CASES ILLUSTRATING THE STATE OF THE HEART AND THE USE OF WINE IN TYPHUS FEVER

Stokes
1839 The Lancet  
admitted on 10th May, eleventh day of his fever, complaining of intense headach ; general eruption of petechiae ; the sounds of the heart were feeble, but proportionate; impulse imperceptible ; pulse 98, full, but easily compressed. -Ordered wine, eight ounces ; camphormixture, with carbonate of ammonia. May 11. Pupils contracted ; countenance flushed; decided bronchitic rales ; impulse of heart just perceptible; the sounds are acquiring the foetal character: between the fourth and fifth
more » ... stal spaces scarcely anything is heard but the second sound; pulse 92. -Continue wine and mixture cupping, and blister to the chest. 12. The bronchitis more severe, but the countenance has a better expression. The first sound is more distinct; at the mamma both sounds can be heard, although feebly; pulse 84.-Wine, twelve ounces; decoct. of senega, and carb. of ammon.; dry cupping between the shoulders. 13. Bronchitis continues. Both sounds are now distinctly audible under the mamma and below the sternum.-Wine, eight ounces; repeat the rest. 14. Slept well; some aphonia, with tenderness of the trachea on pressure ; countenance flushed. The impulse of heart just perceptible; sounds distinct, still feeble; pulse 92.-Wine, eight ounces; blister to throat. 15. Bronchitis less ; passed a good night. Both sounds of the heart are proportionate; pulse 82.-Wine, six ounces. 16. Bronchitis subsiding in the right lung, but engaging the minute tubes of the left to a considerable extent. Both sounds proportionate and distinct; pulse 88.-Wine, six ounces. 21. Impulse of the heart perceptible; the sounds natural; pulse 60.-Dry cupping; senega mixture, with antimony. 24. On this day he was pronounced convalescent. PETECHIAL FEVER.-DIMINUTION AND TEMPO-RARY ALTERATION OF THE FIRST SOUND OF THE HEART.-RECOVERY. Thomas Devereux, admitted into hospital on the 23rd of May, the eighth day of fever. Petechiae plentiful, but of healthy colour; respirations hurried; complains of cough, which is accompanied with a frothy mucous expectoration; bronchitic rales are only heard in the upper portion of the right lung, —is very low; pressure on the abdomen gives pain ; great thirst ; the impulse of the heart is scarcely perceptible ; the sounds are proportionate, but feeble ; pulse 112.-Ordered six leeches to the epigastrium; castor oil, three ounces, in emulsion, with tinct. opii, three minims. May. 24. Complained of intense headach yesterday evening, which was relieved by epistaxis ; bronchitic rales very intense ; ; breathing laboured ; respirations 40. Sounds of the heart are feebler than yesterday ; pulse 116, fuller and stronger.-Wine, six ounces ; cupping to eight ounces ; blister over the heart. 25. Bronchitic rales not so intense; respirations 48; countenance more animated; ; abdominal tenderness completely gone; had slight epistaxis yesterday evening; some headach; pulse 10S; sounds of the heart somewhat louder over the apex ; impulse perceptible.-Omit wine; leeches to the temples. 26. Three leeches were applied, and gave great relief; respirations 48 ; slept well. The Dulse taken earlv in the morning, was 108; later in the day, 116 the sounds of & p o u n d ; the left cavities of the heart are exceedingly feeble, at the apex the first sound can be distinbuished, but at the mamma only the second is heard; the superiority of the second over the first is also perceived over the right cavities ; impulse just perceptible.-Effervescent mixture. 27. Slept well; bronchitis better; complains of stuffing in his head ; countenance to-day is more flushed ; had slight epistaxis yesterday evening ; respirations 44 ; pulse 100, soft and compressible ; the impulse of the heart is perceptible ; the sounds are feeble, the second still predominates over the first.-Omit mixture; porter, a pint; arrowroot diet. 28. Had slight epistaxis yesterday evening ; slept well. The sounds of the heart are yet feeble, the second predominating over the first; pulse 96, good strength.-Senega mixture. 29. Respirations 28, easy; no headach ; slept well. Sounds to the left of mamma very weak, distinct however; much stronger to the right.-Continue. 30. Respirations 28 ; tongue clean and moist; skin cool; slept well; countenance improved ; still has slight bronchitis ; pulse 76, soft; phenomena of the heart as before. -Continue ; porter, one pint. 31. Much improved. Impulse of heart perceptible; the sounds over the left cavities are stronger, the two sounds being now proportionate.-Porter, one pint. June 1. Pulse 60, natural ; the sounds of the heart are stronger; impulse perceptible. , -Porter and beef-tea. 8. Convalescent.
doi:10.1016/s0140-6736(02)80011-3 fatcat:f2uhu6bshvgytlg6oqixfxk4we