Observations on cases of acute tuberculosis / by J.W.F. Smith-Shand.

  • Smith-Shand, J. W. F.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Observations on cases of acute tuberculosis / by J.W.F. Smith-Shand. Source: Wellcome Collection.

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    Pulse 120, weak. He is unable to stand when taken up to stool and has occasional rigors followed by profuse perspirations. To have port wine and an extra allowance of beef-tea.—20th: Cough has entirely ceased. Left side of chest expands more than right. Breathing still forced is now more abdominal. Dulness on per¬ cussion in right infra-axillary region. Crepitation and sibilus over other parts of chest. Great thirst. Tongue dry, with thick brown fur; dental sordes. Bowels regular. No abdominal tenderness on pressure, and no rash on skin.—21st: Confused and delirious to-day. Brandy to be added to the wine.—22nd: Diurnal wandering and nocturnal delirium continue.—23rd: Bathed in profuse perspiration; pulse 130, fluttering; is evidently sinking. Died at 4 p.m. Autopsy, nineteen hours after death.—(Reported by Dr. Beveridge, Pathologist.)—Between one and two pints of sero- sanguinolent fluid was found in the right pleural cavity. The right lung weighed 34 oz., and the left 29 oz.; both were in a state | of venous engorgement, and equally and thickly studded with gray I tuberculous granulations. The tubercles in the apex of each lung I were about the size of split peas, and were larger, softer, and more I isolated than those on the base, where they wet e of the size of l pins’ heads. The pericardium contained about half an ounce of fluid. The heart was small and flabby. The liver was very soft, |] and had small yellow tubercles sparsely scattered through its substance. The kidneys, small and softer than natural, were I thickly studded with gray tubercles. Intestines very pale ; mucous membrane not examined. Spleen healthy. Brain not examined. The duration of the disease in this case was less than four I weeks. After the examination on April 14th I set down the case as one of capillary bronchitis; but for the next four days I could I not reconcile in my own mind the intensity of the febrile 1 symptoms and the dyspnoea with the comparatively slight amount of bronchial rales, the diminution of the cough, and the absence of expectoration; and when I found, on the 19th, that the nocturnal 1 delirium was increasing, prostration rapidly advancing, and sordes forming on the teeth, I was disposed to look upon it as a case of I typhoid fever, although there were no rose-coloured spots, ab¬ dominal pain, or diarrhoea. There was none of the orthopnoea I usually found in capillary bronchitis, and during the whole period I of the illness he lay almost entirely on his back with the shoulders I moderately raised. | Case 2.—J. S-, aged twenty-two, a farm servant, was I admitted into the Royal Infirmary on Jan. 7th, 1871. About 1 five weeks previous to his admission he got wet, and a few days I after he had, as he supposed, a severe cold, which, however, did I not disable him from work for nearly two weeks. About the