Temperature Chart 4.—Primary Hæmothorax. Secondary rise of temperature, with increase in the effusion. Spontaneous recovery. Case No. 155
(155) Severe hæmothorax. Secondary effusion. Spontaneous recovery.—Wounded at Koodoosberg Drift, at a distance of 200 yards. Entry, at angle of the right scapula; exit, at the junction of the left anterior axillary fold with the chest-wall. No signs of spinal cord injury. The patient was brought in from the field twelve miles by an ambulance wagon on the second day, and in crossing the Modder River he was accidentally upset into the stream. For the first four days there was no hæmoptysis, but for the succeeding nine days small brightish red clots were expectorated. There was some tenderness over the ribs from the fifth to the ninth in the axillary line, and on the ninth day some gravitation ecchymosis appeared over the same region. Cough was an early troublesome symptom in this case, and when admitted to the Base hospital, about the seventh day, there was evidence of fluid extending about a third of the way up the back.
On the tenth day after admission a pleural rub was detected at the upper margin of the dulness, and the latter shortly extended upwards over a little more than half the back. Meanwhile, there was no further hæmoptysis, respiration was fairly easy, 24 per minute, but accompanied by slight dilatation of the alæ nasi, and the temperature, which had been ranging from 99° to 100°, began to rise steadily, on the fifteenth day reaching 102.5°. The patient refused even an exploratory puncture, and was treated on the expectant plan. The temperature slowly subsided, with a steady improvement in the physical signs, and at the end of about ten weeks he left for home with only slight dulness and incapacity for active exertion remaining. (Now again on active service.)
Temperature Chart 5.—Hæmothorax, primary and secondary rises of temperature, on each occasion falling on the evacuation of the blood. Case No. 156
(156) Severe hæmothorax. Recurrent secondary effusion. Tapping on two occasions. Cure.—The patient was wounded at Paardeberg, and arrived at the Base on the eighteenth day. Entry, below the first rib, just external to its junction with the costal cartilage; exit, through the ninth rib, just within the posterior axillary line. The whole right side of the chest was dull, with signs of the presence of fluid, the heart being displaced to the left. There was considerable distress; the respirations averaged 40, the pulse 100, and the temperature reached 101.5° the first evening after arrival.
On the nineteenth day the thorax was aspirated (Mr. Hanwell) and 50 ounces of dirty red-coloured fluid, half clot, half serum, were evacuated. Considerable relief was afforded; the respirations became slightly less frequent; the heart returned to a normal position, and distant tubular respiration was audible. The temperature dropped to normal the third day after evacuation of the fluid, but on the sixth day it again commenced to rise, and meanwhile fluid again began to collect.
On the twenty-sixth day a second aspiration resulted in the evacuation of 35 ounces of bloody fluid in which flakes of lymph were found. Three days later the temperature became normal. The respirations fell to 22, and the patient made an uninterrupted recovery.
