Case of Pleuritic Effusion: Paracentes is Three Times: Death: Necropsy

Abstract

June 8, y78.] 7WE BRITISH MEDICAL ?OURNA.I CASE xi.-M., aged 28, has been married four years. Between eighteen months and two years before marriage, he had a primary sore and urethral discharge, which healed under treatment in three months. No constitutional symptoms followed.-F., aged 22, has suffered since marriage from general debility ; but no distinct symptoms of syphilis have shown themselves.-The first child, at the age of four weeks, exhibited well marked syphilitic symptoms, nasal discharge and snuffling, superficial cracks -round the nose and mouth, slight coppery tinge of the skin, and spots on the abdomen. FOR permission to report the following case I am indebted to Mr. B. Walker, Surgeon to the Rotherham Hospital. G. M., aged 30, male, unmarried, was a tall fine made man, and had served nine years in the Indian army. He had enjoyed good health till three months ago, when he had an attack of acute pleurisy. Not recovering from this, and being in poor circumstances, he came under my care as an out-patient, and was attended at his own home. CASE OF PLEURITIC EFFUSIONOn May 27th, 1877, when I first saw him, he was lying on his back in bed, nearly exhausted, and almost cyanotic. His respirations were very frequent, and he had a constant short hacking cough. His finger nails were clubbed. His tongue was foul, and he gave a history of profuse night sweats for some time past. On examining his chest, the right side measured eighteen inches, and was superresonauit on percussion. The cardiac impulse was to the right of the right nipple line. The left side measured twenty-one inches, was absolutely dull on percussion, and no breathing sounds could be heard. The chestwall on the left was so swollen and cedematous, that it was impossible to feel the ribs. Knowing what was the matter with bitr, I had taken the aspirator with me, and at once proceeded to tap him somewhere about the angle of the scapula. I used a large needle, but, although the chest wall was so cedematous, the fluid withdrawn was clear serum. It measured thirty-five ounces. The upper portion of the lung expanded at once, and the heart's apex moved close to the right of the sternum. On the next day, a succussion-splash could easily be obtained, but this soon cleared off, and he nearly recovered and was able to walk about. In about a fortnight's time, however, it began to fill again; and, on June igth, 1877, he was in much the same state as when I first saw him. I again tapped him, and this time drew off one hundred and forty ounces of clear serum. The cardiac impulse returned to its normal site, but the lung appeared to expand very slightly. He recovered in a few days, and used to walk out; but, on July i8th, 1877, I had again to tap him, drawing off forty ounces of clear dark serum. The cardiac impulse again returned to its normal site, but no breathing sounds whatever could be heard over the left lung. On visiting him the next day, he had gone out for a walk. On July 26th, I877, he was seized with vomiting, and his urine was nearly suppressed. It ...