Yale Case Studies

DR. LEONARD: The patient, a 42-year-old civil engineer, was admitted to the Isolation Division of the New Haven Hospital complaining of difficulty in breathing. The present illness began 5 days before admission, after the patient had driven for about six hours through a heavy snowstorm. He arrived home at 10 P.M., feeling cold and "chilly," took a hot bath, and retired. The next morning the patient felt well but remained at home because of "bad weather." That afternoon and evening he again experienced "chilly sensations" and headache. In the evening of that day he took another hot bath, one ounce of gin, and retired. During the night he perspired a great deal and slept poorly. The following day (3 days before admission) his temperature was 1020 F. (per os), his throat felt sore and tonsils felt swollen. At that time he said that his throat was "red with yellow streaks." Two days before admission the family physician was called, who swabbed the patient's throat with silver nitrate solution and left a gargle of potassium chlorate. The temperature was 1030 F., the patient slept very little, and felt much worse. One day before admission the temperature was still 1030 F., slight jaundice of the skin and sclerae was noted, and the patient expectorated thick, sticky, yellow material. There was no cough, or chest pain. At 2:30 A.M. on the day of admission the patient awoke complaining of severe difficulty in breathing. Morphine was given with no effect, a consultant was called and hospitalization was advised. There had been headache and anorexia for the previous four days, and dyspnea was becoming progressively more severe. The patient had had irregular attacks of "biliousness" for the past 15 or 20 years, with gaseous distress, bad breath, and headache, but no vomiting. He had always been a nervous individual. For the four months preceding the present illness he had taken from 5 to 10 grains of Novaldin* every evening because of persistent headache, and for two months he had taken Luminal grs. 1/3 t.i.d. At least 250 grains of "Novaldin" had been taken during the 3 weeks preceding the onset of the present illness.