nux vomica is then added to correct the sweetish taste of the salicylate, which some patients complain of, and to increase the efficiency of the solution by its tonic properties.

According to this formula, a patient takes the equivalent of eleven grains of salicylic acid and twenty-two grains of bicarbonate of potash to a dose, thus making the quantity of acid so small as to be perfectly safe to administer in cases of heart disease; the large dose of bicarbonate of potash preventing the acid from affecting the circulation to any troublesome degree. I have prescribed it with perfect safety in acute rheumatism, where well-marked pericarditis, with pain around the heart, was present, which gradually subsided as the remedy became absorbed, and the blood returned to its normal condition.

The action of salicylate of potassa is very rapid; it becomes absorbed readily, its influence is felt within a few hours in mitigation of pain, patients frequently believing they had taken morphine, yet I have seldom found it necessary to prescribe an anodyne in cases treated by the salicylate of potassa.

In mild cases the urine and perspiration become alkaline in twenty-four hours, but in severe cases two or three days are required to effect this excretion, and this point once reached improvement is progressive; the brick-dust sediment (urates) in the urine disappears, the swelling subsides, and the metastatic character of rheumatism is stopped, no new joints become affected, and the case goes on to recovery.

The patient is kept on the salicylate of potassa until all pain and swelling are relieved, then it becomes necessary to guard against relapses, which are imminent at this stage, owing to the lessened powers of resistance to cold by the thinness of the patient's blood. It is not alone sufficient to eradicate the disease by establishing the natural alkalinity of the blood, but it is also essentially requisite to restore it to its normal warm, rich, healthy condition, and this is more readily accomplished by the administration of an alkaline form of iron, and the best of all kinds for this purpose is the tartrate of iron and potassa. The following is my mode of prescribing it:

M. S.-A teaspoonful three times a day, two hours after

meals; to be taken in two ounces of water or light wine, and in this way it will be found more desirable than the "wine of iron" of the Pharmacopoeia; and as a general chalybeate tonic is the most satisfactory form I have ever employed, the glycerine holding the iron in solution, making it agreeable to the taste, and aiding in its assimilation. This is continued for weeks or months if necessary, until health is restored.

In seeking for the cause of rheumatism, I find the standard authorities agree that abnormal digestive secretions take a prominent part in forming the lactic acid in the blood, Murchison asserting that gout, rheumatism, and derangements of digestion arise from functional diseases of the liver.

I have found many cases with sluggish action of liver and bowels that proved the correctness of this theory. In such I usually begin the salicylate treatment by a mercurial cathartic. Time being limited, I can cite only a few of the most severe cases in which this remedy has been employed.

CASE II. Feb. 2d, 1880.-Mrs. McK., æt. 33, strong and robust, first attack of acute rheumatism, knees, ankles, shoulders and elbow joints badly swollen and extremely painful, with purple or reddish spots two inches or more in diameter dotting over the legs, such as I had seen develop abscesses in other cases; temperature 104, pulse 130, urine acid and loaded with red sediment, heart sounds normal, and free from cardiac pain. The salicylate of potassa was ordered, no other treatment.

Feb. 7th. On visiting the patient this morning I was surprised to see her so much improved and greatly relieved from pain; on inquiry, she said that relief began after taking the third dose of the medicine, and each following dose brought more ease, as if morphine had been taken, though she did not sleep; no anodyne had been given her. Temperature, 1023; pulse, 115.

Feb. 8th. The case is progressing rapidly toward recovery; the urine is now alkaline and clear of sediment; no fresh joints affected; pain and swelling nearly gone. Temperature, 1011; pulse, 100.

Feb. 10th. All pain and swelling have disappeared; the red spots have entirely faded, and the patient is recovering; the salicylate discontinued, and the tartrate of iron and potassa ordered; made last visit to-day. This was the first severe case to test the powers of the remedy, being sufficiently intense to

last from three to six weeks, if treated by any of the older methods, but recovered in eight days under the salicylate of potassa.

CASE VI. March 28, 1880.-Miss K., æt. 28, domestic, has been very ill, with acute rheumatism, for the past six weeks, under the treatment of her mistress's family physician; she was removed to the home of her aunt, and I was called to attend her; the patient's knees, elbows, and one ankle swollen and painful, the skin covered with profuse acrid perspiration and very anæmic. She was ordered the salicylate of potassa every three hours; also the tartrate of iron and potasssa three times day.

March 30th. There is quite a good deal of improvement; pain is less, but the swelling is not diminished.

April 2d. Patient is recovering; the swelling has subsided; no pain; the salicylate left off and the iron mixture advised continually for a couple of months longer.

April 21st. Patient called to-day at my office quite recovered, and going back to her situation.

CASE XI. Aug. 24th, 1880.—Mr. G., æt. 35, delivers ice; a very severe case of gonorrhoeal rheumatism, with feet, ankles, knees, elbows, and right hand badly swollen, which came on one week after the onset of the urethral discharge. Temperature, 1033; pulse, 125. The urine acid, the gonorrhoeal discharge thick, yellow, and profuse; the right hand is very much swollen, attributed to handling an axe in chopping ice. He was ordered the salicylate of potassa, a mercurial cathartic, and liniment of chloroform to hand and affected joints, with cotton wrappings. Aug. 26th. The pain and swelling are somewhat easier. Temperature, 102; pulse, 120. Urine slightly acid.

Aug. 28th. Patient is much improved; freer from pain; the swelling is less; the right hand and left foot remain as in the beginning, swollen, red, and painful; the urine is now alkaline, with marked improvement in the gonorrheal discharge; no pain on micturition.

Sept. 1st. The rheumatism has disappeared from everywhere but the right hand and left foot; its persistence in these places shows the characteristic feature of gonorrhoeal rheumatism; the urethral discharge is cured, with no other treatment than the salicylate. Iodide of potassium and bicarbonate of potassa ordered to-day, the salicylate left off.

Sept. 13th. The hand is still swollen; a variety of local applica

tions have been employed with no better result than to prevent suppuration. As I was leaving town to-day another physician took charge and treated the case for a month longer, when the patient made a good recovery.

CASE XIII. Jan. 11th, 1881.-Mrs. S., aged 23, acute rheumatism, severe, all the joints of the lower extremities, one elbow, and one shoulder are involved in the swelling; suffering much pain. Temperature 1023, pulse 110. No heart disease. Salicylate of potassa administered, and three compound cathartic pills, followed by a small dose of Rochelle salts.

Jan. 13th. Fever is subsiding, 101; pulse, 95; pain is greatly relieved; can move a little without complaining; the urine is now alkaline, and clear of sediment.

Jan. 15th. Rheumatism nearly cured; pain entirely relieved; temperature normal.

Jan. 18th. Made last visit to-day; patient is sitting up; the salicylate left off, and the tartrate of iron and potassa ordered. This case is doubly interesting, as I had treated her six years ago for another attack of acute rheumatism, which lasted three weeks under the old alkaline treatment, while she recovered in seven days when treated by the salicylate of potassa, the outset of each attack being equally severe.

CASE XVIII. April 6th, 1881.-Mr. D., æt. 69. Restaurant keeper; of temperate habits, except a little wine occasionally; has been afflicted with acute rheumatism at intervals for the last forty years, so frequently that he has forgotten how many times, but certainly between thirty and forty attacks, each one lasting from two weeks to two months; had no other sickness but dyspepsia. He is worse now 'than ever before, all the joints of the lower extremities are swollen, and the arms are so stiff as to be unable to reach either hand to his mouth; temperature, 1031; pulse, 120; heart sounds feeble and rough; no valvular murmurs, but there is well-marked pericarditis, with pain, about the apex of the heart; the urine acid, and heavy with sediment. He was ordered salicylate of potassa every three hours; pil. cathartic comp. no. iij, the joints rubbed with chloroform liniment, and wrapped in cotton.

April 7th. Pain only slightly relieved; ordered morphia gr. § at night, and repeated in two hours if required.

April 10th. The pain and swelling of the lower limbs are subsiding; temperature, 101; pulse, 100; the arms remain stiff, but

not so painful. Lead and opium wash applied warm on cloths to both elbows.

April 13th. There is well-marked improvement, except at the elbows; the effusion in the pericardium has disappeared.

April 17th. Patient is recovering; he can move easily now; the left elbow is quite well; the right one still remains stiff, but not so swollen or painful.

April 20th. Patient sitting up to-day; weak, but free from rheumatism; the right elbow is in danger of permanent stiffness, for which gentle, passive motion was employed. The salicylate discontinued, and the iron mixture given instead.

May 10th. Patient walked to my office to-day, complaining of weakness of limbs in walking, for which were used applications of electricity, with the positive pole at the cervical region of the spine, and the negative at the feet, with great benefit. He made a good recovery; even the right arm became quite useful, which, considering his age, the severity of the disease, and the number of previous attacks, speaks well for the treatment. He has been very healthy since.

I am not, and never shall be, a believer in specifics; but from my experience with salicylate of potassa in rheumatism I will state that I think it approaches as nearly that character of drug as quinine does in intermittent fever, and I can safely claim for it, first, rapidity of action; second, almost anodyne effect; third, thorough alkalinity to correct the acid of the blood; fourth, safety in heart disease.

SALICYLATE OF POTASSA IN DYSPEPSIA.

Time will allow only a brief notice of the use of salicylate of potassa in dyspepsia, but it is too valuable a remedy in the treatment of flatulence, pyrosis, heart-burn, and loss of appetite, in fact, all symptoms of dyspepsia of the acid form, to be passed without mention.

The power of salicylic acid in controlling fermentation, first led me to prescribe it in flatulence. Given in powder after meals, it not only relieved this symptom, but digestion seemed to improve under its use. Pepsin and salicylic acid were next given, which acted very well in aiding digestion; then salicylate