The heart in diphtheria / by Charles Bolton.

  • Bolton, Charles
Date:
1902
Catalogue details

Licence: In copyright

Credit: The heart in diphtheria / by Charles Bolton. 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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    When paralysis comes on in the acute stage of the disease, it is usually preceded by some irregularity of the pulse. In the following case the pulse became irregular on the sixth day of the disease, and on the thirteenth day paralysis commenced. The pulse was still irregular on the hundred and twenty-fourth day when the patient was discharged, and the knee-jerks were also absent; the paralysis disappeared on the seventy-fourth day. The heart showed signs of dilatation about the same time as the pulse became irregular. The irregularity of the pulse was not preceded by vomiting, which sometimes happens in these cases. Case 6.—A. G., female, set. 3 years and 7 months. Admitted to Uni- versity College Hospital on 29th August 1901. The onset of the disease was 27th August. On admission there was a large gelatinous-looking piece of membrane on the right tonsil; profuse rhinorrhoea with enlarge- ment of the cervical glands on both sides. Pulse 103, and quite regular; heart normal. Temperature, 103. Urine free from albumin. Anti- toxin, 8000 units administered. August 31.—Membrane has extended to the uvula and left tonsil; pulse quite regular. Antitoxin, 8000 units administered. September 1.—Pulse irregular in force and rhythm, and compressible; cardiac impulse in fourth left intercostal space in nipple line. September 2.—Impulse outside nipple line, and an apical systolic murmur present; knee-jerks present. September 8.—Fauces clean, a little superficial erosion of the mucous membrane being present at the base of the uvula. Nasal voice, but palate moves a little on phonation; pulse more irregular. September 9.—Palate quite motionless; pulse is less irregular since syringing of the throat has been stopped. September 17.—Patient is very languid and limp. Cardiac impulse | in. outside nipple line; systolic murmur still present. September 24.—An occasional strabismus is noticed to-day. September 27.—Marked internal strabismus ; pupils dilated. October 2.—Knee-jerks absent for first time. Cardiac impulse in the nipple line. Breathing during the night was very irregular, and frequently interrupted by pauses. Diaphragm acts quite normally. October 13.—The breathing has frequently been irregular during the night. Squint disappearing; pulse still irregular. October 18.—Cardiac impulse outside nipple line. November 8.—Squint practically gone; voice normal and palate moves well. Knee-jerks absent; child much more lively and stronger. Cardiac impulse in nipple line. December 16.—Child quite well; knee-jerks, heart, and pulse as before. December 28.—Patient contracted scarlet fever and was sent to the fever hospital, the knee-jerks still being absent and the pulse irregular. The pulse in this case varied in the same manner as in the two previous cases. It rapidly changed from a condition of regularity to irregularity several times during the day, and the frequency also varied consider- ably ; the irregularity in this case occurred more often with a rapid pulse than in the two previous cases. Towards the end of the time the pulse
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