An obstinate case of purpura hemorrhagica / by J.H. Burch.

  • Burch, John Holcomb.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An obstinate case of purpura hemorrhagica / by J.H. Burch. 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.

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    tosis was still marked. The nucleated red cells were not present, but the small, round bodies were still observed, and also the same degenerated condition of the leuco- cytes. On February 18th her temperature was ioi° F., and pulse 120, and stronger. There was less hemorrhage from the mouth and nose, but the removal of the tam- pons resulted as before. There was a disagreeable odor from the nose, notwithstanding the fact that strict anti- septic precautions were observed. The swelling of the eyelids and side of the nose was increasing. A free in- cision disclosed the presence of thin, ichorous pus and necrosis of the nasal bones and of the nasal process of the superior maxillary bones. The necrosed portions of bone were removed, and the wound packed with iodo- form gauze. The blood count per cubic millimeter was: Red cells, 2,400,000; white cells, 12,000; hemoglobin, thirty-seven per cent. On the following day her temperature fell to 99 5° F., her pulse being 140, and very weak. The spleen was still distinctly palpable. The urine was of a clear straw- color, and did not contain albumin; the specific gravity was 1020. The diazo reaction was absent for the first time. Indican was also absent, this having been present part of the time during her illness, but not as a constant constituent. The blood-count revealed red cells, 2,100,- 000 per cubic millimeter; white cells, 14,000 per cubic millimeter; hemoglobin, thirty-two per cent. There was still present a marked poikilocytosis, the cells varying both in size and shape. The peculiar round bodies were still seen, but were not so numerous; the small mononuclear leucocytes greatly predominated over the polymorphonu- clear variety. The character of the latter was very dif- ferent, they being much smaller in size, with cell-wall and nuclei of normal appearance. I removed the tampons from the nose again, with less resultant hemorrhage, and