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108
Three days later he complained of a feeling of tightness across the chest and the sputum
was blood stained. Examination of the sputum was negative for tubercle bacilli.
Throughout the illness he was noticeably becoming weaker and emaciated, the loss of weight
being out of proportion for the duration of the illness. On 21st June he sank into a semicomatose
state from which he did not rally.
Post-mortem
findings.
The post-mortem findings were as follows:—
The body was pale and emaciated and there was a small purpuric patch over the dorsum of
the left foot.
On incising the tissues of the head the remains of a subaponeurotic effusion of blood was
found on the surface of the skull. There was no fracture of the skull.
On opening the cranium the remainder of a small subarachnoid haemorrhage was seen on the
under surface or the frontal lobes.
Heart.—The pericardium showed blood stained pericardial effusion and both sides of the
heart were distended with post-mortem clot. There was some thickening above the coronary
vessels.
Pleurce and lungs.—The pleurae were extremely œdematous giving the appearance of masses
of jelly surrounding the lungs. The lungs were congested and œdematous with small scattered
areas of hæmorrhage and thrombosis throughout them.
Stomach and intestines.—The stomach and intestines were normal, but there was some
enlargement of mesenteric lymphatic glands.
Liver.—The liver was congested and weighed 83 ounces.
Kidneys.—The kidneys weighed 11½ ounces each and were congested with small hæmorrhagic
areas.
Spleen.—Was congested and slightly enlarged.
Microscopic examination (for which I am indebted to Dr. W. G. Barnard):—
Heart.—Polyarteritis nodosa of the coronary vessels.
Lungs.—Focal acute inflammation of the lung, mainly interstitial, often peri-vascular.
Thrombi in a few pulmonary vessels.
Spleen.—This organ showed polyarteritis nodosa and chronic inflammatory infiltration,
whilst the kidneys, liver and a small artery near the carotid showed polyarteritis nodosa.
A case is reported of polyarteritis nodosa, illustrating by its history the
difficulties encountered in diagnosis.