Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

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    able cause for this. From enquiries made it is clearly not due to any more dependent position of that arm daring sleep. The dyspnrea causes him to be very restless, and the face is pale and perspires freely. About one ounce of expectoration has been brought up every 2t hours since admission. It is very purulent and very suggestive in its appearance of phthisis, but cousidering the extensive area over which the aus- cultatory signs are audible, and their character, the amount is exceedingly small. The sputum has been three times examined (once by myself and twice by the houte physician. Dr. Ainsworth,) for tubercle bacilli, but in each instance with negative results. June 12, 1S94.—Two guinea-pigs were inoculated in the left thigh with the expectoration on this day, the specimen of sputum from which that for inoculation was taken having been examined for tubercle bacilli, with negative results. June 15, 1891.—The dyspnoja has slightly improved. The cough and expectora- tion remain about the same as before. The left arm is the only one which is cedema- tous, and that is less so than it was three days ago. The physical signs over the chest remain as before. , Sonorous rhouchi are audible all over the chest, in addition to the other adventitious sounds over the apices, as described in the note of June 7, 1894. June 28, 1891.—Patient shows very little change except that he has not only cedema of the left arm, but dropsy of the legs has reappeared. There is no oedema of the right arm. He has still marked orthopnosa and some cough. The expectoration is very purulent, but still only about loz. in 24 hours is expectorated, which small amount still remains remarkable, cousidering the extensive pulmonary disease which is mani- , fest; no tubercle bacilli can be found in the expectoration. The physical signs over the chest remain much the same as before, except that immediately below the left clavicle and over the left supra-scapular region the percussion note is of shallow tympanitic quality, and is not dull as was previously the case. I made the following note on this day:—Although the physical signs are so extremely like those seen in a case of phthisis, the appearance of the man is not at all like that seen in a phthisical case. He is a big, well-nourished man, with a full face, sitting up in bed with evident dyspnoea. Urine : 37oz. passed during last 24 hours ; has now become clear ; does not deposit urates ; it is of fairly good colour, not being yery pale ; is acid ; 1017 sp. gr. ; contains fully ^ albumen ; epithelial and hyaline casts ; no blojd. July 11, 1894. The general condition has somewhat improved. He feels better, and the dyspnoea is less marked. There is still well-marked osdema of the legs and left arm, none of the right arm. The physical signs over the chest remain as before. The expectoration is about the same in amount, and presents the same character. It has been examined 16 times since patient's admission, on some occa- sions by myself, sometimes by the Medical Registrar, Dr. R. T. Williamson, and also by the house physician, Dr. Ainsworth, but always with negative results as regards tubercle bacilli. Urine, 64oz. passed during the last 24 hours, is somewhat paler than normal urine, sp. gr. 1013, albumen i. No blood. The temperature since a week after admission and, therefore, for the past month, as shown by the daily chart, has been generally subnormal, only on one or two occasions has it been above normal,' but never since June 11th has it reached 99°. The temperature therefore has been taken every four hours since July 5 th in order to ascertain if there is any rise of temperature at other times than the usual ones at which it is customary to take the temperature of the patients (8 a.m. and 8 p.m.), but only on one occasion during this time has it been above 99° (July 6th at 4 p.m. it was 99-4°), and on six other occasions during this time it has been at points between 98-4° F. and 99° ¥., at other times normal or subnormal. ^See record of every four hours' temperature.) C