1903 BMJ (Clinical Research Edition)  
MIfARCH 7, 1903.] ROYAL MEDICAL AND CHIRURGIOAL SOCIETY. r O-N 547 could be detected in this. The temperature rose, and at i a.m..on September 24th it was 103,40 F., the pulse I40, and the respirations 42 per minute, while diarrhoea began and continued all next day. At the morning visit the day after admission fine moist rale8 were heard over the base of the left lung, and from the rapid breathing Dr. Finlayson suspected an incipient pneumonia. The temperature fell to normal on the morning of
more » ... on the morning of September 25th, but it rose again the same evening, and indubitable signs of consolidation of the lower lobe of the left lung manifested themselves; the respirations continued to number between 50 and 6o per minute, and the expectoration now became almost black in colour, evidently from altered blood. For the most part the patient continued exceeedingly restless, with diarrhoea and vomiting at intervals, and, although he was able to give his name and address, no information could be elicited from him regarding his accident. The urine was passed into bed at first, but on the 25th it was found to be albuminous, and on the 27th blood as well as albumen was noted. He was now apparently suffering from a severe, almost it might be said malignant, type of pneumonia, with diarrhoea and prunejuice expectoration as ominous symptoms, and, although the temperature during the last two days was rather below than above I01°F., the pulse became imperceptible, and the patient died at 1.15 a.m. on the morning of September 27th, his whole illness having lasted a little over three days. Necropsy. -Th e necropsy, made by Professor Muir, showed that the lower portions of both lungs were consolidated, of a reddish grey colour, and at parts coated with a thin film of fibrin. In the upper part of the left lung there were a number of small ragged cavities where the lung tissue was beginning to break down; both lungs showed signs of an acute bronchitis. Films and cultures revealed the presence of a diplococcus, probably the pneumococcus, in addition a diplococcus of larger size (?diplostreptococcus). The stomach and intestines were oedematous, and here and there were patches of congestion, but there were no erosions of the mucous membrane. The spleen was large, 241 oz., but this seemed due to malaria from which patient was supposed to have suffered while at sea. The liver and kidneys showed some slight changes: the former was described as having cloudy swelling, and the latter catarrhal changes in the tubules. The heart and brain were nearly normal.
doi:10.1136/bmj.1.2201.547 fatcat:t2wiy4hg55ggrda7kzyi7hpy4i