvian bark, the old plan of administering large doses has been resumed. From thirty all the way up to one hundred grains have been administered in the course of twenty-four hours. Never was there a more profligate waste of a precious medicine. Even the physicians who so used it were obliged to acknowledge that it only did good in sub-acute and mild cases. I believe that it has also been fashionable in the so called cases of hyperpyrexia to immerse the patient in a bath varying in temperature from 60° to 98° Fahr. Although patients thus treated sometimes recovered, they also sometimes perished from congestion of the lungs and brain.
Among cardiac and nervous sedatives, digitalis, veratrum album and viride, veratria and aconite, have each, at one time or other, been employed indiscriminately. Such treatment, of course, has only proven itself to be a monument of rashness to those who employed it. Such sedatives may reduce the pulse, but do not shorten the disease. Indeed, if it is possible to prove the absurdity of anything more clearly by mere enumeration of these medicines as cures for rheumatism, I do not know of it. Do digitalis and aconite act in the same manner? This is just one expression of the folly which surrounded the use of digitalis at the time of its discovery. Then every affection of the heart was treated with digitalis.
Within the last few years new remedies have been proclaimed in the shape of salicylic acid and its sodium salt. I confess that I possess no personal knowledge of their use in this disease, for I was at first dissuaded from employing them by a prejudice against the grounds on which they were recommended, and more recently by the contradictory judgments respecting them, and the unquestionable mischief they have sometimes caused. According to their eulogists, the arrest of the disease is secured by them within four or five days, whether the attack be febrile or not; its mortality was diminished; relapses do not occur if the medicine is continued until full convalescence; it is without influence on the heart complications already existing, but it tends to prevent them as well as other serious inflammations. One of these gentlemen assures us that to say it far excels any other method of treatment would be to give it but scant praise. But, upon the other hand, it is accused of producing disorders, and even grave accidents in almost all the functions of the economy. In some cases it has produced ringing in the ears or deafness, or a rapid pulse, or an excessively high temperature, panting respiration, profuse perspiration, albuminuria, delirium, and imminent collapse. In one published case this anti-pyretic did not lower, but, on the contrary, seemed actually to raise the temperature so high that immediately after death it stood at 110° F. Many, very many, analogous cases have been published. I repeat, therefore, that I am personally unacquainted with the effects of this medicine in acute articular rheumatism, and that I have not thus far been tempted to employ it.
It may be difficult to see the connection between blisters and alkalies in their power to influence the course of acute articular rheumatism, and yet it is certain that they do so influence it, and in the same way, i. e., by altering the condition of the blood from acid to alkaline. If you ask me to explain to you how blisters act in this way I am obliged to confess my ignorance. To produce this result they must be applied over all the affected joints. Experience, if not science, has decided conclusively in their favor. They do effect a cessation of the local symptoms, render the urine alkaline, and diminish the amount of fibrin in the blood.
This brings us to a consideration of the use of alkalies. Alkalies neutralize the acids, act as diuretics, and eliminate the materies morbi. Alone, and in small doses, they are unable to influence the course of the disease; but when given in very large doses their effects are marvelous; the pulse falls, the urine is increased in quantity and becomes alkaline, and the inflammation subsides. The symptoms of the disease are moderated, the duration of the attack is shortened, and the cardiac complications are prevented. The dose of the alkalies must be increased until the acid secretions are neutralized. A very good combination of these remedies is the following:
Rx. Sodae bicarb 3 iss. Potas. acet 3 ss. Acid. cit f. 3 ss. Aquae f. 3 ij. 
[Transcribers note 1: Could also be '2/3 ij.']
S. This dose should be repeated every three or four hours, until the urine becomes alkaline. On the subsidence of the active symptoms two grains of quinine may be added with advantage to each dose. The alkalies must be gradually discontinued, but the quinia continued. The diet should consist of beef tea or broth, with bread and milk; no solid food should be allowed. Woolen cloths, moistened with alkaline solutions, may with advantage be applied to the affected joints. To these laudanum may be added for its anodyne effect. The patient must be sedulously protected from vicissitudes of the temperature and be in bed between blankets. The alkaline treatment relieves the pain, abates the fever, and saves the heart by lessening the amount of fibrin in the blood. A long time ago Dr. Owen Rees, of London, introduced the use of lemon juice. This remedy was thought to convert uric acid into urea, and to so help elimination. Though the treatment is practically correct, the theory of it is all wrong. Lemon juice does good in mild cases, but cannot be relied upon in severe attacks. During the febrile stage of acute articular rheumatism the diet should consist mainly of farinaceous and mucilaginous preparations, with lemonade and carbonic acid water as drinks. The cloths applied to the joints should be changed when they become saturated with sweat, and in changing them the patient should be protected from the air. The sweating may be controlled by small doses of atropia, from the one-sixtieth to the one-thirtieth of a grain. To prevent subsequent stiffness the joints should be bathed with warm oil and chloroform, and wrapped in flannel cloths. In the proper season this condition is very well treated by sea-bathing. There is no specific plan of treatment in acute articular rheumatism. The treatment pursued must vary according to the intensity of the inflammation and the peculiarities of the patients.--Medical Gazette.