Hemiplegia in typhoid fever / by William Osler.

  • Osler, William, Sir, 1849-1919
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Hemiplegia in typhoid fever / by William Osler. Source: Wellcome Collection.

    13/22 (page 369)
    Present illness.—About six weeks ago be had a sudden pain be- tween the shoiilders, which made him catch his breath. He had not been exposed to cold or wet. ddiis was followed by a hacking cough and some bloody expectoration. He lost in weight and strength. All this time he did his work regularly until two days ago. ^ esterday and Sunday he felt very much worse. Condition on ad7nission.—The temperature in the evening was 102°, pulse 88, respirations 3G. There were signs of a diffuse bronchitis over the ]X)Sterior part of the lungs. There was a soft apex systolic murmur. There were no rose-spots; the spleen was not palpable. There was no leucocytosis; red blood-corpuscles just under four millions; no malarial parasites. The sputum was serous, in large amount, and contained many diplococci. During the first week in hospital the temperature ranged from 101° to 103°, gradually falling so that on December 4th it was below 100° all day. The patient looked dull and heavy; his heart’s action was somewhat irregular, and the pulse was markedly dicrotic. There was slight impairment at both bases. During the second week the temperature was irregular, ranging from 100° to 102°. On the 9th, 10th and 11th it was a little higher, reaching 103°. Eose-spots were well seen on the 7th. On December 14th, after the temperature had been between 100° and 101° for three days, and he had been doing well, at ten in the montiing he was slightly nauseated, and said he felt “ sick all over.” At midday he was a little excited, delirious, and tried to get out of bed. The pulse was 92, respirations 28. The pupils were equal and reacted normally. At 2.45 P. M. his breathing was irregular and had a distinct Cheyne-Stokes character. At 3 P. M. there were a feAV incoordinate movements of the left arm. At 4 P. !M. there Avas definite paresis of the left side. At 4.15 P. IM. Dr. Futcher made the following note: “ At present patient is quieter than Avhen seen at 1 P. M., is rational, responds to questions. The temperature has fallen at 4 P. H. to 99.8°. Pulse, fair volume and tension, regular in force and rhythm, distinctly dicrotic, 26 to the quarter. The respira- tions are of a definite Cheyne-Stokes type. ISTot complaining of any headache; no stiffness of any neck muscles. Pupils normal in size, equal, react to light and accommodation; no strabismus; tongue protruded in median line. There is appreciable pare.sis of