39
6th he was 1311⁄2 lbs. And on August 20th 136 lbs. Bacilli were found in the blood by KITASATO on the morning of the 30th of June. On the 11th of July when the bubo was opened numerous bacilli were found in the discharge. On the 15th of July no bacilli were found in the discharge. On the 16th bacilli were found in each of the lymphatic abscesses opened. On the 3rd of August no bacilli were found in the blood.
Remarks.-This was a most difficult case to treat. Here was a well built strong man who had been a delightful social companion but when delirious was—well, difficult to manage. Fortunately we had one sister who spoke German and another Japanese and this was a great help as, presumably infected with the war fever, he would not allow a Chinaman to come near him during his delirium. It may appear that too much physic was administered but it has to be remembered that he was in a most desperate condition and ammonia had to be given as practically part of his nourishment and not only that but his mental condition was often such that be could not or would not take part or all of his medicine, so that the above treatment was simply suited to the circumstances of the case at each visit and simply meant stimulate and nourish as much as possible. In his delirium he would often argue in the most rational manner, especially on medical subjects. From the 6th to the 11th July he was too ill to do this as curing the most of this period he was in an apathetic semicomatose condition with occasional outbursts of violent conduct. He became conscious on the 19th July and after that slowly improved until able to leave for Japan. The prominent points in his case were the extremely bad pulse, the long period of pyrexia, the complications-pneumonia, retention of urine for a long time, the unmerous lymphatic abscesses, the profuse and very foetid diarrhoea and the long period during which he was unconscious and of which he remembers nothing. The bacilli disappeared in a few days from the abscesses after use of iodoform. I saw him in September. At many of the incisions there was a tendency to formation of keloid and although I could find no physical evidence of cardiac weakness he informed me that he was very easily perturbed and tired and that he had headache often whenever he tried to do any serious work, He now relates with glee how he disappointed us —as bis coffin had been taken on board on the 3rd July and every preparation made for his funeral - on the morrow.
The physical signs of the condition of the heart on the 29th of June require some explanation, which I am unable to give. One can scarcely imagine it possible that the more application of an ice-bag would cause a change in the position of the heart, which there undoubtedly was.
It is a significant fact that after the ice-bag was removed the apex. beat and the area of cardiac dulness soon returned to their usual positions.
Case III-Japanese. Et. 38.
Dr. I. was assisting KITASATO in bacteriological work. Whilst preparing to remove AoYAMA to the Hygeia our attention was directed to this patient who had that day felt "out of sorts," and on taking his temperature found it was 102° F.-pulse rapid, considerable headache, no shiver, slight pain in the left axilla. In addition he had the indefinable appearance of a plague patient, the recogni- tion of which comes intuitively to one who has seen a lot of the disease. He was at once removed with his colleague to the Hygeia. On arrival there his temperature was 99 F. At midnight it was 102° F. On the 30th at noon it was 104° F. and at 6 p.m. it had reached its primary maximum 105° F.
Examination showed the absence of any open wound on the left hand; but there was the mark of a small scar on one of the fingers, where he said he had scratched himself some days before. On the morning of the 30th the bubo was very painful, the conjunctivæ very suffused and his condi- tion generally worse. Treatment: ainmonia and cinchona, sponging, monobromide of camphor grs. ii. every four hours, with the usual nourishment, egg flip, Brand's essence, beef tea, etc.
JUNE.
JULY, 1894.
29
30
1
2
3 4 5
6
7 8 9
10 11
12 13 14 15
106-
105-
104-
103-
102-4
101-
100-
99.
98-
Pulse
104 108 ¡92 188 18+ 80
120 10$ 101 100 88 76
96
76
78 68 80
80
80 180 $4 80
92 80 8+ 80 80 106
921 88 88 92
Resp.
217