By virtue of their ability to control the arthritis of acute rheumatic fever, the salicylates have received a well-recognized place in the treatment of the rheumatic infection. Maclagan1 of Duindee in 1874 commenced the use of salicin, a glucoside of salicylic acid. To Stricker2, however, working in Traube's clinic in 1876, is given the credit of having first recognized the value of sodium salicylate. Broadbent3 in the same year also wrote enthusiastically in favour of its use, and it is interesting to note that even at this time the value of the larger doses was appreciated, Broadbent recommending 71 to 20 grains hourly.In 1908 Lees4 spoke of the salicylates as specific in the cure of rheumatism, believing that the failure to obtain good results was due to the smallness of the dose. He also emphasized the necessity of giving alkali in addition and, while recognizing that the tolerance of the patient was greatly enhanced by this procedure, stated that the alkali was of benefit because it neutralized the toxins elaborated by the infecting agent and because the bicarbonate per se tended to lessen the degree of cardiac dilatation. This idea of salicylate being 'as specific to rheumatism as quinine is to malaria or mercury to syphilis' was not wholly accepted even at that time, and at present the general view of the value of the salicylates in rheumatism would appear to be that they are specific only for the arthritis but have no influence on the other manifestations such as carditis, chorea, etc.Signs and symptoms of intolerance to salicylates are not infrequently observed, especially where the larger doses are given unaccompanied by alkali, and hence the use of alkali in equal or greater amounts than that of the salicylate employed has achieved a certain amount of popularity in the prevention of the toxic manifestations. In the writers' opinion, the value of the combination of salicylate and alkali would seem to have been definitely proved by routine clinical work. Nevertheless certain observers still deny the necessity of the use of alkali. In a comprehensive monograph on the salicylates written in 1924, Hanzlik5 categorically asserts that alkalis do not prevent or modify the appearance of toxic symptoms, and that the absence of toxic symptoms means absence of therapeutic efficiency. He quotes Meara6 as stating that the use of alkali ' is directed more by tradition than rationale,' but Meara was discussing the alkali treatment of rheumatism rather than the beneficial effect of the ftddition of alkali to sodium salicylate.
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