A Successful Case of Draining the Lung

Abstract

that it appeared advisable to relieve it by moderate bleeding and quite possibly although only 6 oz. were abstracted, and although there was no immediate good result this step was important towards his recovery, for it immediately relieved the pressure on the nervous centres, if only to a very small extent, while it was not enough to retard his convalescence by unduly weakening him. Temperatures over I080 are usually fatal, and the present case is one more in evidence of the efficacy of the direct application of cold to the body in cases of hyperpyrexia. He was given the bath as soon as it could be got ready.For the restlessness and delirium, both morphine and bromide failed, but chloral always had the desired effect: in my experience a somewhat surprising fact after the two former drugs have failed.The relapse on July i6th was by no means unexpected, and here again cold in the shape of a wet pack acted well.The impairment of speech, sight, andL hearing after the first attack are all evidence of the great strain the entire central nervous system must have sustained.In testing his urine, which was done on the earliest occasion possible, it is to be regretted that it was not possible to test for sugar, as E. C., aged 31, a very stout, well-fed woman, working in the laundry of the asylum, developed an attack of acute pneumonia at the base of the right lung on May 20th, I896. The patient had been in the asylum for eleven years, and was aubject to frequent and severe epileptic fits. With the exception of an attack of influenza in 1892 she had been in good health since her admission.On May 22nd the patch of consolidation showed no increase.It was about 5 inches in diameter. There was a resonant interval between the edge of the dull area and the spine, and there wererno signs of pleural effusion. Her evening temperature was I03.50.On the evening of May 23rd the patient appeared to be more distressed, and her breath was noticed to have a pungently foetid odour. An examination showed that the area of dulness had extended in every direction, and there was no resonant interval between it and the spine. The temperature was IO4°. Later in the night the patient's condition was distinctly worse, and her breathing was short, laboured, and very rapid. The dulness had reached the clavicle, and though harsh breath sounds were heard everywhere, the character of the percussion note was that met with when an effusion is present. The dulness extended one inch to the left of the sternum and the heart's apex beat was outside the nipple line. The temperature was 104.50.The patient was sweating freely, and was obviously very ill. She had some cough, but could not be persuaded to expectorate the sputum.The chest was punctured with an exploring syringe in the sixth space in the posterior axillary line. hours later (6 A.M., May 24th) the patient's condition became very grave. Her chest was again explored, and finally about , vj of opalescent stinking fluid, not blood stained, was obtained through a cannula introduced high up in the axil la...