Portable Regulating Ether-Inhaler
Authors: J. T. Clover
Journal: BMJ (1877)

the present, resident physician."The right thorax is much contracted, and thle apex-beat is displaced upwards and inwards under the left margin of the sternum.There are two fistulous openings on the anterior aspect of the right side, one three inches from the middle line of the sternum between the third aiid fourth ribs, the other t-hree and a half inches from the mesial line between the fifth and sixth ribs.In each fistula there is a drainage- tube four inches in length, and from both openings there is dis- charged an ounce and a half of healthy pus in twenty-four hours.No respiration can be detected in the right lung, except from the area surrounding the fistula.There has been great loss of flesh; the weight being 8 st.52 lbs.The pulse is 84, respirations 25; and the temperature normal.The fingers are remarkably " clubbed", and the patient avers they had been even more so in the course of his illness.There is very little cough or expectoration.The appetite is good, the tongue clean, the bowels regular, and he sleeps well."No communication was found to exist between the two fistulae; and ten inches of fresh drainage-tube were easily inserted into each, through which a greatly increased flow of matter was discharged.The surface was dressed with tenax, and a broad bandage firmly applied.He was ordered to have thirty minims of tincture of sesquichloride of iron in water three times a day, with full diet.May 24th.The discharge is more abundant.He feels faint and weak, for which a cordial draught is ordered.June 3rd.The discharge is decreasing.There is now no coucahsHe has a good appetite.Pulse J02, fuller.*June 7th.I-is weight is 8 st.I3Q lbs.; a gain of 8 lbs.June 13th.He is ordered to inject the fistula daily withl solution of boracic acid.June ISth.He complains of debility.Ten minims of spirit of chloroform are ordered to be added to each dose of the ironi mixture.June 2Ist.His weight is 8 st. 12 lbs.June 23rd.Much excoriation of the skin round the parietal orifices is noticed for first time.The part is to be dressed with a weak carbolic acid solution in linseed-meal poultice.July 3rd.He is better; weight 8 st.io34 lbs.The medicine is now changed to half a drachm of syrup of iodide of iron three times a day.July iith.He is doing very well.The excoriation surrounding the fistul;e has completely disappeared.July i8th.The presence of an cesophageal fistula through the upper parietal orifice, although suspected, is for the first time demonstrated.Food, both fluid and solid, when " gulped", that is, swallowed in larger quantities than can readily pass through the cardiac orifice of the stomach, and so distending the cesophagus, pass through the breach in its wall.In this way, porter and milk, for instance, can be at once re- cognised, as also minute portions of solid food, which are often long de- layed in transit, as is determined experimentally with the seeds of pre- served fruit, and such like.July 25th.The discharge is very profuse.A weak watery solution of iodine, in place of the solution of boracic acid, was injected.There is increased temperature with reduced discharge.August Ist.The iodine injection was repeated with similar effect.August 2nd.His weigrht was 8 st.9Y4 lbs.August 5th.The iodine injection is repeated.August 8th.He is not so well; complains of weakness.His ap- petite is bad.He is ordered De Jongh's cod-liver oil in a vinous solution of chiretta, and the following mixture: P3 Acidi hydrochlorici dil. 3 iij; tincturre ferri muriatis 3 vj; liquor.hydrargyri perchloridi ad 3iv.M. One drachm in a wine- glassful of water three times daily..August gth.He is very weak; has had ani attack of vomiting.August igth.His general condition is now much improved.There is increased discharge from the upper fistula; both, however, are patent.August 23rd.There has been sharp pain round the upper opening, relieved by an opiate poultice.August 29th.The discharge is very heavy and fetid.He is ordered mixture of turpentine and senega.