A CASE OF CATHETER FEVER FOLLOWED BY SUPPRESSION OF URINE AND

DEATH.

By HARI MOHAN BHATTACHARJEE, Soory Charitable Dispensary,

N. L. Chaudhuri, at. 32 years, a legal practitioner, contracted gonorrhoea about seven

178 INDIAN MEDICAL GAZETTE. [June 1891.

years ago, which gradually terminated in gleet. Occasionally the discharge would assume a puru- lent character when exposed to exciting causes. He at first consulted the local medical practition- ers. but finding the disease was not radically cured by their medicines, he subsequently placed himself under the treatment of Kabirajes, and he also used patent medicines, but with no better result. Latterly, he had retention of urine on several occasions, which, however, passed off

without the use of any medicine. In the even-

ing of the 4th April last after his return from

court he had retention of urine, and believing that it would pass off as hitherto he did not think

it necessary to consult any medical man. He

passed the night in great agony, and in the

morning of the 5th idem called my colleague, one of the local practitioners, who thinking it was due to organic stricture of the urethra asked me to come over with the case of the gum-elastic catheters and help him to relieve the patient. As I was then busily engaged in the hospital, I sent the case at once and wrote to him that I would be there after half an hour. My col-

league tried with the No. 6 gum-elastic catheter, but could not introduce it more than 3 inches, owing to spasm and pain complained of by the patient. On my arrival I fouud the patient in the following state: ? The patient was a young man of fair com-

plexion and strumous diathesis; countenance extremely anxious; the bladder was full and dis- tended up to about two inches below the umbili-

cus; complained of great discomfort on account of retention, getting up from his bed every now and then to make water but without success. There was a little oozing of blood through the meatus urinarius caused by the introduction of the catheter, though it was done without the

stylet. Became very nervous and fidgety on attempting to introduce the catheter. Pulse

slightly accelerated, about 90 in the minute.

Temperature normal. Forehead moist with per- spiration. Owing to the patient's fidgetiness it was found

almost impossible to relieve his bladder without chloroform, and my colleague being of the same opinion the patient was placed under chloroform, and No. 6 (English) silver catheter was passed with less difficulty than we anticipated, and the whole of the urine drawn out. A draught of Tiuct Opii and Quinine was ordered as soon as the patient recovered from the effects of chloro- form. I came away leaving the patient to the care of my friend.

5 p.m.?The patient's brother-in-law says that soon after the effects of the chloroform passed off, the patient attempted to sit up on his bed, but fainted away and fell upon it. After recovery from fainting, he was attacked with fever attend- ed with shivering. Has passed urine twice tinged with blood since my first visit. Temperature

104?, pulse 120, but very soft and compressi- ble. Is restless.

R

Spt. Arnmon. Aromat. c.. m. xx.

Yin. Gallici. ... 5ii Spt. Chloroform ... m. x.

T.r. Cinchona} ... m. xx.

Aqua ... 51

M. To be taken every 3 hours. Spoon diet.

6th April, 11 a.m.?Pulse barely perceptible at the wrist. Skin moist. Temperature 103?. Is drowsy. Answers questions in monosyllables. Has passed 110 urine since my last visit. No urine in the bladder. Has passed one loose stool. Does not like to be disturbed.

Omit Spt. Ammon. Aromat. and substitute the same quantity of Spt. JEther Sulph. and conti- nue the mixture every 2 hours.

Spoon diet. Diluent drinks. R Tr. Digitalis ... m. x.

Potas Citrat. ... gr. x.

Yin. Gallici ... 5ii Aquae ... 31

Every 3 hours. M.

6^ p.m.?Almost in the same state. Passed 110 urine. No urine in the bladder. Pulse percep- tible at the wrist, but stops on slightest pressure, 140 in a minute. Fever still continuing. Tem-

perature 104?. Is quite conscious but does not like to be disturbed. Complains of pain in the wrist joints.

Continue both the mixtures ; dry cupping over the kidneys.

11 p.m.?Passed two loose motions. Pulse im-

perceptible at the wrist. Temperature of the body 103?, but that of the extremities subnor- mal. Perspiring freely.

Stimulant mixture every hour.

Stop Citrate of Potass mixture. 7th April, at 2 a.m.?Still perspiring. Pulse

barely perceptible at the wrist. Temperature subnormal and that of the trunk lOO'S0. Is

extremely drowsy, but can answer questions in monosyllables. No urine iu the bladder.

At 6 a.m.?Reported by his brother-in-law that at about 5^ A.M. the patient was very rest- less. Wanted to wash his mouth and change his bed, but before he could be removed to another bed he suddenly died. Remarks.?From the history and symptoms

mentioned above, I am disposed to believe that it was one of those cases of fever known by the designation of " Catheter fever" first brought prominently to the notice of the Medical Society of London by Sir Andrew Clark 011 the 17th December 1883 (published in the Lancet, De- cember 1883). The symptoms and termination of the case correspond iu many respects with the

Jcne 1891.] CASE OF " CATHETER FEVER." 179

fifth variety of Velpeau's definition incidentally mentioned in the remarks made by the learned doctor.

I know that this case is incomplete without the record of a post-mortem examination and that of the analysis of the urine. No post-mortem examination was made or allowed. Though there was opportunity of testing the urine when I first relieved the bladder, I did not examine it, simply because I felt no necessity as I never dreamt then that the case would assume such a serious character, but when the necessity arose, there was total suppression of the secre- tion.

I am inclined to publish this case owing to

its rarity after catheterism; so much so that

during my professional career extending over a

quarter of a century I saw only another case which came under my observation in 1884 (the particulars of which were published in the

Lancet, 17th Septemberl884) amongst hundreds of eases in which the bladder required to be re- lieved by catheter.