« ForrigeFortsæt »
but the evening temperature remained at 105° F. for several days. I then ordered the patient sponged with cold water, which immediately reduced fever to 1021° F. So well was I pleased with results that I ordered her to be sponged at 10, 12 and 2 o'clock each day. The temperature never got above 1021° again, and all the symptoms were much improved after beginning the water treatment. I also gave throughout the course of this case salol in eight-grain doses three times a day, quinine in tonic doses, and alcoholic stimulants freely. Diarrhea continued until a strictly buttermilk diet was given, when the bowels only moved once or twice a day. Patient made a nice recovery in about twenty-eight days.
Case II. Colored, male, aged 9. On my second or third visit, which was every other day, to Case I, Čase II was taken with a chill. I gave calomel and followed with quinine liberally for several days, but fever continued. I began sponging as in Case I, with the same internal treatment. Temperature never rose above 101°. No diarrhea. The fever ended on the twenty-first day.
Was the difference in severity of Case II and the first part of Case I due to the use of cold sponging? Was the difference in duration due to the early use of water in Case II, or simply from being called later in Case I? I have a good deal of this kind of fever in my practice, and have treated my patients with the cold bath and without it, but find that they invariably have a milder type where the water is used, and the disease also is of a shorter duration. I am persuaded that water is the sheet-anchor in the treatment of this fever.
A CASE OF SEPTICEMIA FOLLOWING ABORTION Treated by Venesection and Infusion of Normal Salt Solution.
BY DRS. W. A. FRANKS & F. BATES.
DURWOOD, I. T.
One of us (Dr. W. A. Franks) wishes to report a case which he was called to see in consultation with Dr. K. This was the 26th day of March, this year, the patient being Mrs. H., a young woman, primipara, who was in about the fourth month of gestation. She had been troubled with pains and uterine hemorrhages for about nine days, at the same time having some
fever, and was very tender to the touch in the region of the uterus. She had been treated by Dr. K. with the view of controlling the pain and hemorrhage. On my arrival we diagnosed an inevitable abortion, which was completed at 10 o'clock that night; the placenta was removed without force, and an interuterine douch of hot, carbolized water was given, and the patient placed on tr. chloride of iron and quinine sulphate; at the same time vaginal injections of carbolized water were ordered to be used twice a day. The patient continued to have some fever, and some discharge; the soreness slowly disappeared. In about ten or twelve days the patient was able to sit up, and even walk some. On about the twelfth or fourteenth day, after abortion, while standing, she was seized with a sudden hemorrhage, and the reporter was summoned. On arriving found her very much exhausted and in a collapsed condition. The hemorrhage was checked and the family told that an operation was necessary. So we called Dr. Boothe, who brought the necessary instruments for a curetment. We curetted the uterus and found a small cyst and some fragments of membranes. The patient, shortly after being put to bed, began having rigors and high temperature; each rigor was followed by still higher temperature, until it reached 1073° F. without any complete intermissions. Finally Dr. F. Bates, a graduate of the Memphis Hospital Medical College, returning home, was called in consultation with us. After a few days further trial of medical treatment without any improvement we determined to try the therapeutic value of bloodletting, and to replace by saline solution. The first sitting the solution was injected submammary, and the blood taken from the arm. This was followed by some good results-the rigors were lighter and the temperature lower. The second day after this we repeated the operation as before, except the solution was thrown directly into the radial artery, and the blood was drawn from the opposite arm at the same time. At the completion of the operation the patient had a rigor, but the temperature fell to normal within three hours, and never rose above normal after that. There have been no symptoms of a rigor or fever since, and the patient is now able to go visiting.
The curative effect of the salt solution was probably due both to the dilution of the poison and its rapid elimination by the excretory organs, brought about by the high artificial vascular tension.
We believe the treatment saved the woman's life, and hope that other practitioners may attain the same happy results.
A CASE OF ESTIVO-AUTUMNAL MALARIA
BY WM. KRAUSS, M.D.
Visiting Physician to St. Joseph's Hospital.
This patient, Joe Schup, aged 18, had been working in a stave camp, near Helena, Ark., for about two weeks prior to his admission into the hospital. He had had daily chills, followed by fever lasting several hours. An examination of the blood showed some pigmented, intra-cellular bodies, a few hyaline, and two crescents in each of two spreads made. On account of this unusual finding he was interrogated as to his whereabouts prior to coming to the camp. His knowledge of the country being limited, the most definite information I could get was, that the ticket cost him $5.75, and that he went 'way down the river. This would make the distance 196 miles south. I do not remember having seen blood from patients further than 100 miles from Memphis, and had begun to think that crescents were never found away from the sea coast. The therapy consisted of 0.5 gm. calomel, followed in twenty-four hours by 2.0 gms. of sulphate of quinine, divided into three doses, given at six-hour intervals. This was followed by a marked leukocytosis, disappearance of all the malarial organisms, normal temperature, and cessation of all the symptoms. The patient was discharged on the following day.
I still maintain that crescents do not occur within 100 miles of Memphis. I forgot to mention that this man's temperature did not rise above 101° F. while in the hospital.
SIMULTANEOUS USE OF
PHYSIOLOGIC SALT SOLUTION AND VENESECTION IN PUERPERAL ECLAMPSIA.
BY G. W. PENN, M.D.
On May 5 I was asked by a neighboring physician to see a woman about 36 years old with convulsions recurring from half to an hour apart. The child was 24 hours old; woman was comatose, pulse 120, but full and bounding; constipation.
* Reported to the Memphis Medical Society, July 11, 1899.
A half gallon of blood was withdrawn from median basilic, and at the same time a similar quantity of physiologic salt solution was injected under left mammary gland. She was put on 2-grain doses of calomel every four hours and saturated solution epsom salt at frequent intervals. No convulsions occurred for several hours, but she remained comatose, and the same procedure was carried out on the following day. She slowly returned to consciousness, and made a good recovery.
The combined use of venesection and normal salt solution is frequently used in uremia and other toxemia, and the salt solution is advised by recent works on obstetrics in eclampsia as a diaphoretic and eliminent, but I think that the simultaneous use of the large amount of fluid poured into the vascular system permits a greater amount of blood to be taken, and hence greatly dilutes the toxic elements coursing the vital
PROGRESS OF MEDICINE.
UNDER CHARGE OF B. F. TURNER, M.D.
Visiting Physician to St. Joseph's Hospital, Memphis.
Chronic Lead Poisoning.
Alava (Vienna Cor. Med. Press & Cir., vol. 67, no. 3121) records a case of some interest from Eiselt's clinic, a few specimens from which were exhibited at the last medical meeting. The patient was a house painter, æt. 38, suffering from "chronic lead intoxication," according to the clinical records, whose symptoms were described as severe, painful attacks of colic as in nephrolithiasis, albumin and granular cylinders in urine, hypertrophy of the left ventricle, etc. The post-mortem revealed large coagula in the abdomen. Behind and below the right lobe of the liver the serous covering of the organ was torn, and from it protruded a nodulated tumor. On cutting into the parenchyma of the liver a large number of hemorrhagic centers were discovered, while the peripheral surface was white or anemic. This condition was most marked in the right lobe, the external surface having a compressed or crushed appearance. The kidneys appeared quite healthy. In the right ureter, not far from the pelvis, was found a longitudinal hematoma. The mucous membrane of the ureters was thickened, and at various spots raised. The left ventricle was concentrically hypertrophied. The large vessels and vena porta were carefully examined for the cause of this bursting of the smaller vessels, but nothing could be found. On closer examination of the parenchyma of the liver white, fibrous bands were discovered around the smaller vessels of the organ itself, causing the vessels of
the interior to bulge and become varicose.
In one place this aneurysmal condition was beautifully demonstrated by a section. The disease was therefore a multiple aneurysm of the arteria hepatica, which explains the serous rupture and clots found in the abdomen.
Eppinger, in tracing this morbid condition to its source, attributed it to mycotic emboli, while Kussmaul and Mayer are inclined to believe in a periarteritis nodosa extending over the entire arterial system. Yet, strange to say, after careful examination the aneurysmal condition could not be found in any other vessels of the body outside of the liver, thoagh the walls were much thickened.
Alava was inclined to believe in "lues" localized to the vascular system as the remote primary cause of the morbid transformation.
This opinion is sustained by the microscopic appearances, as endarteritis obliterans, in the center of which are to be met with small miliary tubercles resembling the center of a gumma.
Anomalous Eruptions in Typhoid Fever.
DaCosta (Amer. Jour. Med. Sci., vol. 118, no. 1) says that irrespective of the significant rose spots in typhoid fever, there are rashes which are comparatively rare, imperfectly understood, and become the cause of confusion and error. These are a diffused erythema simulating scarlet fever and an eruption like that of measles. In a case of the former, reported by him, he finds these points for study: First, the scarlatinal rash appearing in the first week and at a time in advance of the characteristic rose spots. The rash was uniform, was not, as in the first case, preceded by mottling, was easily influenced by pressure, did not apparently modify the temperature, and persisted to the last. The scarlatiniform rash may remain through the fever, though it rarely does. Irrespective of its appearance in the first week, it may come on late in the disease, and the author has known it to manifest itself even in convalescence. It is a uniform red rash, like scarlatina; it is seen all over the body, though not so in every instance. It is more distinct in some places than in others. It is easily influenced by pressure. It has its periods of greater or less intensity, of partial disappearance, of vivid return. It lasts generally a week or somewhat longer. It passes away without desquamation. It does not perceptibly influence the course of the temperature. It is for the most part unconnected with sore throat or with albuminuria.
Rarer than the scarlatiniform eruption, and much more misleading, is an eruption like measles. This is differentiated from true measles in that in the latter the eruption is coarser, more markedly papular, and has the well-known crescentic arrangement, which is not seen in typhoid fever. Secondly, there is itching and there is desquamation, which are also not observed in the typhoid fever rash. Coryza and catarrhal symptoms are also insignificant in the intercurrent measles. But of greatest value and meaning is the temperature record. In the measly eruption of typhoid the eruption has no marked influence on the temperature, or greater variations are not met with than belong to the stage of typhoid fever in which the measly eruption may occur.
DaCosta also mentions a mottling of the skin, due to a subcuticular rash, which may remain as the only eruption, or precede or attend either of the other kinds.