Original Repository: Osler Library of the History of Medicine, McGill University. Bibliotheca Osleriana
This item is in the public domain. It may be used without permission.
Medical Subject Headings (MeSH):
Medical Education and Early Career, McGill University, 1870-1884
Wards 17 Chapel & 23
W. Osler (dresser) 1/71
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John Casey, an Englishman was admitted into the hospital on 15th of November with some form of sickness and a crop of small
boils. From both of these he recovered nicely. He subsequently had two attacks of Erysipelis. Immediately after recovery from
the second attack rheumatic fever set in. This on 29th December. The attack came on quite suddenly during the evening. Says
he got chills during the afternoon by sitting near the windows. It set in with considerable degree of fever full bounding
pulse. On the following day the right knee became swollen and sore. Dr. Howard ordered the following: Potass[ium] Bicarb[onate]
1/2 dram, Soda Bicarb[onate] 1/2 dram, to be effervesced with 1/2 dram acid citr [citric acid]. To be taken every two hours.
He began his powders at half past three and at 10 o'clock the urine was alkaline. The joints were ordered
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to be wrapped in cotton wool.
Elbows affected today. Fever etc high, pulse quick and bounding, 114. Did not sleep at all through the night; ordered Chloral
Hydr[ate] 1/2 dram.
Monday 2nd -- Shoulder and ankles affected. Tongue coated. Heart unaffected. The alkalies have produced diarrhea. Pulse 116.
Tuesday 3rd -- Joints swollen and painful. Heart unaffected, much the same as yesterday.
Wednesday 4th -- Much the same, has had no perspirations. pulse 120. Tongue a little cleaner. Dr. Howard orders the following:
In Cinchona Co[?] 1/2 ounce Aqua [water] 6 ounces. A tablespoon every 4 hrs
[Thursday] 5th -- Much better. Pulse 104. Can move his arms a little. Had a copius perspiration in the night. Alkalies reduced
to every 6 hours.
6th -- Better. Pulse 100. Heart unaffected.
7th -- Pulse 98. Temp 98 2/5. Tongue nearly clean. Face less anxious.
8th -- Better. Joints not as painful. Pulse 100, Temp 98 4/5. Heart still untouched.
10th -- Better. Pulse 96. Temp 98 2/5. Legs stiff and sore.
11th -- Says he feels much stronger. Had a sweat in the night. Pulse 92. Temp 98 2/5.
12th -- Complains of pains down arms from shoulders to fingers. Pulse 92. Temp 98 2/5. Pain almost gone in legs.
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13th -- About the same. Pains continues in the shoulders and arms. He had a heavy perspiration in the night. Pulse 84. Temp
98 1/5. Dr. H. ordered the shoulders to be painted with Iodine. Medicine reduced to -- [unfinished]
14th -- Shoulders better. Had a profuse perspiration in the night. Pulse 92 Temp 98 3/5.
15th -- Much better. Wrists and elbows a little tender. Tongue clean. Pulse 94.
16th -- Arms still painful. Had a sweat in the night. Pulse 88 Temp 98 3/5.
17th -- Pains continue in arms but
feels very well otherwise. Pulse 104 Temp 98 2/5. Had another heavy sweat during the night.
18th -- Arms still keep sore. General health very good. Pulse 92 Temp 98 2/5.
19th -- Much better. Gets up 3-4 times a day. Stops the alkalies but continues the Quinine. Pulse 94.
20th -- Better though feels weak and stiff. Pulse 96. Temp 98.
21st -- Pulse 100. Feels a little stronger. Perspirations keep up, still very profuse at first part of the night.
22nd -- Pulse 86 Temp 98 1/5. Much better. Keeps up for nearly all day and walks about.
23rd -- Pulse 88 Temp normal.
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24th -- Quite well though still a little weak.
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James Robinson age 28 was admitted to the hospital on 11th of August suffering from a severe wound on the thigh which hasn't
yet completely healed. While resident in hospital he has had two attacks of erysipelas. While recovering from the last an
attach of rheumatic fever set in. This was on the afternoon of January 4th. He complained of pain in the right knee and left
wrist and was pretty feverish. Pulse 112. He has been and is in same ward as previous case and both have probably been brought
by exposure to drafts in the ward. It is an interesting fact that this man had up to the time of the attack of rheumatic fever
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large doses of Iron for the erysiplease. Tongue -- not much found [ . . . ] at lip.
Jan 5th -- Elbows and other wrist affected. No signs of any cardiac complications. The affected joints were wrapped in linseed
poultices. Dr. H. ordered following: Pot. Bicarb. 1/2 dram, Soda Bicarb 1/2 dram, to be effervesced with acid citr [citric
acid] 1/2 dram. To be taken every two hours. He commenced the powders at 3 o' clock in the afternoon at 10 o' clock
p.m. The urine was neutral and in morning was alkaline.
Jan 6th -- Ankles slightly affected. Complains of pains in the back. The affected joints very painful. Dr. Howard ordered
the alkalies to be continued but at longer intervals every 4 hrs. Pulse 114 Temp 99 4/5. Heart fine.
Jan 7th -- Ankles and wrists the most painful parts. Tongue is clearing, heart is unaffected. Powders reduced to half of one
every 4 hours, ordered the bark mixture. [ . . . ] Cinchona Co[?] 1/2 ounce. Aqua 6 ounces, a tablespoonful every four hours.
Pulse 102. Temp 99 1/5, heart fine.
Jan 8th -- Ankles and knee nearly well. Tongue clear, wrists very sore. Pulse 104 Temp 99. Sleeps well.
Jan 9th -- Says he feels a good deal better although it has got now to his shoulders. Heart unaffected. Takes his bark [quinine/chincona]
and alkalies now every 6 hours. Pulse 104 Temp 98 4/5.
Jan 10th -- Left shoulder and wrists painful. Slept well, has had no sweats yet. Pulse 92 Temp 98 1/5.
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Jan 11th -- Wrists better. Left shoulder and elbow painful. The joints [ . . . ] Can walk about. Pulse 96 Temp 98 2/5.
Jan 13th -- Better. Had a profuse perspiration in night. Left shoulder sore. Tongue clean. Alkalies reduced to [unfinished]
Jan 12th [sic] -- Better. Left shoulder not so sore. Wrists and elbows nearly well. Heart fine. Pulse 96 Temp 98.
Jan 14th -- Left shoulder very sore and index finger of right hand. The shoulder was painted with Iodine. Pulse 96 Temp 98.
Jan 15th -- Not as well today. Slight return
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of the fever. Right hip affected so that he cannot move in bed. Slept very badly. Pulse 108.
Jan 16th -- Better, had a profuse perspiration in the night. Hip much better. Still feels some pain in right wrist and left
elbow. Pulse 96 Temp 98 2/5.
Jan 17th -- Nearly well. Left elbow slightly painful. Pulse 92 Temp 98 2/5.
Jan 18th -- All clear. No pains at all. Pulse 86, Temp 98 1/5.