224
46
On the 22nd, five days after her admissiou, a well marked lymphangitis was noticed on the dorsum of the right foot. A small sore between the first and second toes being noticed; this was not visible the day before. The lymphangitis rapidly spread, until it reached up to the femoral bubo. I never noticed a case of plague where lymphangitis preceded the bubo; several cases were sent in with lymphangitis supposed to be suffering from plague, but all of these were not cases of plague. Of course it is difficult to say that there was never lymphangitis before lymphadenitis and when the statement is made that lymphangitis, when it did occur, always followed the inflammation of the gland or glands, it is meant that no redness along the line of the lymphatics was apparent, no hardness was noticed, and no uneasiness or pain felt. The lymphangitis on the postero-internal part of the leg went on to suppuration with extensive sloughing extending from the level of the internal malleolus to the knee and required free incision. After a lengthened convalescence she was discharged on August 20th, repeated attacks of lymphangitis above the knee having occurred for two or three days at a time during that period.
4 5 6
106-
105-
104-
103-
102-
101-
100-1
93-
98-
1-
JULY, 1894.
8
9
10 11 12 13.14 15
16 17 18 19 20
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Case XI-Indian. Et. 20.
Was admitted for observation on the 22nd June, having suffered for the previous twelve hours from headache which he thought was due to malarial fever and in consequence had treated himself with quinine. He was suspected of having plague by Dr. STEDMAN as he was an inmate of a house which had already supplied us with two patients. On the morning of the 23rd the following note was made.
"A right cervical (parotid) bubo appeared during last night and is now very large." During the course of the day the surrounding edema became very great, extending almost right round the neck and swallowing was a matter of extreme difficulty. The breathing was also con- siderably embarrassed and he rapidly sank dying at 8 a.m. on the 24th. His temperature chart is subjoined.* The fall in temperature was caused by phenacetin grs. viii and was another instance of a bad case, easily affected by antipyretics, rapidly proving fatal. The end was sudden, as after passing a motion in the bed pan he turned over and died.
Case XII--Jewess.
Et. 24.
Admitted at 8 p.m. on 30th June, with an enlarged gland on the left side of the neck. (Temperature chart as follows.†) The history which we got of this case was as follows. On the 24th June, she first became ill "giddy and swimming in the head." On the following morning she bad a temperature of 105° F. She had quinine and phenacetin. On the evening of the 26th she had slight vomiting and pain in the chest and was prescribed a mixture of ascetate of ammonia, antipyrin and digitalis. On the 26th she was “very bad.” It seems that about the 21st June, she first began to pass blood in the urine and after that day blood was almost constantly present in the urine until admission. On the morning of the 30th the swelling on the left side of the neck is said to have com- menced. Menstruation finished on the 23rd and returned on the 27th for one day only. One year ago she had a child, a well marked mitral bruit being present at the time of confinement.
On examination on the 1st July she complained of a general pain or soreness confined to the Jeft half of the body. On palpation of the left kidney she complained of pain on pressure and mentioned that she had frequent attacks of pain there; no pain over the right kidney. There was some tenderness over the left ovary; there was a well marked regurgitant mitral bruit-no œdema of the lower extremities. The gums, lips and conjunctive blanched. No bacilli were found in the blood by KITASATO. No blood was now found in the urine, only a deposit of mucus. Diagnosis suspended. July 2nd: complained of much pain in left hip shooting down the leg again. No bacilli found by KITASATO. Diagnosis "not plague." July 8th deep fluctuation in the abscess of the neck; a small incision was made, but no pus was evacuated on account of the patient's violent behaviour. On July 10th chloroform was administered and pus evacuated from the centre of the glaud, a small drain-
* Temperature churt has becu lost since this was written, the fall mentioned was about 4° F.
f This chart bas also gone amissing.