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A CASE OF PUERPERAL FEVER TREATED WITH ANTISTREPTOCOCCIC SERUM; DEATH.
1321 Mr. Cadge of Norwich, in his article on " Litho- She complained of being drowsy and was a little deaf. trity," &c., in Heath’s"Dictionary of Surgery," in contrasting There had been no rigor. The lochia had ceased, but they the results obtained in my first series of 108 litholapaxies reappeared in the evening, when there was very little fcetor. performed in India with a somewhat similar series of cases Milk and beef-tea were taken in good quantities and were by Sir Henry Thompson in England notices this marked well retained. At 1 25 P M. the first injection of 10 c.c. difference in the average age. It is simply due to the of Messrs. Burroughs and Wellcome’s antiatreptococcic fact that the "expectation of life"in India is probably serum was made in the abdomen, the most strict antiseptic bbout ten years less than in England, a native of India precautions being taken in every detail. We saw the patient being at fifty years of age comparatively as old as again an hour afterwards and practically no change had a European at sixty years of age. Secondly, the average occurred in her condition, but she had slept a little. An weight of the calculi removed by me from adults in London hour later she was still drowsy ; the temperature was a little is 149 gr. as compared with an average of 309 gr. in India. higher. At 10 30 P.M. a vaginal douche was given, followed This is a point to which Mr. Cadge also called atten- by another injection of 10 c.c. of serum ; we then found the tion in the article referred to, the average weight of the patient’s state practically the same, but the condition of the
India.
.
A CASE OF PUERPERAL FEVER TREATED WITH ANTISTREPTOCOCCIC SERUM; DEATH. BY J. PAUL ROUGHTON, M.R.C.S. ENG., L.R.C.P. LOND.,
D.P.H., SURGEON TO THE KETTERING GENERAL HOSPITAL, AND
ARNOLD G. TOLPUTT, M.R.C.S. ENG., L.R.C.P. LOND. A WOMAN, aged twenty-seven years, gave birth to her sixth child on March 16th, 1898, at 12.45 P M. Mr. Tolputt arrived at 1.10 P.M. and expressed the placenta with ease, the placenta and membranes being complete. no headache and no rigor. She complained much of Very little haemorrhage occurred. On the 17th the patient’s "wind." She continued to take nourishment well. At condition was satisfactory in every respect. On the 18th ;2.55 P.M. 10 c. c. of serum were again injected and apparshe was not visited, but on the 19th the nurse stated that ently had no beneficial effect whatever beyond keeping the tongue clean and the patient quiet. The condition of the she was "feverish"and flushed and complaining of faintbecame more grave ; the abdomen was ness, and that the diapers were noticed to be "slightly patient ’gradually distended and the motions began to be passed extremely offensive and the discharge scanty." The patient was found unconsciously and were very offensive. At 10 P M. 10 c.c. to be breathing more rapidly than normal; the pulse was of serum were again injected without any improvement. 128 and the temperature was 103 ° F. The bowels had been On the 23rd it was evident that the patient could not opened once. There was no headache. 10 gr. of anti- recover, but two more injections of serum 10 c.c. were given. condition, however, rapidly became worse and she finally pyrin were given and 10 gr. of calomel half an hour after- Her died at 2.30 A.M. on the 24th. wards, the bowels being moved three times and vomiting In this case the seium seems to have been useless as occurring twice. A pill containing 4 gr. of sulphate of regards saving the life of the patient, but her general - quinine was given every four hours and was continued condition was certainly ameliorated. There were no rigors throughout the illness. A vaginal douche was given by a and ther e was scarcely any headache ; the tongue, too, was drained nurse in the evening. On the 20th the condition of much improved. It was perhaps unfortunate that the serum ’the patient was much the same and we decided to inject could not be obtained sooner. The only cause assignable antistreptococclo S3rum, but were unable to obtain the serum for the infection was the insanitary condition of the house, till the next day. The patient was apparently better in the the water having been condemned a short time previously. On the 21st the patient’s condition in the morn- Also the patient had had a bad attack of diarrhoea earlier in evening. was ing grave, although she had passed a good night. the week. We again wish to point out that besides the use A large thrombus appeared in some varicose veins of of the serum the very strictest possible antiseptic precautions the right leg. The abdomen began to be tympanitic. were taken both as regards the instruments used and the The pulse, respiration, and temperature were much hands of the operator. raised and the tongue was covered with a dry white fur. Kettering,
India.
.
A CASE OF PUERPERAL FEVER TREATED WITH ANTISTREPTOCOCCIC SERUM; DEATH. BY J. PAUL ROUGHTON, M.R.C.S. ENG., L.R.C.P. LOND.,
D.P.H., SURGEON TO THE KETTERING GENERAL HOSPITAL, AND
ARNOLD G. TOLPUTT, M.R.C.S. ENG., L.R.C.P. LOND. A WOMAN, aged twenty-seven years, gave birth to her sixth child on March 16th, 1898, at 12.45 P M. Mr. Tolputt arrived at 1.10 P.M. and expressed the placenta with ease, the placenta and membranes being complete. no headache and no rigor. She complained much of Very little haemorrhage occurred. On the 17th the patient’s "wind." She continued to take nourishment well. At condition was satisfactory in every respect. On the 18th ;2.55 P.M. 10 c. c. of serum were again injected and apparshe was not visited, but on the 19th the nurse stated that ently had no beneficial effect whatever beyond keeping the tongue clean and the patient quiet. The condition of the she was "feverish"and flushed and complaining of faintbecame more grave ; the abdomen was ness, and that the diapers were noticed to be "slightly patient ’gradually distended and the motions began to be passed extremely offensive and the discharge scanty." The patient was found unconsciously and were very offensive. At 10 P M. 10 c.c. to be breathing more rapidly than normal; the pulse was of serum were again injected without any improvement. 128 and the temperature was 103 ° F. The bowels had been On the 23rd it was evident that the patient could not opened once. There was no headache. 10 gr. of anti- recover, but two more injections of serum 10 c.c. were given. condition, however, rapidly became worse and she finally pyrin were given and 10 gr. of calomel half an hour after- Her died at 2.30 A.M. on the 24th. wards, the bowels being moved three times and vomiting In this case the seium seems to have been useless as occurring twice. A pill containing 4 gr. of sulphate of regards saving the life of the patient, but her general - quinine was given every four hours and was continued condition was certainly ameliorated. There were no rigors throughout the illness. A vaginal douche was given by a and ther e was scarcely any headache ; the tongue, too, was drained nurse in the evening. On the 20th the condition of much improved. It was perhaps unfortunate that the serum ’the patient was much the same and we decided to inject could not be obtained sooner. The only cause assignable antistreptococclo S3rum, but were unable to obtain the serum for the infection was the insanitary condition of the house, till the next day. The patient was apparently better in the the water having been condemned a short time previously. On the 21st the patient’s condition in the morn- Also the patient had had a bad attack of diarrhoea earlier in evening. was ing grave, although she had passed a good night. the week. We again wish to point out that besides the use A large thrombus appeared in some varicose veins of of the serum the very strictest possible antiseptic precautions the right leg. The abdomen began to be tympanitic. were taken both as regards the instruments used and the The pulse, respiration, and temperature were much hands of the operator. raised and the tongue was covered with a dry white fur. Kettering,