216
38
after.
On the 5th, at 11 p.m., he had 1/100° of grain of hyosein hypodermically and slept eight hours On the morning of the 6th, well marked pneumonia at the right base had developed and by this time the catheter had always to be used. Diarrhoea was also distressing and for this grs. x. bismuth sub-nitrate was given practically every four hours. At 10.30 p.m on the 6th the pulse became suddenly very intermittent and almost imperceptible. Hypodermic injections of ether were given frequently during the following hour and ammouia to the nostrils; the ammonia mixture being continued every two hours. The pulse improved during the night, but the intermittency still remained well marked. At 9 a.m. on the 7th he had a belladonna plaster over the heart and m. vii. of tincture of strophanthus added to the ammonia mixture every two hours, whilst the monobromide of camphor was discontinued.
On July 8th another attack of heart failure occurred, the pulse being imperceptible for some time at the wrist. Hypodermic injection of ether over the heart with hot sponges applied in the same region were followed by an improvement in the pulse within an hour. Diarrhoea afterwards became worse with extreme tencsmus and he was put on salol grs. v. every four hours, stimulation by ammonia still proceeding. In addition, as there was considerable pain in the abdomen and tym- panitis, lead and opium lotion was applied in fomentation. On the 11th the condition of the right lung had improved to some extent. The bubo in the right axilla was opened and found to contain pus. had been very painful during the previous twenty-four hours. Pulse still intermittent, diarrhoea with tenesmus still present. Liq. etrich. m. v. ordered three times a day. On the 12th the diarrhoea bad diminished, no tenesmus, but still very offensive and the pulse was now only rarely intermittent; salol grs. x. was continued three times a day.
It
On the 14th the temperature shot up to 104° F. again, and, on examining the right lung, a fresh well marked pleurisy was discovered all round the right base. A blister was applied, and on the sugges- tion of Dr. CANTLIE, chloride of ammonium grs. vi, were given every four hours with the ammonia mixture. On the 17th he was improving in general condition, ammonia mixture being continued along with the chloride of ammonium, and as the pulse was now fairly good and regular the strychnia was left off. On the 20th quinine grs. v. thrice a day was ordered; extract of malt thrice a day with ammonia mixture every four hours; Burgundy and the most nourishing food being freely administered. On the 21st a very large slough was removed from the axilla. On the 15th the opening of numerous lymphatic abscesses was commenced upon both arms and proceeded at about the rate of six a day for the following week, over 40 in all being opened. On the 24th sulphide of calcium pills gr. every four hours together with 3 . of cod liver oil thrice a day was all the medicine he was getting. By the 26th he was put on a sumptuous diet and small doses of quinine the cod liver oil being continued.
JULY, 1894.
15
16
17
18
19
20
21
24
22
106-
105-
104-
103-
102--
101-
100-
99-
98-
120
101
112
101
108
112
100
112
Pulse
108
112
116
120
112
14 41 36 14 41
48 11 11
80 44
نات
112
10
108
101
32 28 36 32
Resp.
3
2
2
2
1
2
#
1
3
0 2
2
1
V
22
On the evening of the 2nd of August, after getting a little too excited over the prospect of getting home, he was suddenly seized with breathlessness and palpitation and when I saw him a few minutes afterwards I found him with a fast running feeble pulse about 120 and this continued for about an hour; ammonia being the principal stimulant used in treatment. On the following morning he was prescribed a mixture of iron, arsenic, and strychnine. Cod liver oil stopped and extract of malt substituted. He improved until he was discharged on the 21st of August, when he was advised to take the following mixture:-Liq, arsenical m. v., liq. ferri dialysat in. x., liq. strychnin m. v., aq. ad i. t.i.d.
On the 2nd July there was a trace of albumen in the urine, On the 6th of July there was no albumen in the urine. On the 9th of July there was no albumen in the urine. And on the 31st of July there was no albumen in the urine. He woke up on the 19th of July and was quite rational for the first time, after having been non compos mentis for almost three weeks. If I remember right he said that his usual weight was about 160 lbs. On July 29th he was 134 Ds. On August