Henry Baird Favill, AB, MD, LL.D., 1860-1916, a ... - University Library

138 HENRY BAIRD FAVILL
Elimination is the watchword, by skin, kidneys, intestines,
and by liver. Not only must no avoidable accumulation
be permitted, but the activity of the emunctories must be
invited.
It is during this period of intoxication without pain
that the alkaline treatment becomes most useful. Why,
I can not say. Unquestionably, it promotes _/iwa/ excretion.
To what extent does it promote the processes which necessarily
preceded excretion? The value of alkalis in many
toxemias, even those strictly of metabolic origin, is well
known. That this value lies in the neutralization of acid,
is open to doubt ; that its influence is in promoting elimination,
can not be made clear. But there is no doubt of its
value,
given boldly in many conditions of the later stages
of the disease. It is possible to abuse the method. Trousseau
pointed out the objectionable anemia which too much
alkali induces. The use of alkalies should not be uninterrupted,
nor should the current blood state be ignored.
Along this line, also, the phosphate of sodium is of use.
Given in dram doses in plenty of hot water, its customary
influence upon the liver, and the general improvement in
intestinal conditions, are most effective in certain cases.
Mercurials,
which were the standby of our forefathers,
are on the whole not satisfactory. If given, however, my
experience would lead me to prefer occasional pronounced
effects, rather than the sustained effect which I seek in
other conditions.
Of all questions involved in the therapeutics of rheumatism,
the greatest is: Can we influence by treatment the
tendency to the development of grave complications, particularly
in the endocardium? My personal observation
does not lead me to a conclusion on this point. My hospital
experience does, however, lead me to great distrust
of the conclusions deduced from the hospital records, commonly
cited in this argument. I need hardly emphasize
the great inaccuracy of such data in general. Hence, the