angle, and distinct murmurs with both sounds of the heart audible at the base ; the pulse " waterhammer" type. Iu markedly of the both cases salicylate of soda was used with decided benefit, and its use was continued for some days after apparent recovery from the fever and joint pains, and I think this should be done in all cases to obviate the tendency to relapse. In the case of W. M. a bracelet of small blisters was also placed round each ankle joint, and in the case of E. F. a large blister in the cordial area strorgly advocated by Dr. Alexander Harkin. In neither case was the pyrexia excessive, and there were no unpleasant tonic effects traceable to the salicylate, such as deafness, ringing in the It is not necessary here to dwell on ears, &c. tiie benefit derived in cases of acute rheumatism. I will only mention that, of late, I have been endeavouring to get good results from a fresh Willow trees are decoction of willow bark. of in the the compound plentiful Presidency Jail. As an antipyretic, at present the results have been unsatisfactory; this may be owing possibly to defects in the manufacture of the willow decoction. Temperature charts of both cases are appended.
"W. M., 17 years old, a shipapprentice, admitted into hospital on the 22nd October, 1884, with a history of 2 days' illness ; fever and pain in the joints. Never had acute rheumatism before, but his father is subject to Case I.
GENERAL HOSPITAL, 2nd SURGEON'S WARD. TWO CASES OF ACUTE RHEUMATISM. By Sukgeon G. F. A. Harris.
The two following cases were recently in my ward at, the General Hospital, and as cases of acute rheumatism are not commonly met with in this country, I have thought them worthy of record. For the abstract of the notes of these cases, I am indebted to Mr. Reilly, Assistant Apothecary of the Ward. In both cases the endocardial lining membrane was affected, and valvular murmurs developed ; in the case of AY. M. a systolic bruit was audible loudest over the aortic valves, not at the apex, and in my opinion due to the aortic orifice being slightly contracted or roughened ; and in the case of E. F., both the aortic and mitral valves are affected, there being a mitral systolic bruit traceable through the axilla to the scapular
?
States that he attacks of acute rheumatism. was quite well 3 days ago, and was suddenly attacked with fever and pains in the joints; first those of right side were alfected. knees and On admission.?Both ankles swollen (particularly right joints) and excessively tender; the slightest movement causes excruciating pains; tongue coated white; skin moist. Was ordered 30 grs. of sodium salicylate every 4 hours, and number of small blisters The knees to be round each ankle joint. wrapped in cotton wool and a bandage. 2ord.?Pains in joints intense, and ankles much swollen. 1st sound of heart muffled and prolonged at centre of sternum. No sleep at night. Continue salicylate mixture and 20 grs. each of bromide of potassium and chloral hydrate at bed time. The blisters over the ankle joints have risen well. 24th. Slept better. Ankles less swollen and knees still swollen and painful. A the painful, soft but distinct systolic bruit audible at base of heart and centre of sternum. 25th. Swelling of ankles and knees much less, and scarcely at all painful. From this day he steadily improved, and the swelling and pain of the joints diminished slowly, and the salicylate mixture was continued for a week, although He was able to walk he had no more lever. about from the 1st of November.
THE INDIAN MEDICAL GAZETTE.
12
Cask II.?E.
F., an African, formerly a employed 011 the E. I. Railway, 6th December, suffering from fever
now
seaman,
admitted, and pains
011
in all the joints, more especially in knees and ankles. Had rheumatic fever in Australia 16 years ago, and again about 3 months ago in Calcutta. Cannot say whether his heart was affected 011 either of these occasions. On admission both knees and ankles are swollen and painful, also the left wrist. The He is left knee and ankle are mostly swollen. quite unable to move his joints, and the slightcauses est touch great pain. Tongue thickly coated. Bowels confined. Temperature 102.? On examining heart, a large systolic bruit was distinctly audible over whole cordial area, but was loudest at the base.
O
"W. M., 17 years old, a shipapprentice, admitted into hospital on the 22nd October, 1884, with a history of 2 days' illness ; fever and pain in the joints. Never had acute rheumatism before, but his father is subject to Case I.
GENERAL HOSPITAL, 2nd SURGEON'S WARD. TWO CASES OF ACUTE RHEUMATISM. By Sukgeon G. F. A. Harris.
The two following cases were recently in my ward at, the General Hospital, and as cases of acute rheumatism are not commonly met with in this country, I have thought them worthy of record. For the abstract of the notes of these cases, I am indebted to Mr. Reilly, Assistant Apothecary of the Ward. In both cases the endocardial lining membrane was affected, and valvular murmurs developed ; in the case of AY. M. a systolic bruit was audible loudest over the aortic valves, not at the apex, and in my opinion due to the aortic orifice being slightly contracted or roughened ; and in the case of E. F., both the aortic and mitral valves are affected, there being a mitral systolic bruit traceable through the axilla to the scapular
?
States that he attacks of acute rheumatism. was quite well 3 days ago, and was suddenly attacked with fever and pains in the joints; first those of right side were alfected. knees and On admission.?Both ankles swollen (particularly right joints) and excessively tender; the slightest movement causes excruciating pains; tongue coated white; skin moist. Was ordered 30 grs. of sodium salicylate every 4 hours, and number of small blisters The knees to be round each ankle joint. wrapped in cotton wool and a bandage. 2ord.?Pains in joints intense, and ankles much swollen. 1st sound of heart muffled and prolonged at centre of sternum. No sleep at night. Continue salicylate mixture and 20 grs. each of bromide of potassium and chloral hydrate at bed time. The blisters over the ankle joints have risen well. 24th. Slept better. Ankles less swollen and knees still swollen and painful. A the painful, soft but distinct systolic bruit audible at base of heart and centre of sternum. 25th. Swelling of ankles and knees much less, and scarcely at all painful. From this day he steadily improved, and the swelling and pain of the joints diminished slowly, and the salicylate mixture was continued for a week, although He was able to walk he had no more lever. about from the 1st of November.
THE INDIAN MEDICAL GAZETTE.
12
Cask II.?E.
F., an African, formerly a employed 011 the E. I. Railway, 6th December, suffering from fever
now
seaman,
admitted, and pains
011
in all the joints, more especially in knees and ankles. Had rheumatic fever in Australia 16 years ago, and again about 3 months ago in Calcutta. Cannot say whether his heart was affected 011 either of these occasions. On admission both knees and ankles are swollen and painful, also the left wrist. The He is left knee and ankle are mostly swollen. quite unable to move his joints, and the slightcauses est touch great pain. Tongue thickly coated. Bowels confined. Temperature 102.? On examining heart, a large systolic bruit was distinctly audible over whole cordial area, but was loudest at the base.
O
