by ed

the other occupants, and its spores arrestby their nasal and bronchial mucous mem-

branes. Those who low state of

development to imagine,

from

previous catarrh, offer

health,

from

or

suitable soil for the

a

of these micrococci; may, it is easy become the selected victims of the

disease. The

proposition pneumonia supervene is of

course

My

in

that

all these

on a state

of

way advanced.

no

field of observation has been

to in any way

cases

of low health,

indulge

in

limited

Loo

This,

generalization.

however, is the impression yielded by

a

very

experience, that at any rate a large proportion of cases are below par when attacked. limited

Usually even when first seen, the temperature of the body is high, io3?-io5? F., from which circumstance the REPORT ON SOME OBSERVATIONS IN CONNECTION WITH PNEUMONIA AS OBSERVED ON THE

PUNJAB

FRON-

By G. M. Giles, m.b., f.r.c.s., Surgeon, 1. AT. D.

I can, in the 15

well

noticed

altogether

than

had

some some

or

20

cases

which

of my

recently others

be

found

has been reduced some

I

and

to

that

the

recep-

previous ailment,

more

first admitted

with,

been

suffering from fever, and had bronchial catarrh for

time

previously. by which contagion might be from man to man can easily be under-

The method carried stood.

A sepoy, perhaps in the earliest stage of convalescing from the disease, spits on the earthen floor of his hut. This

drying,

dust which

becomes

covers

the

a

constituent of the

walls

and

floor and

fills the air of such habitations, is breathed in

some

Respiration apparently out

being involved

a

cases were

had

compressible

I have have

drawn the rise

from the normal very rapid. The pulse is frequent, weak and

is

generally

costive.

greatly accelerated, quite proportion to the extent of this period, but is very shallow

of

at

catchy. questioning the man, he usually complains of great pain, and tenderness on one side, and on listening at the point indicated, a pleuritic rub may very commonly be heard. In every case I have as yet watched closely, there have been, at some period, more" or less marked pleuritic signs present, generally in the early period of the case. This pleuritis, however, in one of the cases only, proceeded to effusion, and in that one to only a very limited extent. Commonly at this stage there is no marked dulncss, but only irregularly disposed patches, where resonance is impaired. At this period, there is usually but little expectoration, and on appl^frig the stethoscope, the bre'ithing is heard to be harsh, and 'the exOn

it will

cases

patient's system tive condition by 01*

type-case, combining,

met with.

In many

one

a

the characteristics

as

be

and

relaxed, but in

(Concluded from page 2J9.) I will first describe

may

the artery being relaxed and full. The tongue is foul, bowels irregular,

TIER.

as

conclusion

that the invasion is very sudden

GILES ON THE PNEUMONIA OF THE

October, 1883.J

piratory sound prolonged and abnormally audible. Usually some scattered noisy bronchitic rales

are to

be heard.

If the blood be

now

examined with

a

high

power, it will be found to contain multitudes of minute rounded bodies, similar to

magnifying

already described and blood, pleuritic fluid

those which have

present in

the

rabbit No. In the

been

that

cases

day

a

of

I. came

or

two

at first be seen.

the other

nucleated

or

form makes its appearance. These

are

about three times the diameter of

the first sort, the nucleus in size and appearance being much like one of the smaller form. If the

precaution be taken of warming the slide and rapidly brushing a little oil round the edge of the cover, and the examination be made as quickly as many of the smaller sort will be seen to " " Brunonian two motions, the ordinary

possible, have

vibration and

an

independent

locomotion

of

their own, often sufficiently strong to enable them to move in opposition to the general current of

from

the

the

blood, running by gravitation upper to the lower edge of the

cover.

It is hard to

focussed

FRONTIER.

273

a resting condition. In the larger nucleated form I have never observed any signs of loco-

motive power. or soon after, the apnucleated the of form, congeries of pearance the smaller sort are found united together, by a

Coincidently with,

This

material,

into

to

as

four times the size of

a

whatever be its nature, is of

a

hyaline material, large as three or Icucocyte.

earliest under observa-

tion, the small form alone could After

as

PUNJAB

masses

reaching

firmer consistence than the red blood

corpuscles, by pressing on the cover-glass, are seen, as they pass these masses to have their form altered by contact with the masses (which I take to be a zoogloca stage of the parasite), they remaining quite unaltered for the latter, when moved

in

shape. On

or

about the fifth

day

there is

usually

a

sudden diminution in the number of micrococci

present in the blood, but that is less

complete cycle re-commencing.

a

more or

The stages, however, the first instance ; there each sort

not

of the

permanent, same

are not so

distinct

being,

rule,

as a

a

sort

as

in

few of

in addition to those

which present a second After series has been preponderate. completed, it is almost impossible to make out any signs of a third, the process having ap-

image of bodies, adjustment of the parently become confused. of the objective collar light and of the screw As the patient recovers, they become fewer have been lucky, these locomotive particles as and fewer, but persist in scanty numbers up to they turn are seen not to present a circular complete recovery ; indeed in one case (recorded contour in all positions, but to be pear-shaped, further on) they were still to be found five days and as the cooling of the slide causes the blood after the patient had returned to duty. to coagulate, and the motions become thus To return to the clinical progress of our case,? stopped, I have in some instances glimpsed" the temperature with a moderate morning's faint indications of a lash springing from the remission continues high for from 5 to 10 days, smaller end, so that the whole body would be and then drops almost critically nearly to much like a spermatozoon in shape. normal, which is usually reached in two days. It does not appear, however, that all are The pulse grows more frequent and weaker, furnished in this manner, many shew only the Brunonian vibration, and a day or two after the and in bad cases becomes almost imperceptible. onset of the disease, the smaller form are com- Any improvement in its strength, is a most monly found united in chains of from two to favourable omen. ten individuals, under which circumstances they The physical signs increase in gravity, patch must have abandoned their tails and reached after patch becoming, in one or both lungs, dull,

these

get

a

sharply

but when

the

"

THE INDIAN MEDICAL GAZETTE.

274

but, it appears from what is

to me, in

in

seen

quite

a

different fashion

the acute croupous pneuto meet with in

monia

one

Europe

; the distribution of the dulness

was

accustomed

being,

first, curiously irregular, e. g., in the

at any rate at

flank, and mammary region perhaps, but little impaired resonance, while the lower part of the lung in front, and the scapular region behind, may be Even

absolutely

dull.

the disease is at its climax,

when

of the

a

of the per-

slight shifting stethoscope cussing finger will often bring to notice quite altered physical signs, so that a complete report of the physical signs of any given day would or

occupy several pages were all recorded. Hence one is apt to get the impression that the

in

signs

evanescent,

curiously

any given region and have chanced between are

one

Fine

streaking, or slight tinging with blood, enough, but I have not as yet met with the regular "prune juice" sputa of ordinary croupous pneumonia. Up to the commencement of recovery the is

common

sputa

are

ture to acute croupous

course

pneumonia, yet presents,

being probably lobular and not lobar. peculiarity is the strong tendency complicated by inflammation of the

A further

l'ieura-

ns bns noitadiv copy of the notes of the case, the above described bodies were first

tmbnsqobni

,

is

in which

ary for

observed in the blood, with

a

Then,

as

or

a

two after.

rule, the auscultatory signs take

"

only

which there is almost absolute silence, or a few crepitations on making the patient

take

a

over

deep

breath.

These spots begin first to heard larger and larger moist in recoveries, the chest

crepitate, then are rales, and finally, clears up, usually with

great rapidity.

During the stage of sonance and fremitus but

never

/Oin

i

notes of four other

cases. Qlij

Qj

consolidation, are

often

vocal

re-

exaggerated,

that I have seen, to the marked de-

pneumonia

The sputa at first consist of clear, glairy mucus; after a time they become opaque, of

peculiar greyish red colour, with flocculi of more solid grey material, which sink to the bottom of

DT 11

abstract of the

an

ZSrCXfJU

JIIj

lllOii

These will be sufficient to illustrate, without

iteration, the points advanced above. these, however, I observed the micrococci daily in the blood of several other cases, which came under my care in the 4th P. I., and casually in some other cases in the 1st P. C., and 5th P. L hospitals. They were found, in fact, in every case I have too much

Beside

as

yet examined. As to the exact nature of these bodies

causal connection, otherwise, question, I should be unwilling,

in a

number

decided

their

observations,

on so

limited

hazard

to

any

opinion.

Since I case

of

or

with the disease

or

gree characteristic of the croupous of Europe.

the vessel.

a

3?lj

and the few

moister

character, crepitations mixed with coarser bronchitic previously heard, ;r v. rl sounds, become quite drowned by the latter. When at the worst, there are often large patches, a

Appended

area

day

of the tempera-

physical signs and clinical symptoms, a greater similarity to broncho-pneumonia, the

increases up to the time of the sudden fall of temperature, and remains stationThe dull

ex-

to

as

to be

the pre-

scanty

are

and

acute, and similar in the

the exact spot that vious occasion.

on

a

tenacious, clinging firmly to the vessel in which they are contained. As the patient mends, they become more gopious, yellow, and muco-purulent like the expectoration of acute bronchitis ; finally they become again clear and mucous, and then cease. Here then is a disease which, though equally

tremely glairy

disease

examined

very airless, shewing but the surface, and on

amount of froth

day's observation and the next's ; the true reason being, probably, that one has failed to hit upon one

[October, 1883.

commenced

this report,

a

slight

pneumonia has occurred amongst the of the 4th P. I., detected to this station.

of

guard (Shaik Budin.) By some anilen violet, bodies, which

are

chance

I have obtained

and

find

I

that these

present in the blood of the

man, also do stain with this

dye

in the

manner

GILES ON THE PNEUMONIA OF THE

October, 1883.]

described by Koch.

circumstance, their chains, their forming

This

becoming grouped into zoogloca like masses, and the order in which they make their appearance, seem, to say the least, to point strongly to' 'their being of vegetable nature?micrococci in fact,?the larger nucleated form being perhaps in some way connected with their

reproductive process. very significant fact, that these nucleated cells made their appearance the same day in the blood of dying rabbit (No. 2), and It

seems

in the

a

from the

serum

pleura

that had

been

put aside from the autopsy of the rabbit No. which had died on the previous day.

1

pleuro-pneumonia, septic poisoning, is clearly enough

the records of the post-mortem amination of the animals.

shewn

by

Personally clearly

trace

ex,

I have not as'yet been able to any instance of contagion, but am

strongly inclined to believe, that the disease is capable of being transmitted in this way, probably through the medium of dried sputa diffused through the air. Certainly I should always continue to isolate nevertheless

any case that may

occur.

In favour of this view I received

a

strong

confirmatory evidence from Lieut. F. piece Egerton, late of the 3rd P. C., who tells me that in that regiment, some years ago, there occurred confined to an outbreak of pneumonia, almost whom died of the the Dogra troop, 14 or 15 of other remained the while troops disease, nearly of

seen

in

It is

appcarance identical 'with those/

pneumonia. possible

that

may lead to the

more

be a fact, much might be the done prevent spread of the disease. Greater air-space in the huts, and the adoption Should

contagion

to

of brick, stone,

pucka flooring, capable thorough cleansing would, no doubt, do much to prevent not only this, but mumps and other diseases which

of

or

cause

much

inefficiency

among

sepoys during the year. Before closing these remarks I must, however, mention one other point that has been to me very puzzling. This is, that in the blood of

ordinary

malarious

fever,

men

are to

suffering be found

extended observation of

discovery

some

points

of

difference between them, and, in the absence of any means of accurate

micrometry,

by

to pronounce that

no means

prepared identical, but in general are certainly very similar. It was in seeking for the are

that

I

and

blood, it

though

was some

I

I should be

they they

appearance

bacillus malaria?, fever patients'

bodies in

found these

continually

time before I

At last I found

saw

met with

any

sign

these,

of the

patient newly admitted, actually shivering stage, and on examining his blood, the bacillus could be made out plainly enough in addition to the micrococcus-like0 bodies, a couple of hours after the hot stage having supervened no bacilli could be seen. After this, by treating a few cases of quartan fever without any form of quinine, and by making a point of being at the hospital at the time at which the cold stage might be expected to commence, I again and again made out the bacillus quite plainly. My previous want of success was, no doubt, due to my not examining the blood at the right a

in the

else in

period, or quinine.

under the influence of

cases

The stay of these cases (treated without quinine) in hospital was, however, no longer than the average. So far then all that

free.

from

bodies to all

275

bacillus.

That the rabbits died of a and not of

|

FRONTIER.

PUNJAB

that, in this are are

can

pneumonia

be

definitely said, is frontier, there

of the

present in the blood certain bodies which not present in the blood of healthy subjects,

and that

these

changes in I hope

bodies

run

through

certain

fairly regular during the coming cold season to have opportunities of testing this question further, and under more favourable circumstances

as

manner.

a

to

apparatus, re-agents, &c.

At present I labor under the deficiency of being quite without books of reference, all my

books,

and most of my

crophotographic

microscopical

and

mi-

arrangements, being still

at

THE INDIAN MEDICAL GAZETTE.

27r?

will, I hope, incomplete apology of the present investigation.

Calcutta, as

some

racter

which circumstance

for the very

serve

cha-

[October, 1883.

Report on Some Observations in Connection with Pneumonia as Observed on the Punjab Frontier.

Report on Some Observations in Connection with Pneumonia as Observed on the Punjab Frontier. - PDF Download Free
6MB Sizes 1 Downloads 9 Views