Treatment of acute rheumatism with butazolidin.

Case Reports (1) Female, aged 17, had been treated for rheumatic fever 3 years ago, but it appeared to have been a mild attack, and she had been well since; 6 days before admission she had developed pain, stiffness, and swelling of both ankles, and the knees, hands, and shoulders also became involved; 3 days later she had sternal and interscapular pain with cough, and complained also of anorexia, headache, profuse perspiration, and occasional vomiting. The joint pains responded to some extent to salicylate. Examination.-On admission (temperature 101.20 F., pulse 110, respirations 25), she complained of severe sternal pain and was dyspnoeic and cyanosed. There was no notable swelling of the joints, but the knees were tender. The heart sounds were regular, very soft, and a systolic murmur was present at the apex. A soft to-andfro friction rub was heard at the base. The erythrocyte sedimentation rate was 94 mm./hr (Westergren). On the 9th day of illness an area of bronchial breathing was noted at the left base and pericardial friction persisted. Her condition deteriorated, and three days later the fever increased with rapid pulse (130) and respirations (40). Progress.-Two days later she developed a circinate erythema over the abdomen, buttocks, and backs of the thighs, and there was a recurrence of severe joint pains with increase in praecordial pain. She was now very dyspnoeic and cyanosed, and coarse pericardial friction was heard and felt over the whole praecordium. Streptomycin i g. twice daily was added on the 15th day of illness, but there was no response and she deteriorated rapidly to a moribund condition on the 22nd day of illness.