History of Case
Past History: A very acute and severe follicular tonsillitis about April 1st 1919 with considerable swelling of the glands of the neck.
Present trouble began May 22nd when about six P.M. he developed a fever which continued high all night and he vomited several times during that night. The next day at noon face was pinched and drawn and anxiousBlooked like death then, examination then showed heart slow, irregular and intermittent. In moving about at that time he had two short convulsions. White Blood count 110,000; Reds 5,000,000; Hem 70, considerable albumin in urine, no casts. At 10 P.M. discovered that neck was somewhat stiff and Kernigs sign present. Cries out when moved, seems to be sore all over to the touch.
May 24th (2nd day) Spinal Puncture showed fluid under much pressure, turbid, pus and many meningococci. 15 cc serum given. Heart the same. Left hand swollen. Hemorrhagic spot in conjunctiva and all over body.
May 25th (3rd day) Drowsy and stupid. Puncture and serum given. [Puncture=spinal tap and the serum was sulfa which was an experimental medicine at the time. It was so new they did not know the dosage to use.]
May 26th (4th day) Much improved will smile but watches your lips. Seems to be deaf.
May 27th (5th day) Much improved B laughs today. Given watch to his ears he says "Watch won't go". Later in day says "Daddie, I want some ears". Serum given. Spinal fluid still under high pressure.
May 29th (7th day) Eyes bloodshot.
May 30th (8th day) Eyes about the same. No serum given today. No puncture.
May 31st (9th day) Left eye clear in morning then both eyes become much more inflamed in afternoon.
June 1st (10th day) 9 A.M. a spell of delirium lasting about 10 minutes (we are sure now that this spell was terror instead of delirium) Could not be quieted. Cried for daddie and muddee. Probably sight was now gone and he found it so when he woke up. No puncture or serum given.
June 2nd (11th day) 7 A.M. Another spell like yesterday only worse. Today does not seem to see. At noon and for all afternoon was restless, and at times delirious, pains in head, pulls hair.
Diagnosis of relapse made. Serum given at 4:30 P.M. 43 cc now turbid fluid removed under high pressure and again showing meningococci.
June 3rd (12th day) Puncture made and fluid clearer than yesterday. Does not seem to see, but eyes will blink to sudden light. Considerable iritis present. Serum given.
June 4th Spinal fluid clearer than any yet, serum given.
June 5th (14th day) Spinal puncture and serum followed by cyanosis and vomiting and cold perspiration.
June 10th to June 21st Profuse perspiration continually, body cold, clammy and about June 15th pulse became irregular and intermittent and weak, heart became enlarged and liver now became extended to below umbilicus. Cyanosis most of the time. From June 16th to 23rd pulse could not be correctly counted at the wrist.
June 17th (26th day) Urine now 6 oz. per 24 hours and continued from 6 to 9 oz. per 24 hours for the next month (one day 3 oz. and one day 4 oz.)
June 18th Face swollen. X-ray of heart shows much dilatation (4,7/8 inches across)
June 20th Rash on chest and legs (probably toxic hemorrhages)
June 22nd X-ray shows lobar pneumonia on right posterior chest. Respirations now 43 to 56 and continued so until June 30th and then went down gradually to 20 on July 8th.
June 24th 60cc spinal fluid removed. Clear, negative.
June 25th Right leg swollen and painful and purpura rash. [Purpura (from the Latin, purpura, meaning "purple") is the appearance of red or purple discolorations on the skin that do not blanch on applying pressure. They are caused by bleeding underneath the skin. Purpura measure 0.3-1 cm, whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm. This is common with typhus and can be present with meningitis caused by meningococcal meningitis or septicaemia. In particular, meningococcus, a Gram-negative diplococci organism, releases endotoxin when it lyses.]
June 27th (36th day) Left arm purpura with swelling and painful arm
June 28th Oedema [swelling] of body
June 29th General anasarca [also known as "extreme generalized edema”-Wikipedia] continued until July 6th
July 5th Left leg was swollen tight. Face very cyanosed [blue]
About July 1st Liquid intake limited to 20 oz per 24 hours.
July 6th and 7th. Is brighter, dropsical [edema] condition somewhat better and the liver a little smaller. Liver has extended to crest of ilium and two inches below umbilicus on left side.
July 9th X-ray heart shows 4,1/4 inch across
July 10th Oedema all gone and bronchial pneumonia of left chest post. Respirations up to 40 and July 11th were 46 when a definite pneumonia showed over post left chest.
Does not seem as well in any respect, face swollen
July 9th Water limited to 12 oz per 24 hours There has been much albumin and casts in urine but none now. P.SP. on July 9th I 90cc 25% II 35cc 18% Total 43%
On July 11 liquid limited to 16 oz
Chlorides July 8th 5.62 gms July 10th 0.612 gms July 11th 0.68 gms July 12 1.10 gms July 14th 2.09 gms per 24 hours.
July 16th Blood creatinine 1.55 per 100 cc
Now passing more urine and seems on the way to recovery.
Oct 22nd Is now able to stand alone and walk, but does not do so for he is afraid to try. But this past week he has gained much in strength.