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more comfortable, pain is considerably relieved, but the temperature is no lower.
8th.— Temperature 101°; pulse 104. Though the medicine is given carefully and regularly there is no diminution in the temperature, but the opposite. His sleep is very much disturbed. During the following week the symptoms continued much the same. Having had misgivings on my mind that possibly the trouble in the joint might be of Pyæmic origin I had each day made careful enquiry for any history of rigors, and had closely examined the painful part for any evidence of an abscess, but could detect none.
12th.— Temperature 101 2-5°. Pulse 1100. Retains the same position on his right side, and cannot bear to be placed in any other position. His sleep is exceedingly restless and delirium is present, but not constantly.
13th.—Morning temperature, 101 2-5o. Pulse 116. Evening temperature 102 2-5°
15th.—Morning temperature 102 1-5° Evening 103 2-5o. His bladder is excessively irritable ; scarcely able to retain even a few drops of urine, 16th.-Had during the night very severe bleeding at the
He has, however, been often subject to this before. Patient is evidently much worse to-day. Face expressive of the greatest anxiety. Pulse 128 and very irregular. Temperature in the morning 103 1-39. Tongue dry and clammy. I ordered brandy, a half ounce every three hours, and substituted quinine in the place of the salicylate of soda. Dr. Fenwick saw him in consultation with me and regarded the case as one of pyæmia. There was not however, as yet, the slightest evidence of pus. The pain in the hip joint is very severe; the opiate has lost its power though administered in increasing doses from the beginning. He also complains of great pain and tenderness over the scrotum. The quinine was directed to be given—5 gr. dose three times a day. Temperature that evening 104°
17th.-Morning temperature 102 2-50. A rash not unlike measles is now present on the back and forehead. The perspi
rations have continued from the first very profusely, especially at night time. Has also complained of a feeling of coldness, but has never had anything like a chill. Pulse to-day is firmer. A bed sore has formed on right hip. Continued much the same on the 18th and 19th. Has attacks of epistaris each night, which, however, are controlled by snuffing up a solution of iron. On the 19th, the bowels moved three times, a little more liquid than natural. Up to this date there had been a decided tendency to constipation.
20th. From the fact that circumstances prevented his being properly nursed, he was to-day removed to the General Hospital, and placed under Dr. Fenwick's care, to whom I am indebted for the facts of the case up to the time of his death, which took place ten days after admission. On the second day after his admission, a swelling of considerable size was seen over the sacrum, corresponding with the part where he had suffered such acute pain. This abscess was opened. At this stage of the disease the patient was placed lying on his belly, owing to the great pain in his back and the bed sore on his right hip.
Wasting progressed rapidly; he was delirious during the night, and there was a tendency to picking at the bed-clothes. A second abscess formed in the vicinity of the hip-joint, which was opened and discharged freely. The day following, (April the 1st), he died. Unfortunately a post mortem examination was not afforded, as the body was removed to Belleville before such investigation was possible.
It is a matter of interest to notice such a formidable disease as Pyæmia, arising from such a slight cause. Certainly it is a disease to be dreaded in all major operations, but how very unusual to see it follow the presence of a few drops of pent-up pus in such a superficial place and from such a small accident as cutting a small corn too deeply. In looking into the subject I find that pyæmia in private practice and from slight causes was made the subject of the inaugural address by Mr. Prescott Hewitt, at the Clinical Society of London, in 1874. It may be of interest in connection with the present paper to cite some of the cases which Mr. Hewitt reports :
“ A hale old gentleman close upon 80, who had long enjoyed excellent health, had a small warty growth on the skin just over the tendon Achilles. This was removed, as it chafed him in walking. After laying up for a few days and the trifling wound was all but healed, he was allowed to go about a little, but being of active habits, he one day took a longer walk than usual. This was followed by some slight inflammation of the skin, which, however, soon subsided. He was on the eve of returning to his usual avocation, when rigors and sweatings appeared. Then came an immense, deep-seated abscess in the thigh, under the constant drain of which he ultimately sank.”
In another case, the removal of a small sebaceous cyst of the scalp was followed by erysipelas, pyæmia and death.
Another case of a gentleman residing in the country, supposed to be suffering from acute inflammatory rheumatism in both ankle joints, but which proved to be pyæmic abscesses. Here the cause was suppuration about the tonsils. This patient at that time recovered, but four years later he died of pyæmia, following the removal of a small warty growth from the scrotum.
Another interesting case was that of a young woman who had run a needle into the fleshy part of the leg. It was afterwards removed, and nothing more was thought about it till a few days later, when the spot became painful. abscess formed which was attended to, but she shortly after had rigors and profuse sweatings. She ultimately recovered, but was five months confined to her bed.
Other cases equally interesting are recorded, as from the pulling of a tooth, or resulting from periostitis of the 'tarsal bones, from being tripped up in the street; also, cases following or associated with gonorrhoea.
In the case presented to the Society this evening, there was an absence of all rigors, which is one of the distinctive evidences of the disease. He complained of being chilly, especially at night-time, but he never had a distinct rigor. There was the absence also of much fluctuation in the temperature, which is so markedly present in pyæmia. The morning and
A tiny evening temperature ran a pretty definite course. It is worthy of note that many cases of pyæmia in its early stages have been mistaken, as was the present one, for Inflammatory Rheumatism. In the Pathological Transactions Vol. 13, page 189, Dr. Bristowe, of St. Thomas' Hospital, makes this remark in a report of five cases of pyæmia, the result of necrosis, which had been mistaken for inflammatory rheumatism:
“The patient is attacked, not necessarily as the result of accident, with slight rheumatic pains in the course of one of the bones. The disease at first mild, soon becomes severe ; swelling and tenderness soon manifest themselves more or less obstinately. The aspect of the patient is that of a person suffering from inflammatory fever. Soon, however, in a large proportion of the cases, symptoms bearing a superficial resemblance to those of typhus, typhoid or even delirium tremens, set in. pyæmia has become established, and the patient rapidly sinks.”
In connection with the treatment of this most formidable disease, there is a statement made by Mr. Durham, of Guy's Hospital in the Lancet of March 7th, 1874, and coming from so eminent a surgeon, it certainly merits our attention. He says:
“Of late years, whenever I have the slightest indication of the symptoms setting in, I have immediately given large doses of quinine ; and in cases in which pyæmic symptoms have been well established, and which I have no doubt would have gone on to fatal termination, I have also given large doses of quinine, and in some cases the most satisfactory results have been obtained. I have seen over and over again, a patient with a dry, red, glazed, brown-furred tongue, with a rapid pulse and high temperature, having had a rigor a short time previously, with evidence of suppuration occurring in one part or another. I have, in such a case, given a drachm of quinine, and repeated it in three or four hours, and the next day have seen the patient in a totally different condition—the temperature down, the pulse lower, tongue clean and moist, and the patient expressing himself as well.”
While the true nature of the toxic matter that gives rise to the blood-poisoning in Pyæmia, its origin and mode of operation are not fully known, and while it manifests itself more frequently in the surgical department of Hospital practice, but, seen also in private practice, it is interesting to observe that we may have it present without any traumatic cause, following some exhausting disease, notably typhus, and in some cases of typhoid fever; and we may also have it attendant on some of the most simple accidents in daily life—the running of a splinter into the toe, or the prick of a needle, as among the cases recorded by Mr. Prescott Hewitt, or such a simple thing as the cutting of a corn, the notes of which I have had the honor of presenting to the Society this evening.
ANEURISM OF THE INNOMINATE ARTERY CURED
BY THE METHOD OF TUFNELL.*
BY HENRY H. HEAD, M.D.
To the Editor of the CANADA MEDICAL AND SURGICAL JOURNAL.
QUEBEC, June 24th, 1878. SIR,—I herewith send you the report of a case of Aneurism of the Innominata, treated by Dr, Head of Dublin, on the plan suggested by Mr. Joliffe Tufnell, also of Dublin. This report was kindly forwarded to me by the latter gentleman, and as it is to my knowledge that several other cases of internal aneurism have been treated in an equally successful manner by the same method, I think it due to humanity and the spread of science, that the knowledge of Mr. Tuffnell's treatment, at once so successful, and yet so simple, should be extended as far as possible.
You will therefore oblige me much by giving the report an insertion in your valuable journal.
JAMES A. SEWELL, M.D.,
Dean, Medical Faculty Laval University.
The case which I wish to present to the Society is one of an aneurismal sac that had undergone cure by the process upon which so much stress has been laid by Mr. Tufnell — viz.,
Read before the Dublin Pathological Society, January 20, 1878.