A CASE OF ACUTE, NON-TRAUMATIC, MULTIPLE OSTEO-MYELITISPRODUCED BY THE STREPTOCOCCUS, OCCURRING IN A MALE ADULT

JOHN T. BOTTOMLEY
1903 Journal of the American Medical Association (JAMA)  
A. H. C., 43 years old, a theatrical manager, was born in France, lived most of his life in England, and had been five years in this country. His family history was negative. His previous history up to 1892 was not noteworthy. Though he had led an irregular life, with much excitement, travel and exposure, he had always been strong and robust. Venereal infection was denied; a moderate use of alcohol admitted. About 20 years ago he broke his left tibia at the junction of the lower and middle
more » ... wer and middle thirds, but it had given him no bother since. Ten years ago he had an attack of "left-sided pleurisy" which lasted about six weeks. Though he soon recovered his normal weight and strength, he has since then had more or less pain in his left chest, a harassing cough, an almost constant bloody expectoration and the lower lobe of his left lung has been flat to percussion. These symptoms have always been exaggerated after prolonged physical exertion or mental worry. Occasionally, but only for a period of a few weeks at most, he would be free from them. Such a period occurred last spring, but the symptoms, returning in June, continued till his death. Several specialists, both here and abroad, had examined him, but a definite diagnosis had never been made. The uniformly bloody, prune-juice expectoration had been carefully examined again and again for tubercle bacilli, streptothrix, actinomyces and for neoplastic elements, but always with negative results. He had undergone, as a diagnostic measure, most thorough anti-syphilitic treatment without relief or a small hernia this muscular approximation is not difficult, and is the operation of choice, but in the larger openings an inch or more in diameter, it is impracticable, and, so far as I have been able to judge, the attenuated muscles, when secured, are
doi:10.1001/jama.1903.04480010004002 fatcat:lye3dcy3u5cbpnubpdu2pmes5a