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Rheumatism Case Xiii

heart, appearance and temperature

RHEUMATISM CASE XIII. A man, aged 25, of irregular rather than of dissi pated habits, had an ordinary attack of acute rheumatism with the characteristic joint affection and acid sweats of the disease. The temperature ranged from 102 to 103 F. He was treated with sali cylate of soda. His joint pains decreased, but his general condition did not improve. On the eighth day of his illness he was very pros trate, there was some tenderness on pressure over both wrists, the left knee, and right shoulder, but the joint indications were not marked; there was very little swelling and pain was not complained of except on pressure or movement; temperature was 103.8, tongue furred, pulse 120, feeble ; the heart':; sounds were muffled and indistinct, but no bruit could be detected; the area of cardiac dulness was normal; the impulse was scarcely perceptible; the patient was prostrate and sunk in bed; there was wandering at night and occasionally during the day. Patient was freely stimulated, but gradually sank and died. On post-mortem examination all the organs were healthy except the heart. The pericardium contained about an ounce of dark-colored serous fluid ; around the roots of the great vessels at the base there was a slight deposit of recently effused lymph, but the general sur face of the pericardium was smooth and glistening. The muscular

substance of the heart was dark in color and had the appearance of being gorged with blood; it was soft in consistence, and could be broken clown by firm pressure between the finger and thumb; under the microscope the individual fibres were seen to have lost much of their normal striated appearance and to be granular in aspect. There was slight roughening of the auricular surface of the mitral valve; but no other appearance of eudocardial mischief.

The general aspect of the patient in this case was not unlike that noted in some cases of by perpyrexia, and had there been a high enough temperature one would not have hesitated to call it so. mortem examination verified the accuracy of the diagnosis formed during life, that the alarming symptoms were due to inflammation of the muscular substance of the heart.