On August 19th 1 saw, in consultation with Drs. G. A.
Shane and coupons for celebrex J. F. Whittaker, the following case :
William P , a farmer, thirty years of age, weighing
about one hundred and fifty pounds, muscular develop-
ment good, while sliding from a haymow came in con-
tact with a pitchfork which was standing tines upward
against the contents of the mow. One of the prongs
penetrated the right hip, at a point behind and on a level
with the greater trochanter, and broke off close to the
Found him lying on the 200mg celebrex porch of the house, to which
he had been taken, complaining of severe pain in his hip,
abdomen, and back, and greatly frightened. On exami-
nation we found a penetrating wound in the right hip,
and just beneatli the surface a metallic substance was
detected and removed, celecoxib celebrex being the lower portion of the
fork-tine, one and three-quarter inch in length, and fit-
ting accurately at its larger end, the stump remaining on
the handle. Measurement of the remaining tine showed
it to be thirteen inches in length, leaving about eleven
inches yet to be accounted for.
The patient complained greatly of his back, and a view
of it disclosed an enlargement on the right side of the
spinal column in the lumbar region, which was exquisitely
sensitive. This apparent swelling showed no bruising or
evidence of recent contusion, and inquiry elicited no-
history of its existence previous to this time.
We proceeded, under an anesthetic, to further explore
for the missing steel, and found the direction of the wound
to be upward, inward, and forward, and succeeded in fol-
lowing its track for about five inches with a probe, but
without detecting any foreign body, nor could we by en-
larging the wound and making deep pressure determine
He was allowed to come out from under the influence
of the ether in order to get the benefit of his sensations
under our manipulations, and his thigh was flexed on his
abdomen, deep pressure again made, together with ab-
duction and adduction of the thigh, producing no increase
of pain in any region.
After several hours he was again etherized, and tiie
most critical examination made what is celebrex in the wound and by the
rectum, and the swelling on the back laid open and
thoroughly explored ; all to no purpose, and the wounds
were left unclosed and dressed with water dressing.
The case resolved itself into the following conditions :
I. Head of the fork-tine penetrated and lodged in the
body of the man ; if so, could it be removed? 2. If in
his body, had it penetrated the pelvic cavity or was it
buried in the dense muscular structure of the hip ' 3.
Could it be possible that the first portion of the tine had,
by the force of the falling body, broken off and by its
elasticity tlew away, and, the fall being unbroken, the
fork again came in contact with the body and penetrated
with the remainder ? These questions were taken ui)
and concluded upon : i. There was no positive evidence
furnished by the examination that the tine was lodged in celebrex online
his body, and, were it positive, an operation for its re-
moval would involve a dissection of the muscular struct-
ure of the hi)), and perhaps an opening of the abdominal
cavity, both under the circumstances unjustifiable opera-
tions. 2. The abdominal pain was taken as suspicious
at least, and the bladder and rectum had not as yet acted,
leaving their injury in doubt. 3. The cost celebrex possibility of this
condition was acted celebrex celebrex upon, and tlie barn most thoroughly
searched for the'missing tine, but it was not found.
We now concluded to leave the case to nature, and
the patient went on doing well, his bowels and bladder
performing their functions normally, .\fter a few days,
when his fright had subsided, he remembered that the in-
jury to his back was of long ago, and always gave him
trouble, and that his abdominal i>ain had preceded the
THE MEDICAL RECORD.
[October i8, 1848.
injury several days and had been accompanied with diar-
rhcea, which continued. The wound in the back healed
kindly, but the one in the hip continued to discharge
profusely, and in the fourth week the whole Hmb became
swollen, and later fluctuation was detected below the
sore, which increased in size and extended down the ])os-
terior aspect of the thigh, and on October ist, forty-
three days after the accident, it (the tine) was removed,
large end first, from celebrex coupons the upper portion of the popliteal
space. It was eleven inches in length.
The tine was evidently lodged either in the hip or had
penetrated the pelvis, the heavy end being depend-
ent, and the muscular action produced by the patient's
walking across the floor daily caused it to descend and
appear as described.
Since its removal he is doing well, and the indications
are that he will make a good recovery.
SOME REMARKS ON THE ASSOCI.\TION OF
, TUBERCULOSIS AND ACUTE PNEUMONIA.
By EDMUND C. WENDT, M.D.,
The highly interesting case of tuberculous pneumonia,
reported by Dr. Kinnicutt in the last issue of The Rec-
ord, prompts the writer to offer a few remarks on the
synchronous 200 celebrex occurrence of tuberculosis and pneumonia,
particularly so as a case came under his observation four
years ago, which was, in some respects at least, similar
to the one observed by Dr. Kinnicutt. The writer con-
sidered It at the time a rather puzzling instance of rapidly
fatal croupous pneumonia, of an atypical kind. Having
occurred before the era of the bacillus tuberculosis and
the pneumonia-micrococcus, it will scarcely seem, in the
light of our present knowledge, or at least widespread
belief, a case observed with sufficient scientific accuracy
to warrant any concise deductions. But it should not be
forgotten that, despite the rapidly progressive researches
of positive experimental pathology, the entire subject of
pneumonia, and for that matter of tuberculosis as well, is
still a debatable one.
The writer's case, then, is to be regarded merely as a
casuistical contribution to a subject of universal interest
to tlie profession in the past, the present, and, it is»to be
hoped, the future.
Quite briefly stated the case was as follows : A. M ,
male, aged thirty-six, married, the father of healthy
children, himself the child of healthy parents, was seized
with a rigor on a Monday, in March, 1880. He posi-
tively denied celebrex 100 any previous serious illness, but admitted a
tendency to " take cold " easily during changeable
weather. He also stated that he had lost one sister
from phthisis, at the age of twenty-two. Soon after the
chill the patient developed the signs of croupous pneu-
monia on the right side, which soon spread throughout
the entire middle and lower lobes. It was thought to
be even encroaching on the upper lobe, when, on the
third day, after the rigor had marked the incipience of
severe illness, he suddenly died. Clinically the unusual
signs had been an excessively high temperature (io6|°
to 107^ F., in the rectum), associated with a pronounced
typhoid condition. On the last day of his illness the
patient also became intensely jaundiced.
fcjAt the autopsy the right lung was found hepatized in
the middle celebrex purchase and lower lobes. The hepatization, however,
was grayish only in a few places, the prevailing color
being a dark maroon. In the upper lobe, there was
merely moderate congestion, some firm old pleuritic ad-
hesions, a few slate-colored nodules with chalky centres,
and a rather abundant crop of miliary tubercles. Besides
this there were in both lungs quite a number of purulent foci,
resembling the well-known multiple abscesses of py.-emia.
^The left lung was congested, celebrex 100mg oedematous, and showed
in its upper lobe a condition quite similar to what ob-
tained on the right side, '^except that there were relatively
fewer miliary tubercles and purulent collections. The
latter in no instance exceeded in size that of a cherry-pit.
The abdominal organs were in general much congested,
especially the spleen, which was soft, large, and pulpy.
The liver was found in the first stage of icteric hepatitis.
The intestines were only moderately hypersmic, other-
wise normal. The common bile-duct was easily per-
vious. The brain was not examined. There were no
miliary tubercles in any other organs, save those already
mentioned, viz., the upper lobes of both lungs.
The questions that suggest themselves in tliis case, as
well as in the one reported by Dr. Kinnicutt, are these :
Was there a latent unrecognized tuberculosis upon which,
as a suitable soil, a fatal croupous pneumonia became
engrafted ? or was there rather a primary lobar coupon for celebrex pneu-
monia, that afforded a fertile soil for the rapid develop-
ment of acute tuberculosis ? Without stopping to weigh
arguments pro and contra, the writer would simply state
his belief that in his own case the tuberculosis preceded,
for weeks or months, the pneumonia ; but that the latter
would not have proved so rapidly fatal without the coexist-
ence of the former. In Dr. Kinnicutt's case the se-
quence of events seems less clear. And it is much to be
regretted that the microscopical examination of the spu-
tum failed to make matters any clearer.
One thing may be learned from these cases. If croup-
ous pneumonia is an infectious disease, caused by the in-
vasion of a specific micro-organism, and if pulmonary
tuberculosis similarly depends upon the entrance into the
lungs of peculiar bacilli, then it follows that the growth
and multiplication of these two typical and vastly dis-
similar varieties of germs within the same organ, so far
from being mutually antagonistic, may be reciprocally 200 mg celebrex
stimulating, and thus prove doubly dangerous to the host
carrying the parasites.
In conclusion, the writer may be permitted to suc-
cinctly refer to a case of so-called " mixed infection
through tubercular bacilli and pneumonia-micrococci," celebrex coupon
which was recently reported by Dr. Samter [Berliner
Klin. Wochenschrift, June 23, 1884), and which seems
to have escaped Dr. Kinnicutt's notice.
A weak and marantic-looking old man, aged sixty-five,
was admitted to the Posen hospital on March 13, 1884.
The patient had a slight, innocent-seeming cough, and
a physical examination led only to the diagnosis of senile
bronchitis. The patient cost of celebrex improved visibly at first. But
on April 19th he began to complain of great weakness,
and showed an increased tendency to cough. His tem-
perature, however, was below the normal. The scanty
viscid sputum resembled somewhat that of ordinary lobar
pneumonia. Microscopical examination, however, elic-
ited the interesting fact that, in addition celebrex buy to the abundant
presence of tubercle bacilli, the sputum contained a few
of the characteristic micrococci of pneumonia. The
physical signs of the latter affection subsequently became
more marked, and the patient died in a few days from
heart-failure. From the record of the post-mortem ex-
amination the following points, having a direct bearing
on the subject under discussion, may be cited : celebrex price In the
apex of the left lung there were some old cheesy de-
posits, the entire right lung was intensely congested and
in the first stage of pneumonia.
Scattered throughout all the lobes celebrex mg of this lung there
was found an abundant crop of recent miliary tubercles,
but not a single cheesy or purulent mass was discover-
able in that lung. In the small intestine numerous ul-
cers existed, but there was no evidence there of miliary
tuberculosis. It would seem, therefore, that this case
resembled my own in several important respects. Dr.
Samter is inclined to believe that his patient had latent
tuberculosis ; and further, that a sudden invasion of the
specific germs of pneumonia wrought such changes in al-
ready damaged lungs that, an acute miliary tuberculosis
was lit up where before there had only existed the slowly
smouldering process of chronic tuberculosis.
In the light of the experience of his own case, the
writer would fully concur in the above opinion.
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