220
42
On the 27th quinine pill grs. v. three times a day ordered. Tepid sponging every two hours and liquor morphiæ m. xxx. at 9 p.m. On the 28th morning, pulse slightly intermittent and tendency to delirium; tr. digitalis m. xii., sp. ammou co. m. xxx., tr. cinchon co. m. xxx. ordered every four hours. No sleep during the night. On the 29th delirium marked; pulse still slightly intermittent. Hyosein hypodermically gr. YOU.
On the 30th at 2 a.m. he had another gr. r as he had not slept at all and was continually wanting to get out of bed. At 9 a.m. has had no sleep, pulse very irregular now; pupils widely dilated, (? Hyoscin). 12.30 p.m. had grs. x. bromide of ammonium.
1
1st July at 3.30 a.m. he had gr. morphine, "He repudiates the ice-bag"-pulse inter- mittent, and anacrotic-no rebound wave by sphygmograph. The morphia had no effect in quieting him and at 4.30 a.m. he had a hypodermic injection of gr. hyoscin. After this be slept for over an hour. At 10 a.m. urine was drawn off by catheter, highly coloured, ammoniacal, deposit of mucus, trace of albumen, and deposit of phosphates (by microscope). The digitalis and ammonia mixture continued as before. At midnight he at last got a good sleep and slept until 5 a.m., morning of the 2nd July ; pulse still intermittent-no lung complications; taking his nourishment well; ammonia and digitalis mixture continued and grs. iiss. quinine instead of grs. v. three times a day. No sleep at night. July 4th, situation unchanged.
Low
During the night of the 5th as the pulse had improved thongh still intermittent, the digitalis was left out of the mixture. No sleep. Until the night of the 7th condition got worse. muttering delirium, and his pulse was now very bad, stimulants being given freely. On the evening of the 7th he had a hypodermic injection of hyoscin gr. and slept until about 7 a.m. on the 8th. This seemed to be the turning point for on the 8th he was much better and was put upon strychnin and iron, in addition to the cinchona and ammonia.
On the 12th the bubo was opened and a large amount of pus evacuated. On the 16th ammonia and cinchona three times a day was the medicine he was getting. His pulse was still somewhat intermittent but otherwise much improved in quality. On the 18th extract of malt three times a day ordered. On the 20th he was ordered tinct. strophanthi m. x. and liq. strychnin m. v. thrice a day under which the condition of the pulse rapidly improved.
On the 5th of August cultivations from and microscopic examination of blood and bubonic discharge showing no bacilli, he was removed to the Civil Hospital. At this time there was some considerable enlargement of the glands along the iliac vessels and as there had been a great amount of sloughing in the upper part of the thigh careful surgical attention was necessary. The mass in the iliac fossa remained large and indurated for over a month and was opened by Surgeon PENNY whilst I was in Japan, whilst several other openings were made afterwards. A long and tedions convalescence terminated by his discharge from Hospital on December 2nd, the most of the swelling having disappeared and the sear being firmly healed.
JULY, 1894.
13 14 15 16 17 18 19 20 21 22 23
24 25 26 27 28 29
106-
105-
104-
103-
102-
101-
100-
99-
98--
176
190 88
Pulse
88
92 100 96
72 00 $2 92 72
88 94 96 100 9S 96 104 10% 104 104 $$ 83 St
188 60 SS 72
70.
20
20
22
20 18 16 14 19 15. 12/12 16 14
16 16
Resp. 20
20
201 22
16 12 16; 18
14 10 14 16/ 18 16
0:
0
0
B.O.
2
0
2
A
Remarks. This was a most tedious and anxious case up till the end of October. The enlarged iliac glands (the induration round which extended to within an inch of the umbilicus) gave rise to considerable atony and obstruction of the bowel, which necessitated urgent manual mea- sures on several occasions. The femoral artery lay bare on the surface of the callons ulcer for a long time
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