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Related post: swallowing. On the following day rheumatism attacked his
knees, but not severe enough to confine hira to the house.
On August 3d he came to the sea shore, and with difliculty
walked from the railway station to his cottage, a distance of
about an eighth of a mile. 1 visited him soon after his arrival.
At this time his fauces were red and swollen, but the tonsils
were not Buy Manxxx at all prominent. The knees, elbows, and shoulders
were stiff and painful. Walking was slow and difiicult. His
hands were raised to his liead with much effort. Physical ex-
amination revealed no pulmonary or cardiac disease. Tempera-
ture 101° F., pulse ion. He was put to bed in spite of his pro-
testations, and ordered snlol in ten-grain doses every two or
three hours nnd a diet of milk.
On August 3d his morning temperature was 101 "3°, evening
103°. The skin was acting freely, joints painful, though only
slightly swollen, and not particularly tender.
On August 4th, morning temperature 101 -5°, evening
102'8°. The above-mentioned joints were improving, but the
ankles also had now become involved. Tlie throat was relieved
by topical applications of glycerole of iron. Urine was voided
freely, and contained some allnimin.
On August 7th, after taking salol, | ij, daily for three or
four days, the urine was olive-green in color. The rheumatism
not yielding to the remeily, ditliiosalicylate of sodium in three-
grain doses was substituted. This was given every three or
four hours, but failed to relieve. Morphine became necessary
at night to induce sleep.
* Rend hpfoic tlie Now York Cllnicnl Society, Kohruary -J?, 1891.
June 6, 1891.]
KLOMAN: SOilE OBSERYATIOXS UPON THE USE OF ERGOTOLE.
653
On August 9th a pericardial friction sound was heard, and
the sac died with fluid. On this daj the temperature reached
104°, and on August 10th 101-6°. Dithiosalicvlate of sodium
— -^ discontinued, and salol in combination with phenacetin, five
ius of each, was given every four hours when temperature
■ ^ at or above 103°. These relieved the joint pains, improved
tlje frequency and character of the pulse, and reduced the tem-
perature 1'5° to 2o°. The tongue became cleaner, and albumin
disappeared from the urine. Very free perspiration was in-
.liiced.
On August 13th pneumonia appeared in the right lower
lobe: no cough or e.\'pectoration accompanied it.
The fever continued, varying from 101° to 104°, only tem-
porarily influenced by external and internal antipyretics.
On August 17th the skin ceased to act. The pulse was regu-
hir and steady from 112 to 120. Breatblessness was not marked,
and cyanosis was not present.
On August 18th a soft systolic murmur was heard at the
apes of the heart; pericardial effusion had diminished in
iiiiount, and pneumonia was resolving. From the evening of
Aiiu'ust 18th to the morning of tlie 19th the temperature contin-
1 from 104° to 104'4°, and the pulse from 114 to 120, notwith-
iiding frequent sponging and internal antipyretics. Cerebral
iiptoms appeared, the eyes became brighter, every sense
uer, and mild, mirthful delirium appeared. Sodium salicylate
- ordered in twenty-grain doses every two hours, and tepid
[bilging frequently. Physical examination revealed nothing
new in the way of complication. Up to 8.15 p. m. he had taken
3 ij of sodium salicylate, and at this hour his temperature was
105°, and pulse 120, regular and of fair volume. As there were
no facilities for a general bath, he was placed in a cold wet
pack at once, and stimulated with whisky. At 9 p. m., tempera-
ture 104'5°. Phenacetin, gr. xv, was given with whisky. His
spine was rubbed with ice, and ice in cloths was applied to the
head, chest, and abdomen. The pack was renewed.
At 10 p. M. the sublingual temperature was ]fi4'7°; tlie
rectal, 105'2°, although the external surface' of the body was
cool. Under these circumstances the pack was discontinued.
He was now unconscion.s. Respiration became rapid and irregu-
lar — 50 a minote— but the pulse continued regular at 126. At
11.30 the rectal temperature was 106-3°; at 12.30 a. m. (August
20tb), 107-5°; at 1.10 a.m., 108°; pulse, 130; at 1.45 a.m.,
108-9°. General convulsive movements occurred. The heart
beats grew slower and weaker, and dsath occurred a( 2 a. m.
SOME CLINICAL OBSERVATIONS
UPON THE USE OF EEGOTOLE.
By WILLIAM C. KLOMAN, M. IX.
BALTmoRE, XD.
I WILL begin with the staternont that I have no original
irivestigationR to report concerning the therapeutic proper-
ties of ergot or its representative ergotole. Those are gen-
erally known to the profession from the various works on

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