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Rheumatism - Case

hours, grains and salicin

RHEUMATISM - CASE YI.A woman, aged 25, seen March 2d, 1878, had rheumatic fever five years ago, was then laid up for two months. Present attack began five days ago with aching in the limbs.

March 2d: Face flushed and anxious, skin covered with acid per spiration, tongue furred, urine loaded with urates; right knee, both ankles, and wrists swollen and very painful; pulse 104, temperature 102.4. Heart normal. To have light diet, and thirty grains of salicin every hour till pain is relieved; then thirty grains every two hours.

3d: Took a powder every hour for five hours; after that felt easier, and took one every two hours while awake; has had in all thirteen powders, equal to 390 grains. Is now free from pain; the joints are stiff and slightly swollen, but not tender; pulse 80, temperature 99.8c ; skin covered with acid perspiration ; bowels moved ; heart sounds normal. To have a powder every two hours till a dozen are taken; and then one every four hours for a week, and to remain in bed for that time. The patient felt so well that she neglected these precautions ; got up on the 5th, and took only an occasional powder after that time. On the 8th the joint pains returned.

9th : Knees, ankles, and wrists inflamed ; acid sweats ; pulse 100, temperature To have thirty grains of salicin every hour for six hours; and then every two hours.

10th : Ls free from pain ; pulse 76, temperature 98.5'. Has had 3G0 grains of salicin. To continue it every three hours for four days, and after that, four times a day for ten days. This time she did as directed, and remained well.

In this case there can be no doubt that the relapse was due to the too early omission of the salicin.

What happened was as follows : The salicin was taken, during the first attack, long enough and in sufficient quantity to allay the symptoms and nearly but not quite destroy the whole of the rheumatic poison. What remained was re produced, and gave rise to a renewal of the rheumatic symptoms. On the second seizure the drug was taken for a sufficient length of time, and in sufficient quantity to destroy the whole of the poison. Con valescence was therefore permanent.