To cut short the attack much reliance was formerly placed on colchicum which increases the elimination of solids in the urine, and on alkalies, which beside the theoretic antagonism to acidity are at once chologogne and diuretic. The action was somewhat slow but on the whole satisfactory, usually abating the suffering very materially in the course of a few days. To the horse or ox ½ dram doses of colchicum were given daily in combination with 4 to 6 drams of bicarbonate of soda; pigs of 100 lbs. may take 1 grain of the former to 10 grains of the latter; a shepherd’s dog may take half the amount just named. Trimethylamine proved even more effective than colchicum, and acetate or citrate of ammonia, soda, or potassium was often substituted for the carbonate.
But the modern treatment of rheumatism dates from 1876, when the introduction of salicylic acid and later sodium salicylate, salicine and ol. gaultheriæ gave to such treatment an efficacy previously unknown. Salicylic acid acts very harshly on the gastric mucosa, and with sensitive stomachs is advantageously replaced by sodium salicylate, into which it is transformed in any case in the blood. Salicine which is held to be transformed into salicylic acid in the system, is specially recommended for its bitter and tonic action exercised in the stomach and prior to such transformation. In debilitated subjects, therefore, and in those that suffer from the characteristic rheumatic reduction of the red blood globules it would be somewhat preferable. As a prompt and effective anti-rheumatic agent however it appears to be somewhat less reliable than sodium salicylate or ammonium salicylate. Ol. gaultheriæ may be better borne by the stomach of the dog and pig than the salicylates, the dose being 10 to 15 drops thrice a day.
The secret of success with all of these salicylate compounds, lies in the speedy saturation of the system with the drug, rather than in its moderate and continuous administration. The horse or ox may take ½ oz. repeated every two hours for ten hours if relief is not obtained earlier. The pig may take 20 grains, and the dog 5 to 10 grains at similar intervals. It is not desirable, however, to continue this indefinitely, and therefore when immediate relief has been secured it is well to give the agent but twice or thrice a day, and resort in part to the alkaline treatment. If the salicylates fail to relieve when pushed energetically for ten hours, there is reason to fear that the case is not one of genuine rheumatism.
The salicylates are less applicable to chronic cases and may be even dangerous when the heart is affected, as they tend to render the heart’s action slower and weaker, and thus add to the dangers of hypo-hæmoglobin, and heart failure. A similar caution applies to an excessive use of alkalies and especially of compounds of potassium which depress the heart action.
As substitutes for the salicylates, salol, salophen, phenocoll, antipyrin and acetanilid have been largely resorted to. The first is safe and trustworthy and does not irritate the stomach nor interfere with digestion. It may be given to horse or ox in a dose of 3 drams, thrice a day, to the pig in 10 grain, and to the dog in 5 grain doses.
Hübner had good success with pilocarpine hydrochlorate hypodermically (4 grains for a 7 months colt,) but this was not equally successful in the hands of Siedamgrotzky. Other sudorifics like tartar emetic, Dover’s powder, ammonium acetate, hot or spiced drinks (chamomile, boneset,) hot baths, hot air baths, and wet packs have been used successfully and may still be employed in suitable cases. The opium is often very helpful in relieving intense suffering, and beside or in place of the Dover’s powder internally, morphia may be injected subcutem over the affected region. The main objection to its use is its tendency to lock up the liver and bowels. Liquor of the acetate of ammonia fills at once the rôle of a potent diaphoretic, an antacid, and an eliminant.
In the use of baths and packs it is well to consider the condition of the patient. If the surface is cold with little reaction, and if the attack has supervened on exposure, or chill, persistent hot applications are indicated. Dogs and other small animals should have full hot baths lasting for 15 or 20 minutes, and while in full glow may be quickly sponged with cold water and rubbed dry in blankets, great care being taken to avoid exposure or chill when damp. Or for these and the larger animals as well, a hot air or steam bath may be applied under similar precautions. A cold wet wrapping on the cranium will tend to relieve cerebral congestion during the administration of the hot bath. In horses and cattle surface heat and sudation may be secured by active rubbing with wisps of straw, of both body and limbs, or by covering the neck and trunk with large bags containing a small amount of chaff, sand or grain hot from an oven. Hot carminative or alcoholic drinks are excellent adjuvants, and even sedatives or nauseants (opium, veratrum, aconite, tobacco). Another resort is to pass a hot smoothing iron an indefinite number of times over the affected region. The part may be finally wrapped in cotton.
In cases where the temperature runs high, on the other hand, and when the surface glows, this dread of chill and reaction may be dismissed. For the small animal a bath starting at 70° F. may be gradually lowered to 60° or 50° F. Or a full pack may be employed, a sheet wrung out of cold water being closely wrapped around the body, and covered at all points with two or more dry woolen blankets, care being taken to avoid the entrance of air and the occurrence of evaporation from the inner, damp layer. This cools the surface and the blood returning inwards, and in fifteen or twenty minutes it should induce free perspiration. It may be kept up twenty to thirty minutes and may be repeated as often as there is a serious rise of temperature. A less energetic method is the mere sponging of the surface with cold water. In all such cases friction is a valuable accessory.
Anodynes and revulsives are often applied to the affected parts with good results. In very acute cases (especially articular), lotions and liniments of salicylic acid or salicylate of soda with laudanum, aconite, or chloral hydrate may be used. In the less violent cases camphorated spirit, soap liniment, or a combination of essential oils (gaultherium, turpentine, cajeput, origanum, peppermint) with aqua ammonia and sweet oil may secure great relief. Mustard or essential oil of mustard in vaseline is an excellent alternate. Finally active cantharidine blisters are usually most effective. These are applied over the affected joints or muscles and if the inflammation shifts to other parts it is followed up until it finally disappears. A concurrent alkaline treatment, and more important still, absolute rest, will serve to protect the heart to some extent, against a metastasis from the exterior. It has been supposed that the beneficial action of the blister is in ratio with the amount of exudate, and hence cantharides has been highly esteemed in this connection. Friedberger and Fröhner have used tincture of iodine and biniodide of mercury.
The local application of anti-rheumatic agents would embrace all the salicylates, oil of wintergreen and guaiacol, the latter mixed with an equal amount of glycerine. Methyl salicylate has been strongly recommended for external use.