RHEUMATISM - CASE —A man, 44, had rheumatic fever when he was 28 years of age, again when he was 30, a third time when he was 33, and a fourth time when he was 37. On the first occasion he was confined to the house for three months, and was unfit for work for other six, nine in all. The second attack was equally long. During the third and fourth attacks he was in bed for six weeks, and off work for three months. Was always treated by potassium.
A fortnight ago he began to suffer from twinges of pain in the back, neck, and right leg. Two days ago got much worse, and was obliged to take to bed. For two nights the pains have been so severe that he has had no sleep.
December 1st, 1878: Has•an anxious expression; tongue furred, bowels confined, skin perspiring; perspiration and saliva acid; pulse 116, respirations 30, temperature 102.1'; has great pain in the left heel, all along the right leg, and in the knee and hip joints of the same side. The neck and the right wrist and hand are also painful and tender to touch. The affected parts are tender, but not red or dis tinctly swollen. The breathing seems a little oppressed. The heart's sounds are free from bruit, but are muffled in character; and there is a slight click with the systole. To have an aperient, and thirty grains of salicin every hour.
2c1, mane: Took a powder every hour till 4 A.M. At that hour lie fell asleep, and slept on till eight. Has had up to this time sixteen powders, equal to one ounce of salicin. States that he has no pain, only stiffness of the joints and limbs ; can bear firm pressure every where. Indeed, he felt so well that he got up and at the time of the visit was sitting in front of the fire, free from pain but stiff and weak. Skin acting freely, perspiration and saliva acid; pulse 100, respira tions 28, temperature 98.4°. States that he can scarcely believe it possible that he is so well. To remain in bed and take thirty grains of salicin every two hours.
Y esp. : Has been quite free from pain; so much so that he neglected his medicine, and went from his room into a cold water-closet. Has no pain ; but the pulse is 108, the respirations 30, and the tempera ture There is a slight click with the first sound of the but the muffled character of the sounds has disappeared. To remain
in bed, and take a powder every hour.
3c1: Had a good night; slept from ten till three without waking; felt quite well then; got up and went to another room to see what o'clock it was; felt weakened and chilled by doing so; slept again from four till seven. Has no pain, but feels weak; perspiration abundant and acid; pulse 92, respirations 28, temperature 98.1°. To have salicin (80 grains) every two hours.
4th : Passed a very good night, awake only once for a short time; feels quite well; heart's sounds normal; acid perspiration continues; pulse 76, respirations 20, temperature 98.2°.
At this time I ceased to visit him, but gave strict injunctions that the salicin was to be taken in thirty-grain doses every four hours for a week. Five days afterward I was sent for to see him again.
Stated that he felt so well that he did not take the medicine regu larly, as instructed, but took only half a powder occasionally.
Practically the saliciu was omitted on the 5th, and on the 7th he put on his clothes and went about the house. The weather at this time was bitterly cold.
On the 8th the pains began to trouble him again.
9th: Has pain in both ankles and .right wrist, all of which are swollen and very tender, but not red. Skin hot, not perspiring; pulse 100, temperature 100.3°. Heart's sounds normal. To have thirty grains of salicin every hour.
10th : After taking five powders (150 grains) he fell asleep, and passed a good night, waking only once. Pain is gone, only stiffness and slight tenderness on pressure remaining; heart normal; pulse 100, temperature 102.7°. Continue salicin every hour. Has had 210 grains in all.
11th: Has scarcely any pain, but feels wretched and out of sorts; the joints are not swollen, but are more or less tender on pressure; perspiration acid, not very abundant; pulse 100, temperature 101.5°. Heart normal. Has had 540 grains of salicin. To have thirty grains of salicin and fifteen of bicarbonate of potassium every two hours.