A CASE OF CATHETER FEVER FOLLOWED BY SUPPRESSION OF URINE AND DEATH. By HARI MOHAN
Soory
BHATTACHARJEE,
Charitable
N. L. Chaudhuri, practitioner, contracted
Dispensary, 32 years,
at.
a
gonorrhoea about
legal seven
178
INDIAN MEDICAL GAZETTE.
years ago, which gradually terminated in gleet. Occasionally the discharge would assume a purulent character when exposed to exciting causes. He at first consulted the local medical practitioners. but finding the disease was not radically cured by their medicines, he subsequently placed himself under the treatment of Kabirajes, and he also used patent medicines, but with no better result. Latterly, he had retention of urine on several occasions, which, however, passed off without the use of any medicine. In the evening of the 4th April last after his return from court he had retention of urine, and believing that it would pass off as hitherto he did not think it necessary to consult any medical man. He passed the night in great agony, and in the morning of the 5th idem called my colleague, one of the local practitioners, who thinking it was due to organic stricture of the urethra asked me to case of the come over with the gum-elastic catheters and help him to relieve the patient. As I was then busily engaged in the hospital, I sent the case at once and wrote to him that I would be there after half an hour. My colwith tried the No. 6 league gum-elastic catheter, but could not introduce it more than 3 inches, owing to spasm and pain complained of by the patient. On my arrival I fouud the patient in the following state: The patient was a young man of fair complexion and strumous diathesis; countenance extremely anxious; the bladder was full and distended up to about two inches below the umbilicus; complained of great discomfort on account of retention, getting up from his bed every now and then to make water but without success. There was a little oozing of blood through the meatus urinarius caused by the introduction of the catheter, though it was done without the stylet. Became very nervous and fidgety on attempting to introduce the catheter. Pulse slightly accelerated, about 90 in the minute. Temperature normal. Forehead moist with per?
spiration.
104?, pulse 120, Is restless.
ble.
[June but very soft and
1891.
compressi-
R
Spt. Arnmon. Aromat.
Aqua To be taken every 3 hours.
6th
m. xx.
c..
Yin. Gallici. Spt. Chloroform T.r. Cinchona}
...
5ii
...
m. x.
...
m. xx.
...
51
M.
Spoon
diet.
11 a.m.?Pulse barely perceptible Skin moist. Temperature 103?. Is drowsy. Answers questions in monosyllables. Has passed 110 urine since my last visit. No urine in the bladder. Has passed one loose stool. Does not like to be disturbed. Omit Spt. Ammon. Aromat. and substitute the same quantity of Spt. JEther Sulph. and continue the mixture every 2 hours.
April,
at the wrist.
Spoon
R
diet. Diluent drinks.
Tr. Digitalis Potas Citrat. Yin. Gallici
Aquae Every 3 hours.
...
m. x.
...
gr. x.
...
5ii
...
31
M.
6^ p.m.?Almost in the same state. Passed 110 Pulse percepurine. No urine in the bladder. tible at the wrist, but stops on slightest pressure, Tem140 in a minute. Fever still continuing. perature 104?. Is quite conscious but does not like to be disturbed. Complains of pain in the wrist joints. Continue both the mixtures ; dry cupping over the kidneys. 11 p.m.?Passed two loose motions. Pulse imperceptible at the wrist. Temperature of the body 103?, but that of the extremities subnormal. Perspiring freely. Stimulant mixture every hour. Stop Citrate of Potass mixture. Pulse 7th April, at 2 a.m.?Still perspiring. barely perceptible at the wrist. Temperature
Owing to the patient's fidgetiness it was found subnormal and that of the trunk lOO'S0. Is impossible to relieve his bladder without but can answer questions chloroform, and my colleague being of the same extremely drowsy, No urine iu the bladder. in monosyllables. the patient was placed under chloroform, opinion At 6 a.m.?Reported by his brother-in-law and No. 6 (English) silver catheter was passed with less difficulty than we anticipated, and the that at about 5^ A.M. the patient was very restmouth and almost
whole of the urine drawn out. A draught of Tiuct Opii and Quinine was ordered as soon as the patient recovered from the effects of chloroform. I came away leaving the patient to the care of my friend. 5 p.m.?The patient's brother-in-law says that soon after the effects of the chloroform passed off, the patient attempted to sit up on his bed, but After recovery fainted away and fell upon it. from fainting, he was attacked with fever attended with shivering. Has passed urine twice tinged with blood since my first visit. Temperature
less.
Wanted
to
wash his
bed, but before he could be removed bed he
change
his
to another
suddenly died. Remarks.?From the history and symptoms mentioned above, I am disposed to believe that it was one of those cases of fever known by the designation of " Catheter fever" first brought prominently to the notice of the Medical Society of London by Sir Andrew Clark 011 the 17th December 1883 (published in the Lancet, December 1883). The symptoms and termination of the case correspond iu many respects with the
Jcne
CASE OF
1891.]
"
CATHETER FEVER."
fifth variety of Velpeau's definition incidentally mentioned in the remarks made by the learned doctor. I know that this case is incomplete without the record of a post-mortem examination and that No post-mortem of the analysis of the urine. examination was made or allowed. Though there was opportunity of testing the urine when I first relieved the bladder, I did not examine it, simply because I felt no necessity as I never dreamt then that the case would assume such a serious character, but when the necessity arose, there was total suppression of the secretion. I am inclined to publish this case owing to its rarity after catheterism; so much so that
during
my
professional
career
extending
over
a
quarter of a century I saw only another case which came under my observation in 1884 (the particulars of which were published in the Lancet, 17th Septemberl884) amongst hundreds of eases in which the bladder required to be relieved by catheter.
179
Soory
BHATTACHARJEE,
Charitable
N. L. Chaudhuri, practitioner, contracted
Dispensary, 32 years,
at.
a
gonorrhoea about
legal seven
178
INDIAN MEDICAL GAZETTE.
years ago, which gradually terminated in gleet. Occasionally the discharge would assume a purulent character when exposed to exciting causes. He at first consulted the local medical practitioners. but finding the disease was not radically cured by their medicines, he subsequently placed himself under the treatment of Kabirajes, and he also used patent medicines, but with no better result. Latterly, he had retention of urine on several occasions, which, however, passed off without the use of any medicine. In the evening of the 4th April last after his return from court he had retention of urine, and believing that it would pass off as hitherto he did not think it necessary to consult any medical man. He passed the night in great agony, and in the morning of the 5th idem called my colleague, one of the local practitioners, who thinking it was due to organic stricture of the urethra asked me to case of the come over with the gum-elastic catheters and help him to relieve the patient. As I was then busily engaged in the hospital, I sent the case at once and wrote to him that I would be there after half an hour. My colwith tried the No. 6 league gum-elastic catheter, but could not introduce it more than 3 inches, owing to spasm and pain complained of by the patient. On my arrival I fouud the patient in the following state: The patient was a young man of fair complexion and strumous diathesis; countenance extremely anxious; the bladder was full and distended up to about two inches below the umbilicus; complained of great discomfort on account of retention, getting up from his bed every now and then to make water but without success. There was a little oozing of blood through the meatus urinarius caused by the introduction of the catheter, though it was done without the stylet. Became very nervous and fidgety on attempting to introduce the catheter. Pulse slightly accelerated, about 90 in the minute. Temperature normal. Forehead moist with per?
spiration.
104?, pulse 120, Is restless.
ble.
[June but very soft and
1891.
compressi-
R
Spt. Arnmon. Aromat.
Aqua To be taken every 3 hours.
6th
m. xx.
c..
Yin. Gallici. Spt. Chloroform T.r. Cinchona}
...
5ii
...
m. x.
...
m. xx.
...
51
M.
Spoon
diet.
11 a.m.?Pulse barely perceptible Skin moist. Temperature 103?. Is drowsy. Answers questions in monosyllables. Has passed 110 urine since my last visit. No urine in the bladder. Has passed one loose stool. Does not like to be disturbed. Omit Spt. Ammon. Aromat. and substitute the same quantity of Spt. JEther Sulph. and continue the mixture every 2 hours.
April,
at the wrist.
Spoon
R
diet. Diluent drinks.
Tr. Digitalis Potas Citrat. Yin. Gallici
Aquae Every 3 hours.
...
m. x.
...
gr. x.
...
5ii
...
31
M.
6^ p.m.?Almost in the same state. Passed 110 Pulse percepurine. No urine in the bladder. tible at the wrist, but stops on slightest pressure, Tem140 in a minute. Fever still continuing. perature 104?. Is quite conscious but does not like to be disturbed. Complains of pain in the wrist joints. Continue both the mixtures ; dry cupping over the kidneys. 11 p.m.?Passed two loose motions. Pulse imperceptible at the wrist. Temperature of the body 103?, but that of the extremities subnormal. Perspiring freely. Stimulant mixture every hour. Stop Citrate of Potass mixture. Pulse 7th April, at 2 a.m.?Still perspiring. barely perceptible at the wrist. Temperature
Owing to the patient's fidgetiness it was found subnormal and that of the trunk lOO'S0. Is impossible to relieve his bladder without but can answer questions chloroform, and my colleague being of the same extremely drowsy, No urine iu the bladder. in monosyllables. the patient was placed under chloroform, opinion At 6 a.m.?Reported by his brother-in-law and No. 6 (English) silver catheter was passed with less difficulty than we anticipated, and the that at about 5^ A.M. the patient was very restmouth and almost
whole of the urine drawn out. A draught of Tiuct Opii and Quinine was ordered as soon as the patient recovered from the effects of chloroform. I came away leaving the patient to the care of my friend. 5 p.m.?The patient's brother-in-law says that soon after the effects of the chloroform passed off, the patient attempted to sit up on his bed, but After recovery fainted away and fell upon it. from fainting, he was attacked with fever attended with shivering. Has passed urine twice tinged with blood since my first visit. Temperature
less.
Wanted
to
wash his
bed, but before he could be removed bed he
change
his
to another
suddenly died. Remarks.?From the history and symptoms mentioned above, I am disposed to believe that it was one of those cases of fever known by the designation of " Catheter fever" first brought prominently to the notice of the Medical Society of London by Sir Andrew Clark 011 the 17th December 1883 (published in the Lancet, December 1883). The symptoms and termination of the case correspond iu many respects with the
Jcne
CASE OF
1891.]
"
CATHETER FEVER."
fifth variety of Velpeau's definition incidentally mentioned in the remarks made by the learned doctor. I know that this case is incomplete without the record of a post-mortem examination and that No post-mortem of the analysis of the urine. examination was made or allowed. Though there was opportunity of testing the urine when I first relieved the bladder, I did not examine it, simply because I felt no necessity as I never dreamt then that the case would assume such a serious character, but when the necessity arose, there was total suppression of the secretion. I am inclined to publish this case owing to its rarity after catheterism; so much so that
during
my
professional
career
extending
over
a
quarter of a century I saw only another case which came under my observation in 1884 (the particulars of which were published in the Lancet, 17th Septemberl884) amongst hundreds of eases in which the bladder required to be relieved by catheter.
179
