RHEUMATISM CASE XIV.—A man, aged 40, had an ordinary attack of acute rheumatism with inflamed and swollen joints, sweats, and a tem perature varying from 101 to 102.4°. He was treated by alkalies and salicylate of soda. Though his pains were less and the temperature fell a little he did not make satisfactory progress. On the seventh clay of his illness the temperature was 101°, the pulse was 108, feeble and compressible ; the skin was moist, the perspiration acid; the tongue moist and furred ; there was pain and swelling in both ankles, right knee, and both wrists. The patient was depressed and sunk in bed; the hands were tremulous ; he wandered at night and occasion ally during the day ; the bowels were moved by medicine. The area of cardiac dulness was normal—there was no bruit, but the sounds were indistinct and muffled, and the apex-beat could not be felt. The diagnosis was my ocarditis—inflammation of the muscular substance of the heart. He was ordered to have every two hours four ounces of milk or strong beef-tea with half an ounce of brandy ; all movement was forbidden; as medicine fifteen grains of salicin were given every two hours a quarter of an hour before food. He gradually improved,
the muttering delirium ceased, the tongue cleaned, he was less sunk in bed and got some hours of quiet sleep, and the joint pains disap peared. On the nineteenth day there was heard for the first time a distinct pericardial to-and-fro rub audible only at the base of the heart. This persisted for two days and then disappeared. Cardiac dulness remained normal and there was no evidence of fluid effusion into the sac of the pericardium. The patient picked up slowly, but ultimately got well. A year after his illness I examined the heart and found nothing amiss in it.
By various observers attention has been directed to the occasional occurrence of sudden death in acute rheumatism. It is probable that the explanation of this result is to be found in inflammatory softening of the ventricular walls. It certainly was so in the following case: