214
36
he can retain his urine to-day. The blood is very fluid and watery. 12th: much clearer in the mind this morning. No convulsions. Muttering delirium and picking at the bed clothes occasional. Heart's action is very tumultuous. There are no lung symptoms. The superficial veins in the axillæ and chest are notably prominent. There are no more glands to be felt, however, than the enlarged one in the femoral region. The urine is very scanty and contains trace of albumen and bile salts. Rabbit and guinea-pig injected with blood. Rabbit lived three days, the guinea-pig Treatment after the 11th: "ammonia and ether frequently, with brandy, eggs and milk with grs. xxx. bromide of potash on the afternoon of the 11th."
two.
Hemoglobin on the 12th 18 per cent.
Died comatose on the 13th, 10 a.m.
Post mortem examination same afternoon. Small rose-red spot round scratch below the kuce. Small discoloration, scarcely amounting to a petechia just close by bubo,
No enlargement of glands apparent in any other region of the body.
On incision into the petechia below the knee, there is found a hypodermic effusion of thin watery blood. There is no attempt at clotting of blood. On dissection of the bubo the same effusion is found round it. Slight-congestion of the lungs. Spleen is somewhat enlarged. The liver friable and pale. The gall-bladder is empty. Some enlarged mesenteric glands. The kidneys somewhat paler than usual. No hæmorrhages in the peritoneum or thorax. The meninges were intensely congested, and no hemorrhage was found in the brain. Heart (left side) firmly contracted, right side full of dark fluid blood.
REMARKS. This post mortem did not assist much as I had only a few minutes in which to examine the body after it had been opened. This case, however, showed us the value of the ice-bag in relieving the headache as so long as the boy was conscious or even semi-delirious he told us that the ice-bag was the only thing he wanted. He took his nourishment well and being most anxious to get well, contrary to the majority of his fellow countrymen affected, did everything and took everything he was told. The boy was anæmic, always and the low percentage of hæmoglobin on the 12th, which was several times and most carefully estimated, was not so remarkable as if it had occurred in a full-blooded person. This suggested, at the time, transfusion of blood, supply of oxygen for inhalation, and early administration of iron and chlorate of potash. It will be noticed that some of the treatment was different from what I have recommended..
Case II-Japanese. Et. 36.
On the 28th June, at a dinner given by the Japanese Doctors to several of the Hongkong Medical gentlemen connected with the plague, Professor AOYAMA's temperature was 101.6° F. He slept well during that night. On the morning of the 29th Dr. CANTLIE saw him and found him suffering from what he supposed to be the results of a dissection wound. At 5.30 p.m. he was seen by Dr. MOLYNEUX and myself, and, the case being immediately diagnosed as plague, he was removed to the Hygeia. From the evidence which we procured it seems that on the 22nd or 23rd of June, whilst making a post mortem examination, he scratched the left third finger on the posterior and ulnar aspect of the first phalangeal joint. On the 27th of June, he again scratched himself on the end of the right thumb.
When removed to the Hygeia he had a temperature of 105° F.; had a bubo in the left axilla without lymphangitis; had a well marked lymphangitis of the right arm extending up to the level of the middle of the humerus; was delirious, very sleepy, and the conjunctiva were intensely suffused; pulse apparently full and bounding but easily compressible. The bubo was very painful. The heart dulness was increased to the left and the apex beat was about one inch to the left of the nipple line. This was a most extraordinary state of affairs considering that within thirty-six hours the apex beat returned to its usual position and the heart dulness returned to exactly the nipple line; whilst Dr. KITAsato assured us that, as far as he knew, AOYAMA had no previous heart mischief to his knowledge.
Treatment ordered: sponging every half hour; milk, eggs, Brand's essence, with a small amount of brandy ad lib; calomel grs. x. at once; a mixture composed of
every two hours.
Ammon. Carb
Tr. Cinchon Infus. Digitalis...
Aq. Chorof ad.............
***grs. iv.
.m. XX.
3 iì. .zi.
At 2.30 am, on the 30th the pulse was much weaker, temp. 105. Mixture with m. xxx. Sp. ammoniæ added, ordered every hour, in addition to champagne,
At 4.30 a.m. there was no improvement, pulse still very bad. In one of his calm moments he had urged that an ice-bag should be placed over his heart; and, although delirious, had argued so rationally that we permitted him to keep it on during the night. As we thought that this might be one of the causes of the exceedingly bad pulse it was removed; and at 9 a.m. the pulse had considerably improved. At this time on examination he had no splenic tenderness; the condition of anxious dyspnoea was well marked, but did not seem so intense as it was in the early morning. The mixture ammonia, etc., was continued every hour, lead and opium lotion being applied to the right arm and belladonna and glyceriue to the bubo, nourishment. being continued as before.
At 3.30 p.m. ho bad been sleeping somewhat heavily, and in a coherent moment when he awoke announced himself better. The conjunctiva were less congested, the headache, which up to this time had been well marked, now disappeared, and he seemed generally easier. The digitalis is now