1917 Journal of the American Medical Association  
Usual management, the lung condition began to improve, and at the same time the patient was disturbed by slight chills followed by hot flushes, and sharp shooting pains in and around the heart. Abruptly on the afternoon of November '•> there was a chill followed by extreme collapse, a subnormal temperature, and a loss of the wrist pulse. The heart Was irregular, missed every third or fourth beat, and became so weak in action that five hours of strenuous stimulation were required before anything
more » ... red before anything like security prevailed. For several days the heart labored under the influence of a marked toxemia. There was every sign of sympathetic Paresis as expressed by nausea, flatulence, dizziness, cold Perspiration and varying degrees of fever. The patient bad been complaining of pain in the left parotid region. November 17, this gland was markedly swollen, tender and painful'. The opening of the duct was pouting and reddened. By careful manipulation a quantity of greenish-yellow mucopus was expressed. Three days later the right gland became involved "i the same manner as the left. From 3 to 10 c.c. of a meenish-yellow pus was expressed from these glands two or three times daily for a period of about two weeks. November 21, the pus was examined by Dr. C. A. Johnson, pathologist, who found pncumococci in pure culture. Blood examination
doi:10.1001/jama.1917.04270060089004 fatcat:lldnfa5qyjcezlj4rj3q22stge