Sessional_Paper_1895 — Page 229

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age tube being inserted. On this date KITASATO again failed to find bacilli in the blood. August 3rd: the glands on the right side of the neck were slightly enlarged but these went down under lead and opium fomentatious. She was kept under observation in a separate ward by herself until August the 8th when she was discharged.

Remarks. This was a difficult case for diagnosis. The case was sent in by three medical men as a case of plague. Surgeon PENNY who saw her first in hospital had doubts as to the correctness of this diagnosis and ou the following morning Dr. MOLYNEUX and myself saw her in consultation with him. The reasons why we thought it not a case of plague were absence of facies and anxiety generally met with, tongue clean, no cerebral symptoms such as she would be sure to have had after a week's illness if suffering from plague-in fact it was quite the reverse, she was perfectly clear in the head and rational. The pulse was also different from either of the types usually met with in the later stages of plague. The history of the case looked as if she had been suffering from renal colic whilst the enlargement of the gland was, I believe, a coincidence. Hysteria was also well marked.

On the 9th July KITASATO also examined some of the discharge from the wound made in the gland and found no bacilli, but as iodoform had been applied freely the day before, no value can be attached to this observation. On the 10th, when under chloroform and the gland could be freely exposed, it had a totally different appearance from that of a plague-infected gland. Instead of being of a dark blue colour and soft in consistence it was yellow with an outside zone of hardness, which en- closed a cheesy purulent centre and while operating I thought that it must have been of somewhat longer duration than eleven days. Besides this the fact that frequent and careful examination of the blood by KITASATO proved negative further convinced us that the case was not one of plague.

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Case XIII-English. t. 23,

Admitted 2nd June with a temperature of 101° F. A right inguino-femoral bubo. Slight frontal headache. First became ill same morning. Temperature chart as follows:--

106-

105-

104-

103-

102-

101.

100-

99-

98-

JUNE, 1894.

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

180

69

102

8+ 80 84 72

Pulse

Resp.

92 84 108 100! 8+ $8 76

During the 3rd of June his temperature was practically normal and led us to doubt the accuracy of diagnosis. No antipyretics had been administered. On the morning of the 4th, however, his temper- ature shot up to 104° F. and he rapidly became delirious. On the 5th his condition was much worse- pulse dicrotic, and very delirious. Has not slept for three nights. Treatment now ice-bags to head and nape of neck, tepid sponging, quinine grs. x three times a day and at 9.30 p.m. he had grain morphia hypodermically, after which he slept most of the night. As will be seen from his temperature chart he rapidly improved and was discharged on the 27th July. The bubo suppurated and had to be opened about the 11th.

On being examined early in December it is found that he has never regained bis lost weight and he is now over a stone lighter than he was before disease attacked him. There is some enlargement of the cardiac dulness, the apex beat being just outside the nipple line. He has slight enlargement of the spleen, but has suffered frequently from ague. He is often troubled by occipital headache which is occasionally severe; and has had, on several occasions, to fall out of parade. He is very nervous and apparently easily excited and to a medical eye is evidently not the same man physically that he was. His pulse, however, is not nearly so fast as No. VII's, varying between

90 and 95.