The Diagnostic Value of the Discovery of Koch's Bacilli in Sputum
Authors: H. S. Gabbett
Journal: BMJ (1884)

been, and slightly displaced downwards and inwards ; and that there was still no pain in the parts.On the 12th, some purulent discharge escaped for the first time from the left ear; there was, however, no ear-ache or deafness.The tem- poral swelling was somewhat smaller.'The protrusion of the eye- halb had increased, and the swelling in its vicinity was l'arger redder, and more distinctly'fluctiiating.A day or two afterwards the swelling was punctured-with a fine'trocar and cannula, but no fluid escaped.-Qn the2Oth, I remarked that the swelling above the eye had become larger, but that the eye was somewhat 'less pro'minent ; that pus had continued to escape from the left ear, anad that' the temporal swelling had al-most disappeared; and that the child had for some days been able to move its legs freely, but that they were liable to become rigid andto tremble convulsively.About this time, however, the child's temperature began to rise, attaining on one occasion an elevation of 103.4°; her appetite fell off, and her health began to fail.She complained at first ofnausea, and' soon was sick after everything she took, 'and rapidly lost flesh and strength.She still had no pain or tenderness in the back, and still retained the pbwer ofimoving her legs voluntarily.'She was now fed with nutrient enemata.July 30th.'She' had a'very restless night, calling and crying out constantly.She was apparently sensible, but spoke very indistinctly.Her pupils were dilated, equal.There was no paralysis of the face or arms.She had no discharge from the ear this morning.The swelling above the eye fluctuated.Temperature normal.July 31st.She slept well and did not cry out all night.She had taken no food by mouth, and had been sick only once after medicine.She was drowsy.She put out her tongue 'when told ; it was thickly furred.The left pupil was larger than the right.She had no pain in the head.Temperature normal.In the evening she was about the same.Pulse, 108; respirations, 24 ; temperature, subnormal.There was no pain in head, and no sickness nor discharge from the ear that day.There was no facial or ocular paralysis, but the tonguie deviated distinctly to the'left.August 1st.She was much weaker.Her tongue was dry, protruded to the left.The pupils were equal.Pulse, 108 ; respirations, 36, attended with much rattling in the throat.Some hours later (at 1.30 P.M.) she had not spoken, but seemed sensible.The left pupil was more dilated than the right, and was unaffected by light.The tongue deviated distinctly to the left.The swelling above the eye fluctuated.There was no sickness, no fits.She waved her arms about, and picked at her nose ; and had occasional twitchings of the muscles of the shoulder and back.The tache c6rdbrale was readily obtained.Pulse, 120; respirations, 30, attended with rattling in the throat.There vas no sickness, nor discharge from the ear.She died shortly afterwards.Post Mortem Examination.-Thebody was much emaciated.The left eyeball projected.There was ecchymosis of the corresponding upper eyelid.The -left temporo-sphenoidal lobe of the brain was