DIATHERMY IN PNEUMONIA

she contracteda sore throat, swollen glands in the neck and a few days later a rash on her arms and thighs. The rash disappearedin four days and peeling of the hands, feet and abdomenbegan later. The patient had evidently had an attack of scarlet fever. When she first got out of bed after two weeks she noticed that her legs were swollen and that her face and eyelids were cedematous. The amount of urine passedduring her illness had been much less than normal. She had not received medical attention until four days before she was admitted. She had not had any seriousillness before. Shewas a mother of three healthy children. The patient was a rather stout, middle-aged woman. On the day of admissionher temperature,pulse rate and respiratory rate were within normal limits. There was very slight cedemaaround the eyes; the glandsbehind the angles of the jaw were swollen and tender; the throat was inflamed. The only abnormality discoveredon examination of the heart was that the second sound at the base was accentuated. Physical signs in the chest indicated the presenceof free fluid in both pleural cavities, extending upwards as far as the anglesof the scapulee. Nofree fluid was detected in the abdomen,but there was considerabletendernessin the region of the kidneys. Both feet were cedematous. The urine contained a high percentageof albumin and some blood. By microscopical examination of the urine blood cells, epithelial and blood castswere detected. The systolic blood pressurewas one hundred and eighty millimetres and the diastolic one hundred and thirty millimetres of mercury. The patient's condition was diagnosed as acute nephritis complicating scarlet fever. On the fifth day after admission the amount of fluid in the pleural cavities had Increased to such an extent as to embarrass breathing. Aspiration of the pleural cavities was Indicated. Slightly more than a litre of fluid was drawn off from the left side. This temporarily relieved the dyspnoea. Twohours after the aspirationthe patient suddenly began to cough and a large quantity of frothy serum was expectorated. The breathing became very rapid and shallow and was accompanied by "bubbling" sounds. The face, lips and extremitiesbecame very cyanosed and the patient soon lost consciousness. The pulse rate was very rapid. A venesectionwas immediately performed and four hundred and fifty cubic centimetres (fifteen ounces) of blood allowed to escape. Atropine and cardiac stimulantswere given and also continuous inhalationsof oxygen. Two hours after the attack the breathinghad become less rapid and quieter and the cyanosis had disappeared and the pulse rate become slower. The patient had evidently recovered temporarily from the attack of acute pulmonary cedema. Three days later, however, the temperaturerose to 39.4° C. (103° F.), the pulserate to one hundredand fifty and the respiratory rate to fifty. She complained of thirst and expectorated offensive sputum. The lungs had now become infected and she succumbed on the following day to the complication of pneumonia. The attack of acute pulmonary cedemaoccurred In this case two hoursafter a paracentesisof the pleural cavity. The immediate dangeroussymptoms were relieved temporarily by the venesection.