Cases of Sthenic Pneumonia and Asthenic Pleurisy

C. H. Jones
1857 BMJ (Clinical Research Edition)  
years. Sometimes there was an interval, varying from a week to a month, in which there was no discharge, either white or red: lately, however, the discharge had been constant. It appeared that there was no interval between the cessation of the catamenia and the appearance of this discharge: the duration of this latter must, therefore, be uncertain. No enlargement of the uterus was perceptible above the pubes. In the vagina, a softish leathery-feeling mass, larger than a walnut, was felt hanging
more » ... through the os uteri. The circle of the latter could be felt clearly on the right side and fore part, the finger not reaching it well in other directions. There was blood in the vagina; and the speculum showed the surface of the polypus to be superficially ulcerated. April 3rd. When she was under the influence of chloroform, and laid upon her stomach upon the operation table, with the legs hanging down, the vagina was dilated by means of suitable speculum and spatulte. Mr. Humphry then seized the polypus with the vulselluni, anid pulled it down so as to bring its neck through the os uteri, and enable him to pass the chain of the heraseur rounl( it, some distance above the expanded portion which projected through the os. It was easily divided by the instrument, with scarcely any hnemorrhage; anid was brought away. It consisted of the ordinary fibrous structure, covered by a thick lbyer formed, apparently, by a prolongation of the lining membIane of the uterus. This, which had furnished the blood, was, at the extremility of the polypus, vascular an(d ulcerated. April 2i3rd. No unfavourable symptoms followed. On examination, the os uteri was found natural; there was no trace of polypus. A week after the operation, there was some discharge, of a red colour; but this soon ceased, and there has been no return of it. REMIARKS. There is perhaps nio class of affections in which the ecraseur is likely to prove of more real value than polypus uteri, provided the chaini can be applied sufficiently high upon the neck of the tumour. By it would be avoided, to a great extent, the dangers incidental to the ordinary plan of ligaturing the polypus by means of Gooch's canula. such as inflammation of the veins, secondary abscesses, etc., which have so often proved fatal, that the operation of tying a polypus is, with reason, regarded as one of great danger. The lisk of hnemorrhage, which has constituted the objection to the more speedy removal of the growth by the knife or scissors, as practised by Dupuytren, is also avoided. The difficulty of passing the chain hiigh enough round the neck of the polvpus, wlhich will prove the objection to this new method, may be often, in great nmeasure, overcome by seizing the polypus with hooks, and dragging it lower down, as was done in this instance. It was a peculiarly favourable case, from the fact of the tumour having already, in part, passed through the os uteri. It should also be borne in mind that it is not always necessary to remov-e the whole of a polypus; for, when the expanded portion has been taken away, the part of the neck remaining in the uterus commonly wastes, or, at any rate, gives no further trouble. aged 27, a carter, a healthy man, was admitted on Mlarch 9th. He had been ill five days: at first he had shivering, which continued up to his admission; at times he was "' like a furnace ". On admission, his face was flushed; skin warm; pulse weak, ratber frequent; tongue coated; lips livid. He had pains flying all over him, most felt about the lower part of the loins. He had a bad cough all niight long; the expectoration had been like blood for several days. There was some dulness in the lower part of the right back, perhaps also in the left: nowhere else. There was good breathing in the left fronit, with prolonged expiration; fair breathing in the uipper part of the left back; and small crepitation and harsh breath. sound in the lower part. There was loud breathing in the upper part of the right lung; in the lower part, both in front and behind, there was inspiratory crepitation (not fine), with prolonged expiration. There was more vocal fremitus on the right side than on the left. A turpentine stupe was ordered to be applied over the whole dorsal surface of the chest, and to be kept on as long as possible; and the following medicine was prescribed:g Antimon. potassio-tart. gr. ss; liquoris opii sedativi iqv; infusi calumbae Si. M. Fiat haustus tertiis horis sumendus. March 10th. I visited him at his own residence, and found that he had not coughed nearly so much. He felt much relieved; had not vomited, and had been very little nauseated. The pulse was 100, large; the tongue white; he had copious perspiration. The expectoration was free from visible blood, very adhesive, scanty, and transparent. The urine was loaded with lithates; its quantity was not more than half a pint in twenty-four hours. The respirations were 46, chiefly abdominal; the movement of the lower ribs was diminished, that of the upper increased. Dulness, not absolute, existed in all the right back; bronchial breathing was heard at the upper part, at the middle a moist middling sized rale, at the lower part the same, with fine crepitation. In the left chest, there was more vesicular sound, but very imperfect, with moist bronchial rale. In both fronts there were loud snoring and semi-moist bronchial sounds, with very little vesicular. A senna purge was ordered; and he was ordered to take two drachms of bicarbonate of potash daily in his ordinary drink. Repetantur inistura, et fotus terebinthinT. March 11th. Pulse 105; respirations 46. The expectoration is very small in quantity, very tenacious, clear, and transparent: it contains but few mucus-corpuscles, and those delicately granulous, some much larger than others, and a good many red blood-corpuscles, with a few flat scales, and some oil-drops; with here and there a few fibrinous films-quasi-membranesof fibro-homogeneous aspect. The quantity of urine in the last twenty-four hours was 44 ounces; it is very high coloured, almost as if bloody, clear at first, but, after standing a night, precipitating an abundance of lithates; specific gravity, 1026 acidity of about the normal degree, as measured by a test solution. The total amount of urea was 499.84 grains; of uric acid, 19-8 grains. March 12th. His bowels were open this morning. Pulse 93; respirations 40. The expectoration is the sam-le. The left lung is clearer. In the right lung, there is fine crepitation at the upper part of the back; and absence of breathing, with coarse moist rale, at the lower two-thirds. & Antimon. potassio-tart. gr. i; liquoris opii sedativi asv; misturte camphorne i. M. Fiat haustus tertiis horis sumendus. March 13th. Pulse 75, quiet; respirations 27. Pain felt. yesterday in the right side has been much easier since the application last night of a sinapism, followed by a linseed-meal poultice. The expectoration is the same. The left lung is nearly free; the right lung has some vesicular breathing at the upper third, with short, weak, moist redle in the lower twothirds. The tongue is coated at the back. He has slept better, and has had no sickness. The mnixture and the bicarbonate of potass were continued. Sumat pro re nata pilulhe hydrargyri cum colocynthide gr. v. March 14th. Pulse 70, small and weak; respirations 30. The expectoration is frothy, less tenacious, and clear. Resonance is fairly good in all the light back, and in the left, except at the lowest part; air enters freely at the upper half of the right on deep inspiration, not in the lower half. There is much rile in all this back; fine with vesicular sound above, coarser without vesicular sound below, and very brief. Clear and healthy breath sound, without rd&e, is heard in all the left back, except the very lowest part, where it is null. Full and clear breathing is heard in both fronts. In the lower left lateral region, the breath-sound is null, and is replaced by some fine crepitus: no pain is felt here. The sputa of yesterday contained a strikingly small amount of cell-growth, a few fibrinous films, and numerous torlahe in groups or linear series; it was still transparent, very tenacious, and scanty. The quantity of urine in the last twenty-four hours was 30 ounces, of lighter colour than the former specimen. The acidity was much less than on the llth; each ounce was then neutralised by sixty-five drops of the test solution, now by fifteen. Specific gravity 1026. It is full of glistening prisms of triple phosphate. The total amount of urea is 334-56 grains; of uric acid, 17-550 grains. Pergat in usu mistura quater die. March 16th. Respirations 29; pulse 70. Much perspiration still continues, as has been the case throughout. The tongue 408
doi:10.1136/bmj.s4-1.20.408 fatcat:wwg75q2c2jecvasabp7xfvedza