BACTERIA IN THE SPUTA, ETC. 301 



Mr. G. F., 41 years of age, having already been twice attacked 

 by obstinate miasmatic affections, and once by an acute affection 

 of the air-passages (the nature of which he does not remember), fell 

 ill last March with very high fever (from 40*6° to 41 "2° in the 

 evening hours, falling about a degree in the morning) ; with serious 

 dyspnaea (from 45 to 50 breathings a minute), and very rapid pulse 

 (135 — 145). On the chest it was only noticed that the right apex 

 was less sonorous, giving an indistinct respiratory murmur ; Httle 

 coughing, with scanty and infrequent expectoration ; tumour of 

 the spleen by percussion, but probably chronic. The sensorium 

 sound ; a little insignificant epistaxis ; remarkable bilious diarrhoea. 

 Albumen, one and a-half grammes to every pint of urine, with a 

 few hyaline and granular urinary casts, and increase of ordinary 

 pigments. 



In the first days there was a doubtful expectoration, which was 

 thought to proceed from the nose. An eruption of herpes labialis 

 appeared (which I remember having deceived me in a case 

 of ileo-typhus). At any rate, the diagnosis of ileo-typhus was 

 given, and three baths were prescribed which gave great relief. 

 On the seventh day the fever suddenly subsided, as generally 

 happens in pneumonia. Dyspnoea remained, only diminished by 

 the quota due to fever ; and in thirty-six hours 1 obtained a small 

 quantity of rusty sputa, a portion of which, nearly free from saliva, 

 I examined, to ascertain whether it proceeded from the air-passages. 



The diagnosis was made even clearer when, later on, crackling 

 wheezings and murmurs of friction in unison with the beatings of 

 the heart (pleuro-pericardiac friction of Wintrich) became mani- 

 fest ; these continued up to the sixteenth day of the illness. I 

 have met with this phenomenon on other occasions, in pleurisy 

 or in pleuritic granuloma, but on the left side ; here, on the con- 

 trary, it was heard on the right upon the line of the sternum, and 

 below towards the mammillary line. Consequently, the grave 

 dyspnoea had been the means of spreading the process to the 

 pleuritic coating of the pericardium, and perhaps to a limited part 

 of the pericardium itself. At any rate, the examples of a great 

 disproportion between the extension of the local and the magni- 

 tude of the general facts are not rare, especially when the apices of 

 the lungs are affected with pneumonia. 



