A CASE OF EQUINIA (GLANDERS); RECOVERY

T.W.H. Garstang
1895 The Lancet  
Taking now the three yearly averages for the different weeks separately, and so forming an annual temperature curve, a similarly slight degree of total variation is seen. It appears that the highest sustained average temperature occurred in the winter and early spring months, as may better perhaps be seen by taking four weeks together, when we obtain for these lunar months, commencing in the middle of June, the figures 9875°, 9875°, 98-80°, 9872°, 9880°, 9889°, 9892° (December), 9890°, 9897°,
more » ... r), 9890°, 9897°, 9890°. 9895°, 98 82°, and 9885°. This result is in agreement with what we I might perhaps expect, since in cold weather loss of heat must be more rapid, and so a higher level of temperature should be maintained to compensate for increased radiation, just as small animals, which lose heat more quickly in proportion to their bulk than large ones, have generally higher temperatures. Before leaving this part of the subject it may be noted that the temperatures in the mouth and rectum respectively bore to one another a very variable ratio, the latter being almost invariably the higher, with an average difference of 08°. Thus on some occasions, as immediately after eating, the temperature in the mouth exceeded that in the bowel ; while on others, as during vigorous exercise, the heat of the mouth sank considerably-e.g., to 96°-that of the rectum rising to 99-8° or 100°. Coming to the pulse-rate, one fact which was well marked was the regular fall in frequency throughout the day, the average number of beats at each of the four times of observation mentioned being respectively 88 (72), 86 (71), 80 (67), and 77 (64), the numbers in parentheses being those taken in the sitting position, the others standing. A steep rise in pulserate appeared to occur at breakfast time, the average rate I before this meal being, on the few occasions when it was I observed, 80 (64), and after breakfast 89 (73). The heart would thus appear to tire slightly with its work during the day and to recover its energy by the night's rest, being thus at its best in the morning, as seems to be the case with the mental faculties and perhaps with all the functions of the body ; one might even suggest a causal connexion. The ratio between the pulse-rates taken in the sitting and standing positions respectively varied within very wide limits, the difference being on some occasions not more than three or four beats and at others as many as thirty, without any apparent reason. The average difference for the whole time was fifteen beats. It occurred to me that atmospheric pressure might have some influence on the rate of beat, but a comparison of the pulserates for the different weeks with the readings of the barometer did not give any definite result, though during a sojourn in Norway, when staying at very different altitudes for successive weeks, there appeared to be a tendency for the pulse-rate to fall with the barometer, very low frequencies being found at high altitudes, and also on many occasions very low temperatures ; but this correspondence may well have been a mere coincidence. On hearing the above notes Professor Burdon Sanderson was good enough to call my attention to the observations of Professor Jnrgensen 2 on body temperature, and also to lend me the paper in which these are published. These experiments were carried out under very different circumstances from my own. Several different subjects were taken ; they were kept in bed for the most part during the course of the experiments made, and other observations were made at very frequent intervals throughout the day, often several times in a single hour. They thus afford a very exact record of the normal body temperature, free from all disturbing influences such as the ordinary business of life introduces, but it was obviously not feasible to keep a healthy man in bed for experimental purposes for any considerable length of time, so that each series of observations was confined to a space of a few days, and the whole were comprised within one year. Comparing Professor Jiirgensen's results with my own, it appears that the average figures obtained by him for the four times of day at which my observations were taken are 3?°. 373°, 375°, and 37'3°C. respectively, or approximately 98 60, 991°, 995', and 99T F., showing a rather higher level sustained throughout and a maximum towards evening, corresponding to the familiar fact in clinical observation where the conditions are similar. These observations were all taken per rectum. In conclusion, I may perhaps mention that the times chosen for taking observations in my own case were not ideally the best, but were such as a more or less busy life 2 Die Korperwärme des gesunden Menschen; Studien von Professor Dr. Jurgensen. Leipzig, 1873. rendered possible. It is unnecessary to emphasise the fact that such observations as these made on only one individual can have but a limited value for establishing any general rule, while fallacies owing to the "personal equation" may lurk in making experiments on oneself. My best thanks are due to Dr. Mott for kindly looking through these notes, and for affording me the opportunity of submitting them to the distinguished society before whom they were first produced. THE rarity of the occurrence of recovery from equinia is my excuse for recording the following case. The patient, a veterinary surgeon fifty-four years of age, concluded a period of attendance on a certain horse suffering from "nasal catarrh " of a suspicious type on March 22nd, 1894. On April 4th the animal, having had a relapse, was brought to his house. He administered a II drench" on the spot, and whilst doing so the horse coughed, and a quantity of sputum bespattered his arm and face. This was at 10 A.M., and he, being pressed for time, set off on a professional journey without washing. The arm felt " uncomfortable " the same night, and the patient had " felt ill " ever since. It was not until April 12th that I was called in, and on this date I was consulted for a pustular rash on the right arm, said to have appeared the day before. The above history was not at that time given to me. The case was treated with compound sulphur ointment. On the following day the patient reported his arm as " better." On the 14th he had gone out when I called, and I did not see him ; but he had left a message that he was still "better." On Sunday, the 15th, I was sent for at midday, and was then for the first time able to make a complete examination. The man was practically covered with pustules from head to foot. The face and scalp had a few, the chest and back more ; but the extremities suffered most ; the inner surfaces of the arms and thighs were very bad, but the right thigh was the worst of all. Here the skin was completely covered with pustules in the following stages : small, hard lumps forming subcutaneously, the size of a pea or bean ; similar lumps burst and discharging pus ; others scabbed over ; and, finally, foul ulcers of various shapes and sizes where the scabs had separated. The most intense burning and itching were complained of. The extremities were said to feel as though " wrapped in blankets through which scalding water was being poured." Ribbing and scratching were incessant, although that only aggravated the pain. The pustules were appearing in rapid successive crops, about twelve hours sufficing for a given one to run through the whole of the stages mentioned above. The patient, though much prostrated, refused to go to bed, and managed to keep on his feet. I gave him a strong dose of iron and quinine, and feeling sure that he had not more than a few days to live arranged that Dr. D. J. Leech of Manchester should see him on the following day. On this day, the 16th, there was a discharge from the nose and eyes, and the legs were so greatly swollen that the patient said "they felt as if they would burst." Boric acid dissolved in Carron oil was ordered locally, with a nasal douche of Condy's fluid, and the iron and quinine were to be continued. On the following day the patient appeared slightly easier. Daring this time he was taking a large quantity of brandy, and by the 20th I had to administer large doses of bromide. Improvement, however, continued slowly in the local symptoms, though the patient still refused to go to bed and was very obstinate about treatment of any kind. Sometimes he would refuse to take his medicine or to obey orders in any way. By the 24th the rash had disappeared from the arms, leaving only red and purple stains to show where it had been, and the legs were improving. On the 25th a large quantity of pus was expectorated from the lungs; also on the 26th. The nasal discharge had increased. His strength was greatly impaired. On the 28th a quantity of sputum was collected and sent to Dr. Leech for bacteriological examination. By May 2nd the rash had disappeared everywhere, and the nasal discharge and expectoration of pus had ceased. On the llth I
doi:10.1016/s0140-6736(01)93074-0 fatcat:3ocjnuv2kndghaeli4t3evt534