Home >> Volume-02-nutritive-disorders >> Obesity Plethoric Form to Symptomatology Of Gout >> Rheumatism Case_3

Rheumatism - Case

treatment, pain, rheumatic, temperature, symptoms and relapse

RHEUMATISM - CASE V.—A man, yet. 22; never had rheumatism before.

December 12th, 1877: Present attack commenced four days ago with sore throat and general aching. Now the pain is localized in the left knee, both ankles, and right shoulder. Except the shoulder, the affected joints are slightly swollen, and all are distinctly tender, though the pain is not very acute when he is at rest. Any move ment aggravates it much. The skin is covered with acid perspiration ; tongue furred ; urine high colored and loaded with fawn-colored unites; bowels moved by medicine; heart sounds normal. Pulse 104, respirations 28, temperature 100.8°.

To have twenty grains of salicylate of soda every hour till pain is decidedly relieved; then every two hours.

13th : Is much better. Was decidedly relieved after five or six doses of the medicine, but went on with the hourly dose for eight hours. After that he fell asleep, and woke up only now and then during the night. Has had up to this time (11 A.m.) thirteen doses, equal to 260 grains of the salicylate. The joints are stiff and slightly swollen, but the pain is gone. Perspires freely ; secretion acid. Pulse 84, respirations 20, temperature 98.8°.

14th : Pulse 68, respirations 18, temperature 98.2°. Heart nor mal. Took the salicylate four times a day for four clays, and thrice a day for a week more. Remained well.

These cases suffice to illustrate the controlling power exercised by the salicyl compounds over the rheumatic process.

In young subjects, and in those who have not suffered from re peated rheumatic attacks, such is generally the course of events, if the remedy is given in sufficient quantity, and for a sufficient time. But it is of importance that these two conditions should be observed ; for if given in insufficient quantity the desired result is got slowly Or not at all, and if omitted too soon the symptoms are apt to recur.

It has been said that acute rheumatism is more apt to relapse when treated by the salicyl compounds than when treated by alkalies.

It is not so, if the salicyl treatment is properly applied. When treated by alkalies the treatment is continued for several weeks and is omitted when the temperature is normal and pain has ceased. But this result is not due to the treatment. The disease has run its natu ral course and worn itself out. For that reason there is no tendency to relapse. But when treated by the salicyl compounds the course of the disease is arrested and the temperature falls to the normal standard in a few hours. If treatment be omitted as soon as this result is attained the symptoms are likely to recur, for though the rheumatic process is arrested the rheumatic poison is not all de stroyed; what remains is reproduced and the joint pains and fever reappear. It is not a true relapse, but a recrudescence of the symp toms consequent on the too early omission of the drug, a result which may readily be guarded against by continuing the treatment for a time after acute symptoms have disappeared.

To effect the complete destruction of the poison and ward off the chance of recrudescence or relapse the drug (salicin or salicylic acid) should be continued for a week or ten days after all rheumatic symp toms have disappeared. When this is done the complete destruction of the poison is insured, and the disease does not relapse.

To get the full benefit of the salicyl treatment two things are essential: 1. The drug must be given in full and frequent doses till the tem perature is normal and the pain gone; 2. It must be continued in smaller doses for ten days after all acute symptoms have ceased.

The two following are cases in which the early omission of the treatment was followed by a return of the rheumatic symptoms.