Up to comparatively recent times, alkaline treatment, by potash especially, was accepted as the best for rheumatic fever. Among its principal supporters, Dr. Fuller claimed that it would prevent cardiac lesions, for such lesions did not occur in any of a large number of cases thoroughly brought under the influence of alkalies (Lancet, ii., 1862). He argued that these remedies not simply neutralized abnormal acidity, but restored normal alkaline conditions, maintained fibrine soluble, exerted a sedative influence on the circulation, and favored complete metamorphosis of tissue; he pointed out, also, that for a fair trial correct diagnosis was essential, and that true rheumatism should not be confounded with the gonorrhoeal affection, with rheumatic gout, pyaemia, etc., and such a mistake would account for failures; he approved of a compound prescription - thus, R. Liq. ammon. acetat. 3 ij., sodae bicarb. 3 iss., potas. acetat. 3 ss., with citric acid in effervescence.

Sir Thomas Watson recommended liquor potassae, and Dr. Parkes made use of it (Medico- Chirurgical Review, 1864), but it is not really so suitable as the neutral salts. Todd preferred the bicarbonate or acetate in 1/2-dr. doses every three hours (Ranking, i., 1869). Dickinson has written in favor of the same method, and Golding Bird in favor of the acetate specially, while Dr. Basham was a constant advocate of the nitrate (Lancet, 1848, and ii., 1862); he used large doses, from 1 to 3 oz. daily, in 4 pints of barley water. Dr.Wade found the best results from a combination of these two salts in moderate doses, 15 to 20 gr. of acetate with 8 to 10 of nitrate, and other observers have corroborated his experience (Fleischman: Lancet, i., 1869, etc.). On the other hand, Dr. Sutton concluded that none of these remedies could influence the course of rheumatic fever, or prevent heart-complications, though they might allay pain ("Medico-Chirurgical Transactions," vol. lii.). Dr. Ringer, from his own observation, came to a similar conclusion, while Dr. Ridge and others have argued that they are injurious (Medical Times, ii., 1871). No doubt the continued use of large doses may induce depressing anaemia, and consequent tedious convalescence, and now that the salicylates and other remedies are better known, we are not so dependent on alkaline medication; it must, however, be held a valuable resource in cases marked by high degree of acidity and loaded urine, and its judicious use may greatly relieve. In my own practice I commonly combine iodide of potassium with bicarbonate in effervescence.