The Study of Symptoms
BMJ (Clinical Research Edition)
A large, mass of greenish-yellow pus was found on the vertex near the median fissure (pneumococcus isolated). Base of brain clear. No arterial emboli or areas of softening seen. The brain was congested and oedematous. The ears were dry. The spleen was soft. Cause of death: ulcerative endocarditis, septicaemia. R. N. TATTERSALL, M.D., Captain, R.A.M.C. The recent interest shown in cases of renal 'failure after crush injuries makes the following report worthy of record. CASE REPORT The patient, 4
... man aged 20, was buried in the basement of a house on September 8, 1941. He was -pinned down, lying on his side, with debris pressing chiefly on his left thigh and right forearm. He was dug out after eight and a half hours, and reached hospital at 9.30 a.m. He was thin, anaemic, and poorly developed, but his general condition then gave rise to no concern. He complained of pains in his back, legs, and right arm. The temperature was subnormal, the pulse 100. He passed urine containing blood. At 11 a.m. he collapsed, his pulse rose to 140, and he sweated profusely. The systolic blood pressure was 90. Restorative measures were started-hot-air cradle, raising the foot of the bed, and a pint of plasma was given intravenously. By noon his pulse was 130 and the blood pressure 110/70. Morphine 1/4 grain was given, and the plasma drip was continued until a total of two pints was reached. He vomited once. At 2 p.m. his pulse was 140, but of good volume, and he was obviously improving. He could move both legs slightly, though with pain. The abdomen was soft, moved normally, and showed no rigidity. There was a short systolic murmur, most audible at the base. Curious patches of erythema, almost like erysipelas, appeared on each buttock and were thought to be due to compression; these persisted for three days. At 7 p.m. his pulse was still 140, and he was sweating; he vomited back fluid soon after taking any drink. A rectal drip saline was started, and he was given a further 1/14 grain of morphine. He slept fitfully. During September 9 his pulse varied from 140 to 170; he felt better and had no pain, the right forearm and left thigh were swollen, foot-drop was present, but the radial and anterior tibial pulses were palpable. The urine passed was scanty (12 oz.) and still contained blood. On the 10th his general condition had improved; the pulse had dropped to 120, but vomiting continued, 10 oz. being returned out of a total of 40 oz. taken. No urine was passed. He had no desire to micturate, nor was the bladder full. He slept better and continued to drink well. On the 11th the pulse dropped to 92, he made no complaint except of numbness in the left leg; vomiting continued (regurgitation of part of the fluid taken). At 7 p.m., having passed no urine for forty-eight hours, and there being no sign of the bladder filling, one pint of glucose saline was given intravenously, together with 2 c.cm. of mersalyl. Two hours later he passed urine; altogether 32 oz. was passed in the three hours following the injection. It was free from blood, but contained a moderate amount of albumin. On the 12th his condition was satisfactory; the pulse was 80 to 90, vomiting had ceased, and the urinary output was 24 oz. ; alkalis by the mouth were started. Since then his condition steadily improved; the albumin,disappeared, and he began to take food readily. On October 4 the oedema had gone from both affected limbs, but there remained in the flexor muscles of the right forearm a patch of swollen tender tissue, roughly 3 in. by 1 in. Full extension of the wrist and fingers was difficult and painful. A similar condition existed in the hamstrings of the left thigh, and foot-drop was still present. These disabilities were dealt with by splinting, massage, .and exercises. The condition was exactly .comparable to that seen in Volkmann's ischaemic contracture.