Case of Purulent Infection. Service of M. Roux. Hotel Dieu.
Reported by J. H. Weir, M. D., Philadelphia.
Julien, aged 21 years, had received a blow on the frontal
region by falling against the corner of a door. He entered the
hospital St. Antoine, where he remained for eight days. No
symptoms of compression of the brain appeared after the accident,
and the small wound cicatrized rapidly. Six days after leaving
the hospital, an abscess formed at the lower part of the cicatrix ;
this was opened, and the patient then entered the Hotel Dieu on
the 30th of April.
April 30. Abscess situated on a level with the left frontal pro-
tuberance, an inch in length, and about one half in breadth. Sup-
puration commenced freely ; the bone was soon exposed; the fever
became intense, with little appetite. Ordered simple dressing,
with absolute diet.
During the following six days the fever greatly abated ; the
pus was healthy, the integuments surrounding the wound were not
inflamed, and the appetite was better.
On the night of the seventh, the dressings of the wound became
detached, so that the wound was exposed to the air for the space
of six or seven hours. Soon after, the patient was seized with a
chill, dry heat of skin, vomiting of bilious matter, pain between
the shoulders, and the abscess ceased discharging pus.
May 8th. The vomiting still continues ; the patient in a low
state; abscess nearly dry ; pulse small and frequent; skin hot and
dry ; the pain between the shoulders has greatly augmented. On
percussion, dull sound at the base of right lung, respiratory mur-
mur absent at this point. Pleurisy diagnosed with symptoms of
purulent infection. Tartar emetic grs. iii.
May 9th. Patient complains of a severe pain in the region of
the liver, accompanied with great weakness.
May 10th. Blister to right hypochondrium. Patient about the
same. Surface of abscess glazed and dry.
May Wth. No new phenomena have occurred ; there is greater
prostration ; pulse very small; severe pains in the region of the
liver, accompanied with a dry, painful cough; diarrhoea ; icteric
tinge of the skin.
May 12th. Patient continued to sink up to 12 o’clock, when he
expired.
Autopsy.—An icteric tinge of the skin over the whole body ; the
wound of the forehead is enlarged, and the periosteum is detached ;
no fracture of the cranium ; surface of the coronal suture rugose,
bathed in pus. On examining the internal surface of the bone, it
was found to be denuded, its greyish color and its rugosities show
that there has been effusion of pus from the exterior to the interior.
The dura-mater beneath the wound is of a black color, slightly
softened and soaked in pus; no false membranes above the arach-
noid ; slight injection of the surface of the brain ; the cerebral
substance is of a normal consistence and color.
Pleurisy of the right side with exudation of a troubled liquid ;
pseudo-membrane enveloping the lower lobe of the right lung;
underneath this membrane were found several superficial metas-
tatic abscesses ; no induration of lung ; some metastatic abscesses
in the left lung. The brain was healthy throughout. In the
interior of the spleen three metastatic abscesses were found ; one
of them in process of suppuration. Stomach and intestines gene-
rally healthy. Jugular veins and the sinuses of the dura-mater
contained some black clots, slightly consistent ; these were found
without any traces of pus.
The above is one among the many cases (collected during a
residence in Paris of some two years) of death occurring from
nothing but that insidious and most fatal sequence of suppuration,
purulent infection, or metastatic abscesses. It has been my desire
to give a report of such cases only in which the powers of this
“ purulent infection ” are most evident. In reading the case just
reported, any one will be struck with the fact, that up to the night
of the 7th May, the patient had continued to do well; that during
that night the abscess was left exposed to the action of the air for
several hours, and that from that time the unfavorable symptoms,
which ended in the speedy death of the patient, date themselves.
Previous to the exposure, the abscess suppurated freely ; imme-
diately afterwards the discharge ceased, and so continued till death.
The general health of the hospital Hotel Dieu, at the time of
the patient’s death was good. Most of the operations performed
at this time progressed favorably, unmarked by any peculiar symp-
toms, so that we cannot charge the hospital as the exciting cause
of the man’s death. We are, therefore, brought to the conclusion
that it was something distinct and individual that caused this fatal
termination to a very slight injury ; and we are led to believe, from
the history of the case, that the exposure of the suppurating sur-
face of the abscess to the air, thereby altering the nature of the
pus, was the exciting and effectual cause of the death of the
patient.