Suppurative pylephlebitis : being a clinical lecture delivered at Guy's Hospital on January 6th, 1900 / by J.H. Bryant.

  • Bryant, John Henry.
Date:
1900
Catalogue details

Licence: In copyright

Credit: Suppurative pylephlebitis : being a clinical lecture delivered at Guy's Hospital on January 6th, 1900 / 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.

    8/26 (page 6)
    G discuss tlieir bearin'^ on the diagnosis. diagnosis must be based on a very careful estimate of the significance of the previous history, of the symptoms, and the physical signs. The first point that I have to draw your attention to is the onset: it was acute, it com- menced with vomiting and pain in the right side ; and it is definitely stated that, the day before, the boy went to work and appeared quite well. He was admitted on the seventh day of his illness, and died on the ninth day. The previous illness of appendicitis is an important point to consider, and it is also of importance to take notice of the diagnosis of the doctor who sent the boy into the hospital, viz., that the patient was suffering from gastro- enteritis. When I saw him in the ward the temperature was 104° the respiration rate was 44, and the pulse was 140. I shall draw your attention to the ratio between the pulse, the temperature, and the I’espiration again. The other prominent symptoms were, the vomiting, the pain in the right side, the diarrhoea, and ■ the dyspnoea. The general appearance of the boy was in- teresting. He looked very ill, he was rather ■ collapsed, his face was flushed, his eyes sunken,. his lips cyanosed, and his skin hot and dry. Of the physical signs, the shape of the chest: first attracted my attention. I noticed that it* was not symmetrical; the right side was bulged,. was much more prominent than the left, andi the spaces on this side were filled out. There^ was less respiratory movement on the right side than on the left. The tactile vocal fremitus- was increased at the right base, and there was- absolute dulness extending round the chest on the right side {vide Diagram). There was-