Volume 1

Clinical medicine / by Lewellys F. Barker.

  • Barker, Lewellys F. (Lewellys Franklin), 1867-1943.
Date:
1922-
Catalogue details

Licence: In copyright

Credit: Clinical medicine / by Lewellys F. Barker. Source: Wellcome Collection.

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    violent sneezing spells. This attack occurred about seven months ago and the symptoms lasted for two or three weeks. As the season did not correspond to that of hay-fever, the attack is suggestive of a coryza vasomotoria. A couple of months later, when he was at French Lick Springs, Indiana, he began to suffer from pains in the knees and in the left shoulder. He asserts that his hands and feet were always cold and that he had sensations of “pins and needles” in them. There was neither redness nor swelling of the joints at the time. He says that he suffered from a series of similar attacks not so severe, however, many years ago. The question that arises here, of course, is: Were these symptoms due to a low grade of arthritis or to a mild multiple neuritis? In considering this point the mind goes back, of course, to the history of fifteen or twenty whiskies a day, for, as you know, such a history would be entirely compatible with the occurrence of an alcoholic polyneuritis. About four months ago the patient returned to his home in Canada, and soon afterward began to lose weight rapidly. At this time he suffered from pain in the interscapular region, relievable by hot applications. He had some cough, though not much more than he had had for some time. His former cough he had attributed to excessive smoking. But he now began to bring up a considerable amount of mucoid sputum. There was little or no shortness of breath. The development of cough with mucoid sputum takes the mind back at once, of course, to the history of recurring attacks of influenza and to the occurrence of cases of tuberculosis in the patient’s family. The patient continued to lose weight. He now found that he was having a slight rise of body temperature every afternoon. He lost his appetite, had some nausea, and occasional vomiting. The cough now became paroxysmal. He was shortly obliged to go to bed, and soon after this his expectoration for several days was blood streaked. Note here the presence of low fever, the loss of appetite, the nausea, and the increase of cough, becoming paroxysmal, accompanied by blood-streaked sputum. What does this combination suggest to you? Student: It suggests the possibility of pulmonary tuberculosis. Dr. Barker: Yes, very strongly. But, again, let us hold the suggestion strongly in leash until we accumulate further data. For about two weeks after the patient was confined to bed he had night-sweats, and he states that at that time the ends of his fingers