Clinical History of Joséphine Guéris

Clinical History

On December 24, 1833, Joséphine Guéris, a 27-year-old seamstress, arrived at the hôpital de la Pitié in a state near death; excessively thin, pale-faced, experiencing diarrhea and night sweats for some time. Her breathing was painful and labored. She gave incomplete and inconsistent answers when asked about her medical history, but it appeared that she had been ill for several months and especially for a fortnight. Outwardly, she entirely appeared to have tuberculosis. She was so weak and complaining that auscultation was only practiced incompletely, but doctors heard mucous rattle with large bubbles near the upper part of the chest. Her condition and pain worsened, and she died two days later. Her autopsy was so interesting that Professor Rostan, who attended her, sought more information about her, but it was discovered that she had given the hospital a false address and possibly a false surname.

Autopsy Results

The autopsy was performed 36 hours after death.

Head: The dura mater sinuses were filled with a dull pink liquid swimming with grayish and crumbly flakes. The walls of the sinuses were smooth and pale. The veins in the pia mater contained the same substance as the dura mater, and in others, yellowish gray pus. The membranes of the brain were adhered to the brain matter, and all cerebral veins contained the same matter as the dura sinuses. The veins showed no redness or change to their walls. The white matter of the brain, ventricles, and related organs were normal.

Chest: The lungs were generally healthy and without real hepatization. The bronchi contained much phlegm and their walls were slightly red.

Heart: The heart was large and distended; upon incision, its ventricles (particularly the right) released a wine-colored liquid full of clots and many crumbly flakes of a dirty yellow color resembling half-concrete pus. The left atrium contained one of these flakes which was about the size of a large nut. These masses did not adhere to the walls of the vessels of the heart. Throughout the body, the blood in examined arteries and veins appeared the same as in the heart and head. There are no traces of phlegmasia.

Abdomen: The stomach, duodenum, Peyer’s patches, kidneys, bladder, uterus, and ovaries were normal. The walls of the large intestine were slightly enlarged, especially in the coecum. The mucous membrane had small rounded, superficial ulcerations. All mesenteric glands were swollen, some to the size of large hazelnuts. Inside, they are red and their tissue resembles a hepatized lung, but there is no trace of suppuration. As in other parts of the body, the arteries and veins are filled with a mixture of pus and blood, but their walls are not inflamed or thickened, nor are there adherent pseudo-membranes which reveal phlegmatic work. the liver is huge, reaching as far as the left hypochondrium, and slightly hardened. The liver shows no traces of suppuration. The spleen was enormous; measuring 5 x 3 inches in size and the peritoneum covering it appearing thickened. In several places, it had pearly white plates. The tissue was excessively firm and compact, and tan colored. The blood in the spleen was the same as elsewhere in the body.

Circulatory system of the limbs: The blood in the arteries and veins, and vessels of the fingers, all appeared the same as elsewhere in the body. There was no inflammation anywhere in the blood vessels.

Duplay and his colleagues struggled to explain the source of the pus they encountered in the blood, although they compared the case to others about which they had read, including one published by Velpeau.

Source

Duplay M. Observation d’une altération très grande du sang. Présence d’une quantité très-grande de pus dans le système artériel et veineux, sans origine appréciable, suivie de quelques réflexions sur ce genre d’altération. Arch Gen Med, Paris, II. 1834;6:223-34.

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