The blood sedimentation rate is a very useful guide to progress. Relapse may follow if the patient is allowed up before the rate is normal, but on occasion this rule may have to be ignored when a slightly raised rate persists for an undue length of time. Should symptoms not rapidly subside it is improbable that they are due to rheumatic fever and some other cause should be sought. However, other somewhat similar illnesses may be benefited to some degree and occasionally rheumatic fever is slow to respond so that too much reliance should not be placed on this test. Salicylate may be given every two hours for the first day or two, and thereafter four-hourly with a double dose at night to save waking the patient from sleep. Salicylates are best given in the form of aspirin 6-10g. This is well tolerated in children and has a greater analgesic effect. Calcium aspirin has the advantage over aspirin (acetyl salicylic acid) in that it is more soluble and hence larger doses are less likely to cause gastric irritation. The total daily requirement of sodium silicate for adults varies from 8-13g according to body weight. Children will need a proportionately smaller dose.
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