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CRITICAL DAYS IN PNEUMONIA; VALUE OF BLEEDING
36 wound, semilunar in shape likewise, longer than the other, butb in the same direction. On each side of the head the scalp was9 separated for some distance upwards and downwards, so ass almost to separate it entirely from the bone. The man walkedI into the ward. His head was shaved, hot bottles put to hiss Under these means he became gradually more ronfeet, &c. scious ; he bled profusely from the cuts, and complained off -
faintness. Mr. Erichsen
fushes of heat, thirst, and anorexia. He complains of pain in the right side, cough, with thick, viscid expectoration; the latter rust-coloured, and streaked with blood. He ascribes his disease to cold and intemperance. His respirations are 46; the temperature of his body (which Dr. Parkes always ascertains with a thermometer) 103° Fahr.; pulse 118. The physical signs are well-marked, and, as expected, are those of pneumonia ; there is dulness of percussion under the right scapula; bronchial breathing, and over both lungs, bronchitic rhonchi. He was ordered to be bled to twenty ounces; and to take
operated on him at about seven o’clock. The patient insisted on walking into the theatre, having at first: objected to the operation. He was rather restless and violent, calomel, twenty-four grains; ipecacuanha, twenty-four grains; and became slightly stertorous. A large trephine was appliedL tartrate of antimony, six grains; opium, six grains: to be made at the upper margin of the fracture, half of the circle projecting into twenty-four pills. To take one every hour. over the fractured portion. The bone was elevated, andl On the sixth day of the disease, (November 10th,) the physome loose splinters removed from the surface of the duras sical signs were much the same. The base of the right lung mater. This membrane was lacerated for about a quarter ofF had escaped; respirations were 40; pulse 118, in the proportion an inch by a spicula. The scalp was laid down. The patient; 1 to 2’95; pain in the chest severe, and various nervous was removed to bed in a private darkened room, and ice symptoms. Seventh day.-Pyrexia; respirations 40; pulse 120, or as I applied to his head. His bowels were opened spontaneously soon after admission. As he had lost about twenty ounces off to 3; urine high-coloured, and chlorides in that excretion abblood from his head, venesection was not had recourse to tilll sent. This day and the previous one the calomel was omitted the next day, when twelve and subsequently six ounces were from the pills, and he got instead, nitrate of potash, ten grains, in a mixture with liquor of acetate of ammonia. taken from him with evident benefit. Ninth day.-He got rapidly worse, with excessive dyspncea; Up to the present time (Dec. 30th) he has gone on favourably. He has been put on calomel, low diet, with perfect: respirations 52! pulse 136, in the proportion 1 to 2-61; exquiet in a dark room; purgatives when necessary. With the tremities and ears cold and congested; pulse irregular and inexception of occasional dreams and fancies, which prevent himtermittent, possibly from the tartar-emetic. Calomel alone sleeping for a time, there is nothing to remark in his condition. was now given, two grains every fourth hour. Tenth day.-This is about the critical day. He was so very The wounds are granulating. The one on the right side, where the trephine aperture is, gapes a little, and discharges freely. weak now that the treatment was changed, and he was ordered Some amount of bone is still exposed here, but is rapidly being; wine, ammonia, and senega. The effect was admirable. covered in. On the eleventh and twelfth days, the report stages—Marked feels himself all right again; over left lung perimprovement; CRITICAL DAYS IN PNEUMONIA; VALUE OF BLEEDING. cuasion clear; some crackling in the tubes, but no crepitation; (Under the care of Dr. PARKES.) extremely well-marked friction-sound of pleuro-pneumonia; temperature down to 98° Fahr.; respirations at one part of the A GOOD deal of conversation has taken place of late in hm twelfth day 32; pulse 100,1 to 3; all the physical signs greatly pital wards, relative to the old doctrine of critical days. Ou] improved; percussion-note under right clavicle clear; back of forefathers would not seem to be so unwise as we take them t( the same in the left; chlorides reappeared in clear; lung right without and the of the wisest of thai men, be, adopting saying which Dr. Parkes considers always a good sign. the urine, is under the sun, or nothing new in medi there nothing new Fourteenth and fifteenth days.-Improvement going on cine, we may do good occasionally in examining, if not adopting the lessons of practical experience. We were struck with this rapidly; percussion more and more clear; friction-sound dimiline of observation last month, by observing a case of pleuro. nished. Sixteenth day.-Quite well. We obviously leave out the pneumonia lately under the care of Dr. Parkes, at University site of the disease, and its more minute day by day, Various need it be fevers, scarcely remarked, the right lung being consolidated from thechanges College Hospital. beginning. As we have their critical days; indeed, Stokes and others tell us, ij are more anxious to dwell on this novel point of critical days, the patient live over the critical day, he will recover; that we and what seems somewhat of a corollary from it, as believed by do not so much cure the fever as keep the patient up against it. that about the ninth day, when one lung only is This " idea" of fever has of late entirely changed its method of Dr. Parkes, the second, from purulent absorption, is likely on attacked, wine and broths for and treatment, substituting bleeding this day also to be attacked; that on the ninth day of pneuleeches. In fact, that if we sustain the system, the various monia, ecrteris paribus, you have to dread what may be called emunctories, skin, kidneys, &c., get rid of the disease them- relapse, but which, in reality, is pneumonia of the opposite we nourishment so as to enable the that if selves ; give patient lung. At this period the original disease ceased. to survive the critical day, the chief danger is already surpassed. Wedo not mean here, of course, that complications of fever may not occur, and very grave ones, to try all our skill. We were ST. MARY’S HOSPITAL. scarcely prepared for this doctrine in pneumonia, or pleuro- OVARIAN DROPSY TREATED BY TINCTURE OF IODINE INJECTION. pneumonia, yet Dr. Parkes finds that about the tenth day this disease also, almost like a fever, yields; whether it be that the (Under the care of Mr. L B. BROWN.) disease takes that time to form, and then to cure itself by resoTHE interest attached to the obstetric department of St. lution, or that at this period the softening down of the lung, Mary’s begins to be more obvious every season; the cases of and absorption of the lymph products, become more amenable female diseases here under the care of Dr. Smith and Tyler to the remedies already given, may be still open to inquiry, the Mr. I. B. Brown form a of study, from which subject special practical fact remaining of no little moment, that up to the we expect much interest and novelty. ninth or tenth day we need not in pneumonia look for any very Of the later cases in the wards, though not perhaps immarked amelioration or change of symptoms. We have, in very favourably with the operation of injecting an pressed fact, in pneumonia, a formative period, and a period of disin- ovarian sac with iodine, from the result of a similar case last in tegration, the latter very often so long and tedious, that at University College Hospital, we feel it our duty to give year French hospitals, under the advice of Louis, bleeding in pneu- an abstract of the following instance of this operation, as permonia has been interdicted, and wine given from the beginning, formed Mr. Brown on the 30th ult. by over the critical thus economizing the patient’s strength to get Mary B--, aged thirty-four, was admitted under Mr. days, assisting the capillaries and absorbents at the same time Brown on one of the earlier days of last month, presenting all to get rid of the morbid products of inflammation. the usual signs of ovarian dropsy. She informed him she had The case does not present any features of unusual interest; had two children and one miscarriage. She had, previous to it is useful, however, sometimes, stare sucper vias antiquas, and admission to the been much troubled with the size of hospital, while taking notes of such cases day after day, to find our pre- the tumour and ordinary evacuation of the bladder, and wished ,
!
vious views corroborated. CASE.-T. P-, aged nineteen; pleuro-pneumonia; admitted into University College Hospital, November 9th; suffering apparently under high fever, cough, and inflammation of the lungs. States he is a labourer, and has been exposed to "all weathers;" has generally enjoyed good health. The present attack came on with shivering four days ago, followed by
The very much to be relieved of such an inconvenience. woman’s appearance was good, her face not betokening much
pain
or
acute
suffering.
Dec. 12th.-" On a careful examination of the tumour today," says the report-book, " there did not seem any doubt as to the nature of the case, the walls of the cyst appear very thin, and it is doubtful if there be more than one." In this
faintness. Mr. Erichsen
fushes of heat, thirst, and anorexia. He complains of pain in the right side, cough, with thick, viscid expectoration; the latter rust-coloured, and streaked with blood. He ascribes his disease to cold and intemperance. His respirations are 46; the temperature of his body (which Dr. Parkes always ascertains with a thermometer) 103° Fahr.; pulse 118. The physical signs are well-marked, and, as expected, are those of pneumonia ; there is dulness of percussion under the right scapula; bronchial breathing, and over both lungs, bronchitic rhonchi. He was ordered to be bled to twenty ounces; and to take
operated on him at about seven o’clock. The patient insisted on walking into the theatre, having at first: objected to the operation. He was rather restless and violent, calomel, twenty-four grains; ipecacuanha, twenty-four grains; and became slightly stertorous. A large trephine was appliedL tartrate of antimony, six grains; opium, six grains: to be made at the upper margin of the fracture, half of the circle projecting into twenty-four pills. To take one every hour. over the fractured portion. The bone was elevated, andl On the sixth day of the disease, (November 10th,) the physome loose splinters removed from the surface of the duras sical signs were much the same. The base of the right lung mater. This membrane was lacerated for about a quarter ofF had escaped; respirations were 40; pulse 118, in the proportion an inch by a spicula. The scalp was laid down. The patient; 1 to 2’95; pain in the chest severe, and various nervous was removed to bed in a private darkened room, and ice symptoms. Seventh day.-Pyrexia; respirations 40; pulse 120, or as I applied to his head. His bowels were opened spontaneously soon after admission. As he had lost about twenty ounces off to 3; urine high-coloured, and chlorides in that excretion abblood from his head, venesection was not had recourse to tilll sent. This day and the previous one the calomel was omitted the next day, when twelve and subsequently six ounces were from the pills, and he got instead, nitrate of potash, ten grains, in a mixture with liquor of acetate of ammonia. taken from him with evident benefit. Ninth day.-He got rapidly worse, with excessive dyspncea; Up to the present time (Dec. 30th) he has gone on favourably. He has been put on calomel, low diet, with perfect: respirations 52! pulse 136, in the proportion 1 to 2-61; exquiet in a dark room; purgatives when necessary. With the tremities and ears cold and congested; pulse irregular and inexception of occasional dreams and fancies, which prevent himtermittent, possibly from the tartar-emetic. Calomel alone sleeping for a time, there is nothing to remark in his condition. was now given, two grains every fourth hour. Tenth day.-This is about the critical day. He was so very The wounds are granulating. The one on the right side, where the trephine aperture is, gapes a little, and discharges freely. weak now that the treatment was changed, and he was ordered Some amount of bone is still exposed here, but is rapidly being; wine, ammonia, and senega. The effect was admirable. covered in. On the eleventh and twelfth days, the report stages—Marked feels himself all right again; over left lung perimprovement; CRITICAL DAYS IN PNEUMONIA; VALUE OF BLEEDING. cuasion clear; some crackling in the tubes, but no crepitation; (Under the care of Dr. PARKES.) extremely well-marked friction-sound of pleuro-pneumonia; temperature down to 98° Fahr.; respirations at one part of the A GOOD deal of conversation has taken place of late in hm twelfth day 32; pulse 100,1 to 3; all the physical signs greatly pital wards, relative to the old doctrine of critical days. Ou] improved; percussion-note under right clavicle clear; back of forefathers would not seem to be so unwise as we take them t( the same in the left; chlorides reappeared in clear; lung right without and the of the wisest of thai men, be, adopting saying which Dr. Parkes considers always a good sign. the urine, is under the sun, or nothing new in medi there nothing new Fourteenth and fifteenth days.-Improvement going on cine, we may do good occasionally in examining, if not adopting the lessons of practical experience. We were struck with this rapidly; percussion more and more clear; friction-sound dimiline of observation last month, by observing a case of pleuro. nished. Sixteenth day.-Quite well. We obviously leave out the pneumonia lately under the care of Dr. Parkes, at University site of the disease, and its more minute day by day, Various need it be fevers, scarcely remarked, the right lung being consolidated from thechanges College Hospital. beginning. As we have their critical days; indeed, Stokes and others tell us, ij are more anxious to dwell on this novel point of critical days, the patient live over the critical day, he will recover; that we and what seems somewhat of a corollary from it, as believed by do not so much cure the fever as keep the patient up against it. that about the ninth day, when one lung only is This " idea" of fever has of late entirely changed its method of Dr. Parkes, the second, from purulent absorption, is likely on attacked, wine and broths for and treatment, substituting bleeding this day also to be attacked; that on the ninth day of pneuleeches. In fact, that if we sustain the system, the various monia, ecrteris paribus, you have to dread what may be called emunctories, skin, kidneys, &c., get rid of the disease them- relapse, but which, in reality, is pneumonia of the opposite we nourishment so as to enable the that if selves ; give patient lung. At this period the original disease ceased. to survive the critical day, the chief danger is already surpassed. Wedo not mean here, of course, that complications of fever may not occur, and very grave ones, to try all our skill. We were ST. MARY’S HOSPITAL. scarcely prepared for this doctrine in pneumonia, or pleuro- OVARIAN DROPSY TREATED BY TINCTURE OF IODINE INJECTION. pneumonia, yet Dr. Parkes finds that about the tenth day this disease also, almost like a fever, yields; whether it be that the (Under the care of Mr. L B. BROWN.) disease takes that time to form, and then to cure itself by resoTHE interest attached to the obstetric department of St. lution, or that at this period the softening down of the lung, Mary’s begins to be more obvious every season; the cases of and absorption of the lymph products, become more amenable female diseases here under the care of Dr. Smith and Tyler to the remedies already given, may be still open to inquiry, the Mr. I. B. Brown form a of study, from which subject special practical fact remaining of no little moment, that up to the we expect much interest and novelty. ninth or tenth day we need not in pneumonia look for any very Of the later cases in the wards, though not perhaps immarked amelioration or change of symptoms. We have, in very favourably with the operation of injecting an pressed fact, in pneumonia, a formative period, and a period of disin- ovarian sac with iodine, from the result of a similar case last in tegration, the latter very often so long and tedious, that at University College Hospital, we feel it our duty to give year French hospitals, under the advice of Louis, bleeding in pneu- an abstract of the following instance of this operation, as permonia has been interdicted, and wine given from the beginning, formed Mr. Brown on the 30th ult. by over the critical thus economizing the patient’s strength to get Mary B--, aged thirty-four, was admitted under Mr. days, assisting the capillaries and absorbents at the same time Brown on one of the earlier days of last month, presenting all to get rid of the morbid products of inflammation. the usual signs of ovarian dropsy. She informed him she had The case does not present any features of unusual interest; had two children and one miscarriage. She had, previous to it is useful, however, sometimes, stare sucper vias antiquas, and admission to the been much troubled with the size of hospital, while taking notes of such cases day after day, to find our pre- the tumour and ordinary evacuation of the bladder, and wished ,
!
vious views corroborated. CASE.-T. P-, aged nineteen; pleuro-pneumonia; admitted into University College Hospital, November 9th; suffering apparently under high fever, cough, and inflammation of the lungs. States he is a labourer, and has been exposed to "all weathers;" has generally enjoyed good health. The present attack came on with shivering four days ago, followed by
The very much to be relieved of such an inconvenience. woman’s appearance was good, her face not betokening much
pain
or
acute
suffering.
Dec. 12th.-" On a careful examination of the tumour today," says the report-book, " there did not seem any doubt as to the nature of the case, the walls of the cyst appear very thin, and it is doubtful if there be more than one." In this