« PředchozíPokračovat »
irst week in February ; but no renal or cardiac trouble was discovered. Improvement was gradual and continuous after January 4, 1892.
The accompanying chart shows the temperature variations up to the period of convalescence. The pulse chart presented corresponding curves. The peculiarities of the chart, for a case of enteric fever, need no pointing out (it should be borne in mind that the patient entered the hospital at the end of the first week of his illness) ; but the symptoms, as recorded, establish the diagnosis.
The treatment after January i consisted of ars., hyos., and rhus tox., as called for, the ars. being almost constantly used. Sponge baths were given occasionally, and the diet consisted of milk. About four weeks after leaving the hospital he reported, and had gained so much in flesh as to be almost unrecognizable. Discharged February 10, cured.
ECZEMA, CHRONIC. No. 713. Male; aged, 38; printer.
History. For five years has been troubled with periodical attacks of eczema, and with occasional attacks of facial erysipelas. The eczema begins in left leg, and spreads to entire body. There is a great deal of burning and itching; is constipated ; has been in habit of smoking three or four cigars daily ; has varicosis of legs.
Present Condition. Face, neck, chest, greater part of surface of arms and legs intensely red ; skin dry, thickened and covered with minute vesicles and crusts ; abundant desquamation of fine branny scales ; fierce burning and itching, the latter being nearly intolerable, and interfering with sleep. Otherwise, his condition was that of health.
Use of meat prohibited. Eczematous lesions not to be moistened. A generous farinaceous diet and an abundance of water to drink was given.
Anacardium 3x was given during January. There was marked improvement after use of anacardium.
Discharged January 18, improved.
Reported several times ; the last time showing quite a clean skin, and being practically cured. Anacardium was continued after leaving the hospital.
REMITTENT-INTERMITTENT FEVER. No. 51. Female ; aged, 48; widow. Admitted Jan. 2, 1892.
Previous History. Has been suffering from headache, frequent spells of vomiting, pain in abdomen, and afternoon chills for nine weeks. Was taken sick while in Vicksburg, Miss.
Present Condition. Skin dry and eczematous, and of a yellow color— feels harsh, and never perspires ; spleen not enlarged ;
teeth loose; flatulent; raises much wind; coppery taste in mouth, and desire for cold foods only; chill, morning and afternoon— light and creeping, always accompanied by elevation of temperature, and sensation of great heat ; vomits in the morning, about every third day. Nausea occurred daily, with marked prostration.
January 5. Urinalysis showed twenty-four hours' amount to be only twelve ounces (sp. gr. 1020), with phosphates in excess; no albumin. The quantity of urine increased gradually until thirtytwo ounces were passed daily. Vomiting occurred at intervals of two or three days, until February 27th, after which there was no return of vomiting, though there was still some nausea. Chills became less and less frequent, and ceased on the 24th.
Diarrhæa set in February 26, and was followed by constipation February 28th.
Fowler's solution, I gt., t. i. d., was given during the greater part of her stay in hospital, and nux v. 2x internally, for the gastric and intestinal disturbances.
Discharged March 7th, cured. The accompanying chart shows the variations in temperature.
CLINICAL CHART. TOUR SON NOGTON INDOVIDER
No. 71. Female ; aged, 22; unmarried. Admitted January 16, 1892.
Previous History. An eruption began two weeks ago on the right arm, and extended over face and body. The eruption was attended by neither pain nor itching. She received medicine from the Bennett Street Dispensary (allopathic), and the eruption disappeared in four days. Swelling about inferior
maxilla began three days ago, and salivation followed rapidly.
Present Condition. A few brownish, irregular spots here and there on surface of body; sordes on teeth, which cannot be brought in close contact ; gums bleed easily ; opens mouth with difficulty, on account of swelling about the face and neck; tongue large, flabby, indented by teeth, and coated ; mouth has a very strong and most offensive odor ; excessive and constant ptyalism, the saliva running in almost a stream from the partially open mouth; many small and superficial ulcers in mouth.
Peroxide of hydrogen was used as a mouth wash three times daily, and a solution of hydrastis was used every one half-hour; nitric acid ix internally.
January 22. Much improvement has been made, the general and special symptoms diminishing in severity ; but the gums are still swollen, and bleed easily. The temperature, which was elevated for four days, is now normal. Kali iod. 5 gr. in twentyfour hours, with the idea of accelerating the excretion of mercury, and thus assisting in the recovery.
January 27. Great improvement; can open mouth easily ; slight fetor to breath ; two small ulcers remaining; no swelling of face.
The question of diagnosis in this case was a somewhat puzzling one. The patient's social status, and her condition on admission, more than suggested the existence of syphilis. The ephemeral character of the eruption, according to the anamnesis, the fact that no signs of characteristic lesions could be found on careful physical examination, and the positive and apparently sincere denial of unchastity, in addition to the rapid and satisfactory recovery, would seem to offer convincing testimony that the disease was not venereal. Sectarian prejudices prohibited any attempt to find out what treatment the patient had received at the hands of her dispensary physician; but the very characteristic objective symptoms pointed to an accidently excessive, or unjustifiably rash use of some form of mercury. Discharged January 29th, cured.
History. Had la grippe last November. Thought he had recovered. Has been sick for ten days with pain in the right side, and cough. Now has pain in the hepatic region; cannot take a long breath, the pain is so severe. Feels weak; no appetite ; much thirst ; coughs but little.
Physical examination shows marked dulness over lower lobe of right lung, crepitant râles, whispering bronchophony, increased vocal fremitus.
Pustular eruption appeared on the face. The cough became less frequent, and the expectoration more scanty. Eruption became more extensive, but disappeared before discharge. Signs of consolidation of lung gradually disappeared. The pain on breathing, which was present February 2, lasted only two days, and a similar pain was felt. February 13. Was able to be up and dressed part of the day February 13. Improvement was constant from the first. Hepar sulph. 3x was given internally.
Discharged February 16th, cured.
Peculiarities. The attention of the internes and a few students was called to this case; and they were asked to examine it carefully. Signs of hepatization of the lower lobe of the right lung were marked, and the differences between the two lungs were distinct and easily demonstrated ; and yet the temperature was but slightly elevated. Pulse was not very rapid, and "rusty sputa” were absent.
SUPPURATIVE OTITIS MEDIA, WITH MASTOID PERIOSTITIS. No. 135. Female ; aged, 28. Admitted February 16, 1892.
History. There has been some discharge from right ear since January 1, 1892. Discharge was bloody for first few days, then became of a purulent nature; has been deaf in the same ear since discharge commenced. Very little pain has been present until the last three or four days, during which pain has been quite severe.
Present Condition. Now there is considerable swelling and much tenderness in mastoid region ; integument, over mastoid process, of a dark-red color; some shooting pains over right side of head and in mastoid region; slight purulent discharge from external meatus; watch not heard upon pressure. Dr. H. P. Bellows was called in consultation, and it was decided, in spite of the indications for operation, that syringing the ear with hot water ten minutes every hour, day and night, keeping an ice-water coil constantly applied to the mastoid region, and giving capsicum 3x internally, might still abort the impending mastoid abscess. Trial of these measures for twelve hours (or longer if indications were favorable) was determined upon, the temperature and pulse, as well as the local condition, to be carefully watched
February 19th. Temperature and pulse show steady improvement, but locally not much change is noted; discharge from external meatus rather diminishing. Dr. Bellows made a free incision in the tympanic membrane, and in the superior wall of the external canal. The above measures to be continued for twenty-four hours longer, and, unless more decided local improvement, should resort to operative measures.
February 20th. Improving; after inflating ear with Politzer bag could hear watch three inches from ear; meatus swollen and red. Bell ) on small pledget of cotton kept in ear to allay pain.
February 22nd. Water, of the temperature of the room, was used in the coil during the day, to be discontinued at night ; ear syringed with hot water every two hours. Rapid improvement, yet much swelling of lower part of auricle and walls of external meatus. Milk and gruel diet.
February 26th. Much improved; some itching in meatus; very slight pain, and no discharge. Discontinue syringing and cold coil. Full diet. Merc. dulcis 3x.
March 2nd. Improving, yet rather weak. Hoff's malt t. i. d,
After February 22nd Dr. Bellows inflated the ear by catheterizing, or by the Politzer bag. The catheter had to be carried through left nostril, on account of a deviated septum. The ear was carefully inspected and cleansed daily by Dr. Bellows.
March 8th. Feeling well; can hear watch twelve inches from ear after inflation. Discharged, cured.
SCARLATINA. Female ; aged, 10. Admitted February 24, 1892. Has been sick four days. Tonsils large; deglutition not painful; herpetic eruption about lips, and on left cheek ; fine, elevated eruption over entire body ; very little redness; strawberry tongue. Says she feels very well. Pulse, 128; temperature, 100.4° F.
She was given a milk diet, and bell. ix, 10 gtt. in half glass water - two teaspoonfuls every hour.
Temperature never was higher than 100.6° F. during entire illness. There was considerable photophobia during first four days. Eruption disappeared on 28th.
The correctness of the diagnosis was doubted by several who saw the case, on account of the mildness of all symptoms. The doubt was definitely removed, however, when there was complete desquamation of ends of fingers on March 8th. Bran-like desquamation commenced March 2nd, and continued, more or less, while in hospital; after which date she was given full diet, excepting meats, which were not allowed. No albumin in urine at any time. She made a very satisfactory recovery, and was discharged March 9th, cured. A few doses of sulph. having been given during the last few days.
PNEUMONIA. No. 180. Female; aged, 25; chambermaid. Admitted March 15, 1892. II A. M.