RHEUMATISM - CASE II.—A girl, aged 17; had always enjoyed good health. With the exception of measles and scarlatina in childhood never had any ailment.
On May 26th, 1878, she felt out of sorts and had such aching in the limbs that she did not leave the house. On the following day she was worse and toward night got very bad.
May 28th : Lies in bed, unable to move, the least effort to do so causing intense pain, and making her scream. Has anxious, pained expression. The knees and wrists are most painful, but the ankles, right shoulder, and neck are also complained of. The affected joints are a little swollen, and exquisitely tender; except over the wrists, there is no redness of the surface. Tongue moist and furred. Skin hot and perspiring; bowels moved by medicine; urine scanty, and loaded with orates. Heart's sound normal. Pulse 112, respirations 22, temperature 103°. To have thirty grains of salicin every horn' till decidedly relieved.
She began to take the medicine as 6 P.M., was then in great pain. She felt easier after the third powder, and after the fifth (taken at 10 P.M.) was so decidedly relieved that she fell asleep. Her mother, who remained beside her all night, stated that she would probably have slept on, but that she woke her up to give the salicin at 11 o'clock, and at midnight. After that, she had a powder only every second hour.
29th : Has a pleased, smiling expression. Is quite free from pain, except when the joints are pressed; allows one to grasp them, and can move them without more than a feeling of stiffness. Thinks she
would have slept all night if her mother had not wakened her to give the medicine. Perspired a good deal during the night. Skin is now covered with acid perspiration; saliva acid ; tongue cleaner; pulse 88, respirations 20, temperature 99.8°. Heart's sounds normal. Up to this time (9 : 30 A.M.) has taken eleven powders, equal to 330 grains of salicin. To have thirty grains every two hours.
7 P.M.: Has had no pain, and says she would like to get up. Complains only of a slight degree of deafness. This her mother no ticed before the patient did. Has perspired a good deal; reaction acid. The joints feel stiff when she tries to move them, but can be firmly pressed without pain. Pulse 76, respirations 20, temperature 98°. Heart's sounds normal. Has had in all exactly one ounce of saliciu, 16 thirty-grain doses.
She continued to take the salicin in gradually diminishing dose for four days, during which she was kept in bed. At the end of that time she was allowed to get up, and the salicin was given in twenty grain doses four times a day for a week longer. She made a perfect recovery and had no return of pain.
In this case the acute pain was abolished within six, and all joint tenderness within twenty-four, hours of the time that treatment com menced. Within that time, too, the temperature had fallen from 103° to the normal standard, a fall of five degrees. The case was a very acute one.