AN ATLAS OF HISTOLOGY

The patient was a rather thin woman; her face was very rtushed but not cyanosed, and her expression was anxious and w~ary. Her temperature was 100'8° F., her pulse rate was 116 per minute, the respirations numbered 24 per minute, and the systolic blood pressure was 110 and the diastolic pressure 65 millimetres of mercury. The chest signs were as follows: impairment of percussion note and decrease in the intensity of breath sounds over the bases of both lungs posteriorly and also in the lower part of the right axilla. Crepitations could be heard at the bases of both lungs posteriorly. A diagnosis of bronchopneumonia was made, and routine treatment was instituted. In addition, "M & B 693" was given for seven days. For the first week the patient was miserable and depressed and vomited frequently. The temperature ran an uneven course between 99° and 101 ° F., and the respirations were rapid; the physical signs remained practically unchanged. Towards the end of the second week the temperature began to settle and the patient's general appearance improved, although she was still very depressed. On February 12, 1940, her temperature having risen over the previous two days, she complained of pain in the left side of the abdomen. She was tender in the left flank and pus was present in the urine. ,The lung signs were slight; there were only a few rales at the base of the left lung. Culture from the urine yielded a growth of Staphylococcus aureus. A blood examination on January 27, 1940, gave the following information: the erythrocytes numbered 38 and the leucocytes 9,250 per cubic millimetre; the hrem~globin value was 13'26 per 100 cubic centimetres (85% Sahli) . On February 15, 1940, she appeared much better, but still complained of pain in the chest. The temperature was still between 99° and 101°F. An X-ray film of the chest was taken, and this revealed several abscess cavities in both lungs. On receipt of the X-ray film the chest was examined very carefully, and a small patch of amphoric breathing less than two inches in diameter was detected at the angle of the right scapula. This was the only sign of cavitation discovered. Postural drainage was begun, and the patient began coughing up sputum in moderate amounts. For the next fortnight she expectorated copious quantities of foul yellowish brown sputum. An examination of the sputum revealed both Gram-positive and Gram-negative cocci, and no tubercle bacilli; leucocytes and erythrocytes were present, but no elastic tissue. On February 23, 1940, a friction rub was heard in the lower part of the right axilla. During the next two days an abscess developed on the right heel. This was incised and the pus on culture yielded a growth of Staphylococcus aureU8. At this stage bronchoscopic drainage was considered, but was deemed inadvisable because of the good response to postural drainage and the thinness of the abscess walls. The signs of cavitation became rather more definite. and further X-ray films revealed increase in size and coalescence of the cavities. On March 8, 1940, the patient began to feel much better, and her appetite, which had been poor throughout, improved. An X-ray film taken on March 18, 1940, showed that there had been a rapid resolution of fluid and a decrease in size of the cavities. The clinical improvement continued and the sputum became scanty. On March 29, 1940, examination of the chest revealed no signs of cavitation, but the percussion note was impaired, the breath sounds were decreased, and rates were present at the base of the right lung. Further X-ray films revealed a continuation of the process of resolution; the last film, taken on June 11, 1940, revealed complete resolution except for a small patch of infiltration at the base of the right lung. On May 4, 1940, the patient was transferred to a convalescent ward situated in the foothills, where she stayed and maintained her improvement until June 7, 1940; she then had a "flare-up" of acute pyelitis. The right kidney was palpable, and the urine still infected with Staphylococcus aureus. After ineffective treatment with milder drugs a course of "Uleron" tablets was begun on July 4, 1940. The urine was sterile on July 15, 1940, and the "Uleron" treatment was discontinued on July 17, 1940. Since then her condition has been improving constantly, and she was transferred to a convalescent hospital at the seaside on August 16, 1940.