- Email: [email protected]
A CASE OF PUERPERAL SEPTICÆMIA.
496 colours ; and (h) riders. For clinical work they are packed with milk, raw meat juice, and brandy. On the 18th the in a small case in which room is found for candles, extra temperature was 1042° in the morning and the pulse was test tubes, &c. The case has a compartment shut off from 120, soft, and very compressible. The gauze was rethe rest to serve as a camera tube. At the lower aperture moved from the uterus, but the septic odour was easily of the camera two holes are perforated under one of which perceptible through the iodoform, and the skin was sweating
placed the saliva to be examined and under the other the colour standard with which it is to be contrasted. To one side of the upper aperture a piece of green glass is attached for the purpose of rendering the retina more sensitive to red light should the eye become fatigued. With regard to the method of using the instrument. Some saliva is first collected in a test tube and 2 c.c. poured into the centimetre measure. By this little manoeuvre the air bubbles are retained in the test tube. To this 1 c.c. of glacial acetic acid is added and shaken up a little to ensure complete mixing. Next the 0’045 c.c. of iron is taken up and mixed with the acid and saliva, it being necessary to pass them two or three times up the tube of the pipette to make certain that all the iron is added. The cell is then filled from the centimetre measure and a cover glass-which, by the way, is absolutely colourless-placed on top. If the cell is accurately filled to 2 c. c. a small air-bubble will be seen on the surface of the fluid. It is then placed under one hole of the camera and the standard with which it apparently corresponds placed under the other. The candle is then lighted and placed in such a position as to equally illuminate the surfaces of both saliva and standard. If the two colours correspond the amount of the sulpho-cyanide is at once known. If they do not it is only necessary to shift the standards till one is found of the same shade. Should none be found to exactly match the riders are brought into use, taking care that for every rider employed an additional cover-glass be placed on the cell in order to equalise the reflecting surfaces. Of what use the instrument may be remains to be seen. I have worked with it enough to be unable to confirm Schiff’s statement that the sulpho cyanide increases in saliva that is kept I can also a few hours owing to decomposition of the fluid. say its existence does not in any way depend either on the presence of carious teeth or the use or non-use of tobacco. is
Sloane-street, W.
and was blotched over the chest and abdomen. At 3 P.M. 10 c.c. of anti-streptococcic serum were injected into the cellular tissue of the abdominal wall. At 8 P.M. the temperature was 1026°, the pulse was 106, the respirations were 24, and headache was nearly driving the patient frantic. She felt so ill and weak that neither she nor her friends would allow further washing. On the morning of the 19th the temperature was 100° and the pulse was 92. The patient had had a better night ; the headache was much less severe, the discharge was not so foetid, and she had 10 c.c. of the serum were a sense of feeling better. injected. At 8.30 P.M. the temperature was 101.2° and the pulse 104. The discharge did not smell foetid. The headache, however, was still severe, but a sixgrain dose of butyl-chloral relieved it. On the 20th the temperature was 101° and the pulse was 104. The headache was easier, the pulse firmer, the tongue cleaner, the skin drier and less blotchy, and the anxious, pinched face had smoothed out a little. The uterus was washed out with carbolic solution and 10 c.c. of the serum were injected. On the 21st the temperature was 100° and the pulse was 108. The headache was easier as also were the other symptoms. On the 22nd the morning temperature was 99 6° and the pulse was 100. She was still improving and the head especially was comfortable. The uterus was washed out with strong carbolic solution and a shred came away of what appeared like macerated membrane about two inches long. The fcetor was not marked. At 8 P.M. the temperature was 101° and the pulse was 108. The headache was worse and altogether the patient was not so well. On the 23rd, to my great disappointment after such a struggle, the temperature was 104°, the pulse was 120, and all the symptoms were aggravated, the headache being terrible. A pain had attacked the left leg which was slightly severe swollen. The veins in the popliteal space were hard and corded and the calf was very tender to touch. Large linseed poultices were applied. On the 24th the temperature was 103 4° and the pulse was 116. The head was very painful, but the pain in the leg was not so intense. There was no foetor at all from the discharge and the other symptoms were more
profusely
A CASE OF PUERPERAL SEPTICÆMIA. BY CHARLES L. FRASER, F.R.C.P., F.R.C.S. EDIN., favourable.
The course of events from this point is of great interest for the temperature fell 1° every morning until it reached THE following notes of a severe case of puerperal septi- normal on the 29th, the pulse corresponding. The tenderness of the leg gradually disappeared, likewise the swelling, the caemia. may be of interest from the fact that grave corded veins softened very quickly, and by the end of the complications seem to have been modified by the use of month the patient could move the leg about quite freely and anti-streptococcic serum. I have reason to believe that some without pain. Her further progress has been uneventful if practitioners in such cases take no steps to remove from the slow. It seems to me that it is just possible that the serum uterus any putrescent offending matter or to render its&verba; may have assisted such a very rapid resolution of symptoms had all the appearance of a genuine phlegmasia. cavity surgically clean, and such a case as the following which Berwick-on-Tweed. amply demonstrates the necessity for such interference, otherwise the probability is that the patient slips through HEALTH OF TRURO.-The annual report preone’s fingers. sented by Dr. T. M. Bonar, medical officer of health of the The patient was a very thin, pale, and delicate woman, aged Truro Rural District, shows that during 1897 there were 350 twenty-five years. At her confinement on Dec. 10th, deaths, or 15 45 per 1000, and 517 births, or 22’85 per 1000. 1897, she could render herself very little help, the During the year 1 case of puerperal fever had been notified, pains were feeble and useless, consequently she was delivered 17 of diphtheria (with 2 deaths), 20 of erysipelas, and 31 of by forceps, in regard to which operation there was no par- scarlet fever (with 2 deaths). There were 9 deaths from ticular difficulty. For two days she did very well. but on measles. Dec. 13th the temperature in the morning was 102° F. and VILLAGE SANITATION IN DEVONSHIRE.-At the pulse was 104. There was no abdominal tenderness but there was very slight foetor of the lochia. On the 14th the Ipplepen, on Feb. 8th, a Local Government Board inquiry temperature was still 102° and the fcetor was more marked. was held to consider the application of the Newton Abbot The uterus was washed out with a 1 in 60 solution of carbolic Rural District Council for power to borrow L600 for works of acid and then with hot water. On the 15th the temperature sewerage in that village. Evidence showed that the cesspits was 101°, but no local treatment was allowed as the patient were " indescribably bad " and very little could be said of the felt so ill. On the 16th the temperature was 1015° in water-supply ; a witness in’describing one of the village the morning and 103° at night. On the 17th the wells stated that at one time the well overflowed and to temperature reached 103° and during the night a severe prevent this happening again a drain was laid between the rigor had occurred; the onlookers thought she had well and a sewer and added that when the sewer is choked convulsions. The pulse was very fast and thready, nearly the sewage goes into the well. He also said that sewage "running." The face was pinched and anxious, with a from a certain street " runs openly into a pasture field among death-like pallor. With difficulty the uterus was curetted, cows which supply Torquay with milk." Fourteen years ago well washed, and flushed with carbolic acid solution and then there was an inquiry at the same village almost precisely packed to the fundus with iodoform gauze. Its cavity was similar to that held last week and it is to be hoped the large and uncontracted and before the washing the odour district council will see that the village gets a proper waterShe was being well nursed and was fed supply as soon as possible. was very strong. SURGEON TO THE BERWICK INFIRMARY.
’
placed the saliva to be examined and under the other the colour standard with which it is to be contrasted. To one side of the upper aperture a piece of green glass is attached for the purpose of rendering the retina more sensitive to red light should the eye become fatigued. With regard to the method of using the instrument. Some saliva is first collected in a test tube and 2 c.c. poured into the centimetre measure. By this little manoeuvre the air bubbles are retained in the test tube. To this 1 c.c. of glacial acetic acid is added and shaken up a little to ensure complete mixing. Next the 0’045 c.c. of iron is taken up and mixed with the acid and saliva, it being necessary to pass them two or three times up the tube of the pipette to make certain that all the iron is added. The cell is then filled from the centimetre measure and a cover glass-which, by the way, is absolutely colourless-placed on top. If the cell is accurately filled to 2 c. c. a small air-bubble will be seen on the surface of the fluid. It is then placed under one hole of the camera and the standard with which it apparently corresponds placed under the other. The candle is then lighted and placed in such a position as to equally illuminate the surfaces of both saliva and standard. If the two colours correspond the amount of the sulpho-cyanide is at once known. If they do not it is only necessary to shift the standards till one is found of the same shade. Should none be found to exactly match the riders are brought into use, taking care that for every rider employed an additional cover-glass be placed on the cell in order to equalise the reflecting surfaces. Of what use the instrument may be remains to be seen. I have worked with it enough to be unable to confirm Schiff’s statement that the sulpho cyanide increases in saliva that is kept I can also a few hours owing to decomposition of the fluid. say its existence does not in any way depend either on the presence of carious teeth or the use or non-use of tobacco. is
Sloane-street, W.
and was blotched over the chest and abdomen. At 3 P.M. 10 c.c. of anti-streptococcic serum were injected into the cellular tissue of the abdominal wall. At 8 P.M. the temperature was 1026°, the pulse was 106, the respirations were 24, and headache was nearly driving the patient frantic. She felt so ill and weak that neither she nor her friends would allow further washing. On the morning of the 19th the temperature was 100° and the pulse was 92. The patient had had a better night ; the headache was much less severe, the discharge was not so foetid, and she had 10 c.c. of the serum were a sense of feeling better. injected. At 8.30 P.M. the temperature was 101.2° and the pulse 104. The discharge did not smell foetid. The headache, however, was still severe, but a sixgrain dose of butyl-chloral relieved it. On the 20th the temperature was 101° and the pulse was 104. The headache was easier, the pulse firmer, the tongue cleaner, the skin drier and less blotchy, and the anxious, pinched face had smoothed out a little. The uterus was washed out with carbolic solution and 10 c.c. of the serum were injected. On the 21st the temperature was 100° and the pulse was 108. The headache was easier as also were the other symptoms. On the 22nd the morning temperature was 99 6° and the pulse was 100. She was still improving and the head especially was comfortable. The uterus was washed out with strong carbolic solution and a shred came away of what appeared like macerated membrane about two inches long. The fcetor was not marked. At 8 P.M. the temperature was 101° and the pulse was 108. The headache was worse and altogether the patient was not so well. On the 23rd, to my great disappointment after such a struggle, the temperature was 104°, the pulse was 120, and all the symptoms were aggravated, the headache being terrible. A pain had attacked the left leg which was slightly severe swollen. The veins in the popliteal space were hard and corded and the calf was very tender to touch. Large linseed poultices were applied. On the 24th the temperature was 103 4° and the pulse was 116. The head was very painful, but the pain in the leg was not so intense. There was no foetor at all from the discharge and the other symptoms were more
profusely
A CASE OF PUERPERAL SEPTICÆMIA. BY CHARLES L. FRASER, F.R.C.P., F.R.C.S. EDIN., favourable.
The course of events from this point is of great interest for the temperature fell 1° every morning until it reached THE following notes of a severe case of puerperal septi- normal on the 29th, the pulse corresponding. The tenderness of the leg gradually disappeared, likewise the swelling, the caemia. may be of interest from the fact that grave corded veins softened very quickly, and by the end of the complications seem to have been modified by the use of month the patient could move the leg about quite freely and anti-streptococcic serum. I have reason to believe that some without pain. Her further progress has been uneventful if practitioners in such cases take no steps to remove from the slow. It seems to me that it is just possible that the serum uterus any putrescent offending matter or to render its&verba; may have assisted such a very rapid resolution of symptoms had all the appearance of a genuine phlegmasia. cavity surgically clean, and such a case as the following which Berwick-on-Tweed. amply demonstrates the necessity for such interference, otherwise the probability is that the patient slips through HEALTH OF TRURO.-The annual report preone’s fingers. sented by Dr. T. M. Bonar, medical officer of health of the The patient was a very thin, pale, and delicate woman, aged Truro Rural District, shows that during 1897 there were 350 twenty-five years. At her confinement on Dec. 10th, deaths, or 15 45 per 1000, and 517 births, or 22’85 per 1000. 1897, she could render herself very little help, the During the year 1 case of puerperal fever had been notified, pains were feeble and useless, consequently she was delivered 17 of diphtheria (with 2 deaths), 20 of erysipelas, and 31 of by forceps, in regard to which operation there was no par- scarlet fever (with 2 deaths). There were 9 deaths from ticular difficulty. For two days she did very well. but on measles. Dec. 13th the temperature in the morning was 102° F. and VILLAGE SANITATION IN DEVONSHIRE.-At the pulse was 104. There was no abdominal tenderness but there was very slight foetor of the lochia. On the 14th the Ipplepen, on Feb. 8th, a Local Government Board inquiry temperature was still 102° and the fcetor was more marked. was held to consider the application of the Newton Abbot The uterus was washed out with a 1 in 60 solution of carbolic Rural District Council for power to borrow L600 for works of acid and then with hot water. On the 15th the temperature sewerage in that village. Evidence showed that the cesspits was 101°, but no local treatment was allowed as the patient were " indescribably bad " and very little could be said of the felt so ill. On the 16th the temperature was 1015° in water-supply ; a witness in’describing one of the village the morning and 103° at night. On the 17th the wells stated that at one time the well overflowed and to temperature reached 103° and during the night a severe prevent this happening again a drain was laid between the rigor had occurred; the onlookers thought she had well and a sewer and added that when the sewer is choked convulsions. The pulse was very fast and thready, nearly the sewage goes into the well. He also said that sewage "running." The face was pinched and anxious, with a from a certain street " runs openly into a pasture field among death-like pallor. With difficulty the uterus was curetted, cows which supply Torquay with milk." Fourteen years ago well washed, and flushed with carbolic acid solution and then there was an inquiry at the same village almost precisely packed to the fundus with iodoform gauze. Its cavity was similar to that held last week and it is to be hoped the large and uncontracted and before the washing the odour district council will see that the village gets a proper waterShe was being well nursed and was fed supply as soon as possible. was very strong. SURGEON TO THE BERWICK INFIRMARY.
’