218
40
On the 1st of July he was rather delirions and breathing, at times, spasmodie, pulse good and regular, but with slight inclination to throw the ice-bag about. The first cardiac sound is prolonged and booming and occasionally a distinct bruit is noticeable. At 6 p.m. he complained of a sore throat and on examination the pharynx was found intensely congested with an ulcer on the palate and left tonsil. Delirium had not been so marked during the day. On this day in the after- noon he had some digitalis added to the ammonia mixture as the pulse began to get weaker and somewhat dierotic. Chlorate of potash gargle for the throat. On the 2nd of July calomel grs. x. given at night. Urine contains trace of albumen.
4th
3rd of July: seems better this morning-pulse improved, throat also improved. Digitalis left out of mixture during the day. Monobromide of camphor grs. ii. every four hours, still going on. of July: condition unaltered, digitalis again given with the ammonia mixture-dozing slightly through the day, but very delirious at night. July the 6th: retention of urine. Began to sleep now first time for three days. July the 7th some cystitis evident,―some muco-pus in the eye of the catheter and a tinge of blood. Large quantities of barley water ordered. 8th of July: delirium practically gone and condition improved-strychnin and iron mixture ordered, liq. strychnine m. v. and liq. ferri dialysat, m. viii, thrice a day.
On the 13th of July slight pleuritic rub right side, mustard plaster locally. On the 26th of July some lymphangitis of the left arm, treated by lead and opium. Discharged cured on August the 3rd. Bacilli found in blood morning of the 30th June. Bubo was opened on the 8th and was almost closed when he left for Japan. The pleuritic rub disappeared in a few days.
Remarks.--This patient was easy to manage as he was not physically so strong as some of the patients who were on the Hygeia at the same time. The study of delirium in its early stages was a most interesting one at this period. In one ward we had Case V, whose great desire was to have a "quiet wrestle" with his attendant whom he nearly threw out of the window at an early stage of the disease and which he was inclined to try again had not effectual ineans been taken to prevent him getting out of bed. In the next room was a patient who fancied himself a "fowl in the air
" and who usually was in a most happy mood. Next to this patient we had one who, until prostrated, was a most violent subject to deal with, whilst I's failing was a desire to stand up in bed and address an imaginary audience, but-quite different from II.—always ready to listen to our reasoning and at once obey orders. It will be noticed that this patient's temperature fell from 103° F. to normal in twenty-four hours, a fall closely resembling a crisis. The throat affection was the only marked one we had where the prominent glandular swelling was not in the cervical region and led me to consider if he had been infected by respiration and not by inoculation. Here also, notwithstanding scrupulous attention to the cleanliness of the catheter, cystitis developed in about thirty-six hours after the catheter was first used but which got rapidly well by simply giving diluent drinks and strychuin and iron. The occurrence of lymphangitis during convalescence was noticed in several other patients, but is only to be expected if the slightest irritation is present,
Case IV-English. Æt. 35.
Admitted May 31st with high temperature, considerable headache, vomiting and a left inguinal bubo. Treatment: tr. aconite m. vi, vin. antimonial m. viii., aq, chlorof. ad. 3 i. 4 times a day with draught chloral hydrat. grs. xx. and pot, bromid. grs. XL. at 9 p.m.; nourishment-
--as much as he could take. Same treatment on the 1st, but as the aconite mixture had not brought down his temperature at 6 p.m. he had antipyrin grs. x. every four hours, four doses in all, aconite being stopped.
MAY.
JUNE, 1894.
31
1
2
3
4
106-
105-
104-
103-
102-
101-
100-
99.
:
98--
Pulse
Resp.
B.O.
116
100
108
101
100
116
2
3
2
36 40 48 50 56
N
2
3
Ι
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