|
Patient 90/27
Prior to admission to Stannington this patient had undergone enucleation (removal) of the right eye at the RVI, Newcastle, in treatment for ulcerations on the eye. Following the procedure she was recommended for sanatorium treatment and admitted to Stannington. Initial review showed tuberculosis was evident in the lungs with an enlarged hilar shadow and mottling in the both lungs, which was suggestive of military tuberculosis. This may account of the extent of disease shown in this individual and the number of skeletal elements involved in the disease; with particular emphasis towards the hands and feet in the initial condition report:
"Fluctuating swellings above L. wrist and above L. ankle. Sinus palm R. hand. Septic middle R. finger. Swelling R. ring finger. Enucleation R. eye."
This was supported by the x-ray report of July 1940:
"R.hand. Term[inal] phal[anx] middle finger shows rarefactionand some expansion with suggestion of periosteal thickening of diaphysis. Soft tissues swollen distal to joint. 1st phalanx ring finger expanded and mis-shapenin diaphysis part with periosteal new bone formation. L.hand. Erosion tip terminal ph[alanx] ring finger & swelling of soft parts around tip, some periostitis of ring metacarpal. Advanced periostitis thumb metacarpal with new bone formation."
Little progress was made with this patient, multiple lesions are noted throughout the medical notes for the rest of 1940, all considered to be active and discharging. The focus of the x-ray notes in December 1940 moves to the right foot where infection is noted to have spread to the os-calcis (heel bone), 3rd metatarsal and the 1st phalanx of the great toe with marked decalcification shown in the bones.
Deterioration in the foot continues to include new lesions on the 5th right toe and swelling in the left 1st metatarsal. There is no lessening of the active lesions and this patient is eventually considered to be making 'No Medical Improvement'. Upon discharge she is noted to be very ill and the notes question whether the disease may have involved the brain. After 39 weeks this patient was discharged. She subsequently died two days after discharge.
|
