43
and at one period it was a question whether the external iliac artery should be tied for fear of serious hæmorrhage, as had occurred in two fatal cases. There was also some cystitis which persisted for a cousiderable time. The cardiac condition improved slowly-the intermittency persisting for at least two months. On December 31st he was examined again and his pulse although not inter- mittent was very irregular--no valvular disease of the heart could be detected.
221
Case VI.-Eurasian,
Et. 18.
Became feverish on the morning of the 1st July,
A right femoral bubo developed during the day and he was removed to the Hygeia on the 2nd. Treatment: nourishment; ammonia and cinchona every two hours; phenacetin grs. v. every four hours, if temperature above 103° F., quinine grs. v. thrice a day and sponging frequently with water at temperature of 75° F.
JULY, 1894.
1
2
4
106-
105-
104-
103.
102.
101-
100-
99-
:
.
98-
108
Pulse
110
120
$2
120
24
22
24 20
Resp.
T
A
24
2
On the 3rd he was delirious, complaining of being cold and the sponging was left off. Skin was moist and clammy; and there was a considerable degree of cyanosis; he had no sleep during the night; always wanting to get out of bed; plague pulse, but not intermittent. Ammonia and cinchona every two hours as before and quinine grs. v. three times a day. At 7.30 p.m. the temperature was 106° F. and he was now sponged, but without much effect in reducing the temperature; his pulse was still fairly good though dicrotic but not intermittent.
At 2 a.m. on the 4th while the Sister was calling me to see another patient, he got out of bed to go to stool, his attendant having gone to procure ice, and when I went into the ward the attendant was putting him into bed. I found him pulseless and moribund. He had ether injections frequently, hot mustard and water to the heart, ammonia to the nostrils; but all of no avail and he died at 2.30 a.m.
Remarks.—The rapid onset of delirium in this case and the extreme cyanosis which developed on the third day betokened a fatal ending, but the mere coincidence of the attendant and the Sister having to leave the ward at the same time brought about an earlier death than was anticipated. At this time we were able to give an attendant to each bad case on the Hygeia in order to prevent as far as possible any accident occurring. It was noticeable that there was a greater tendency to heart failure in Asiatic patients than in Europeans. In this case also the delirium was low, muttering and stupid from the commencement-I much prefer a trace of violence with a tendency to argument, in which case the patient's vitality is generally considerable and there is not the rapid succumbing that is so often seen when the delirium partakes of the stupid dazed type. Note in this case the fall of four
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