Pneumococcus peritonitis : paper read in the Section of Pathology, at the Annual Meeting of the British Medical Association, Cheltenham, July-August, 1901 / by J.H. Bryant.

  • Bryant, John Henry.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: Pneumococcus peritonitis : paper read in the Section of Pathology, at the Annual Meeting of the British Medical Association, Cheltenham, July-August, 1901 / by J.H. Bryant. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    o o On Saturday, May 19th, slie appeared to be perfectly well. Tlie mother stated that she had eaten some raw rhubarb on this day. On Sunday morning, the 20th, about 8 a.m., she vomited freely, and about the same time suffered from diarrhoea. Both the vomiting and the diarrhoea con- tinued to be profuse throughout the day, and she complained of “pain in her stomach. She was very fretful and only took a little milk and soda water. At 6 p.m. she was much worse, and at 7 p.m. she was admitted into the hospital. Condition on Admission.—Temperature 1020, pulse 124, respirations 36. She was a well-nourished child, but was very fretful, and seemed to be wandering in her mind. She appeared to be in pain, and was very thirsty. Respiratory System..—She had no cough. A pleuro-pericardial rub was heard over an area about 2 inches in diameter just below and external to the left nipple. The Pulse was small and of low tension. The cardiac dulness was not increased. There were no bruits. Alimentary System.—Lips dry; teeth good ; tongue furred on the dorsum, but clean at the tip; papillae red and prominent; fauces normal. The abdomen moved on respiration, and was quite supple. Palpation appeared to give her pain. The percussion note was normal. Urine, acid, 1021. Small amount of albumen present. No blood, pus, or sugar. The temperature came down to 990 until just before 6 p.m., when it sud- denly rose to 1050. There was no diarrhoea after admission, but, even with the temperature down, she seemed ill. and was very fretful and thirsty. She vomited once during the afternoon for the first time since admission. At 5 45 p.m. she again vomited, and then went into a fit. She became quite pulseless, and remained collapsed for two hours in spite of the administration of oxygen and injections of brandy, strychnine, and ether, and a saline injection. She died at 7.45 p.m. The post-mo-rtem examination was made on May 21st, fifteen hours after death. Rigor mortis was well marked, and there was marked hypostasis of the back, neck, and gluteal region. The extremities were much cyanosed. The body was well nourished. There was no anasarca. There was no otitis and no meningitis. The spinal cord, cervical glands, and thyroid were healthy. There was a good deal of snbpleural ecchy- mosis on the upper two-tliirds of the right lower lobe of the lung, and this part of the pleura was also covered with very thin flakes of reoent lymph. There was also recent lymph covering the base of the left lung. There was no pneumonic consolidation. The larynx, trachea, bronchi, and bronchial glands were normal. There was a little recent lymph covering the outer surface of the peri- cardial sac. The heart weighed 75 grams. There was no endocarditis, and the cavities were not dilated. The arteries were healthy. The mouth, pharynx, oesophagus, and stomach were normal. There was general acute peritonitis. The peritoneal cavity contained about 10 ounces of thin greenish yellow, opaque purnlent fluid. The liver, spleen, and intestines were covered with small flakes of pale yellow lymph. The appendix vermiformis was quite healthy. There was no local collection of pus which would have caused the peritonitis, and there was no perfora- tion of any of the hollow viscera. The pelvic organs appeared to be quite healthy. The liver, gall bladder, and pancreas wore normal. The lymphatic glands were swollen and sodden. The spleen weighed 54 grams, and was normal. The suprorenals were healthy. The kidneys weighed 83 gnams, and were quite normal. Coverglass preparations were made from the peritoneal fluid, and stained with methylene blue and with capsule stain. An almost pure growth of capsulated diplococci was seen. A few large long thick rod- shaped bacilli were seen also. Case Thomas S, aged 45, a stone carver, was admitted on October9th 1900, under my care for abdominal pain, lie had always enjoyed good health, with the exception of an abscess on his knee, which he had when he was a boy. On October 1st he first noticed a pain in his epigastric region, which was accompanied by flatulence. From October 1st to October 3rd he suffered from constipation. He was able to work on the 1st, but on the 2nd had to give it up, and he went to bed until the 4th. He attempted to work again on the 4th, but soon had to give it up. On the 5th Ins motions were scanty and fluid. He remained in bed on the jth, feeling very ill and suffering considerable pain, which was con- tinuous, with occasional exacerbations which made him cry out He was admitted on the oth. Condition on A amission—Temperature 101.20, pulse 100, respirations 36 He was very pale, and his eyes were much sunken, lie complained of extreme tenderness all over his abdomen, but the muscles were not rigid. I saw him soon after admissiem, arid diagnosed general suppurative peri- tonitis. I called in my colicky Mr. Dunn, who decided to operate at once.