RHEUMATISM - CASE I.—A girl, aged 16, never had rheumatism before. Was quite well on April 12th, 1876. Ou the 13th felt out of sorts, and had a general feeling of cold, with some pain in the limbs. On the 14th the pains increased, and toward evening got very bad. She got up on the 15th and went about as usual, saying nothing to any one about her pains, which were severe in both arms and legs. On the 16th she got up, but was obliged to go back to bed.
April-16th, vesp.: Lies in bed unable to move, and every now and then screaming with pain. The back, shoulders, elbows, wrists, knees, and ankles are all the seat of severe pain, but the knees and ankles are most complained of. All these joints are slightly swollen, and so exquisitely tender that the least touch or movement causes her to scream. Has no pain in chest. Skin hot, not perspiring; tongue moist and furred; urine scanty, high colored, and loaded with pink urates. Has a soft blowing murmur with first sound, loudest at apex, but audible over whole heart. Pulse 112, respirations 20, temperature 103.8°. To have fifteen grains of salicin every hour till three powders are taken, and then one every two hours.
17th, mane : Wandered at times during the night, but had occa sional short snatches of sleep. Pain, especially in ankles and knees, is still severe, but not nearly so bad as 'yesterday. Can move the right leg a little, and does not complain when the joints are touched. Indeed she allows them to be pretty firmly grasped without com plaining; yesterday the least touch made her scream. Tongue furred ; skin moist, and perspiration acid. Urine scanty and high colored; bowels confined. Cardiac blow is softer in character, and precedes as well as accompanies the first sound at the apex. Still heard over whole heart, but not so distinctly as yesterday. Pulse 96, respira
tions 26, temperature 102.8°. Has had eight powders, equal to 120 grains of salicin. To continue to take fifteen grains every two hours.
18th, mane : Had a good night, free from pain. To-day feels quite well. Has no pain in any of the joints and can move the limbs with out more discomfort than what is caused by a slight feeling of stiff ness in the knees. Tongue cleaning; skin natural. Pulse 72, barely perceptible, respirations 20, temperature 99.6°. Has had eighteen powders, equal to 270 grains of salicin.
19th : Slept well; is free from pain, and feels quite well. Wishes to get up. Tongue clean; skin natural; bowels moved; urine abun dant, of pale amber color. Pulse 70, feeble, irregular, respirations 20, temperature 98.2°. Has had in all 405 grains of salicin.
The cardiac blow remained, but gave rise to no subjective phe nomena. There was no return of the rheumatism. She went on with the saliciu for a fortnight.
Rapid as was the cure in this case—the pain having been prac tically abolished within twenty-four hours, and the temperature brought to the normal within, at the most, sixty hours of the time that treatment commenced—it would probably have been still more rapid had the salicin been given in the full close in which I now ad minister it. At the time that Margaret T 's case occurred (April, 1876) the present certainty regarding the safety as well as the desi rability of large doses had not been attained. To such a case occur ring now I would give double the dose which Margaret T— got; and probably with a more rapid result, as in the following case, which bore a close resemblance to hers :