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which he retained. During all this time there were no decided symptoms of inflammation, his pulse was never over 90, and the temperature was almost normal; but there did exist tenderness on pressure over the abdomen. On the 16th he appeared to be doing well, and the following day he got up and dressed. This indiscretion was followed on the 19th by a tendency to diarrhea, which was, however, arrested by the use of opium.
On Saturday, 22nd March, he suffered from some discomfort and pain in the abdomen; his bowels had not moved for two days, and his friends gave a cathartic pill, and, as there was much pain fomentations were applied and a dose of solution of morphia given in the evening. The following morning, Sunday the 23rd, he had a free motion and passed by stool a portion of intestine, after the passage of this, he had two more motions, liquid in consistence, no blood but feculent in character, after which he was free from pain, and slept well during the night. I had not seen the patient since the previous Wednesday, as at time he appeared to be convalescing, and I ceased my attendance.
attendance. On Monday, 24th March, I was again requested to see my patient, his friends being anxious about what had been passed by stool. They kept it for my inspection and at the visit I found him looking much better and stronger. There was some soreness of the bowels, on pressure over the abdomen, but perfect absence of all pain, his pulse was about 75, skin natural, tongue clear, and he was taking his food with a relish. He felt so well that he desired to be up and dressed, but I deemed it more prudent to keep him still in bed. The following day, Tuesday, he was much in the same condition. Had a stool in the evening accompanied with some pain, which was relieved by a draught of solution of morphia, and he passed a comfortable night; from this time he gradually recovered, and is at present. in fair health.
I will now endeavour to give a description of the portion of intestine passed: When laid on a flat surface it measured seventeen inches in length, attached to its outer surface was a portion of the mesentery about 24 inches in width; the diameter of the tube varied from 14 inches, at its smallest end, to three inches
at or about its centre. The smallest extremity was dark and easily broke down when handled; it was considerably fringed. The cavity can be filled with water, when it presents the usual appearance of a portion of bowel. There was no appearance of exudation of lymph on the peritoneal covering; with the exception of one extremity the color was that of normal bowel, though darker than in the healthy state, and was firm in consistence, the valvulæ conniventes being well seen. The portion of bowel I secured at the time of my visit on Monday the 24th, and after cleansing it preserved in a mixture of carbolic acid and alcohol, for the purpose of sending it to the museum.
Charlottetown, P. E. I., April 20, 1879,
MEDICAL AND SURGICAL CASES OCCURRING IN THE PRACTICE OF THE
MONTREAL GENERAL HOSPITAL.
MEDICAL CASES UNDER DR. OSLER.
I. Miners' Phthisis.
Reported by Mr. Rankine Dawson.
J. T., æt. 60, native of Cornwall, admitted April 16th. Father, a miner, died at the age of 63, of consumption. Mother at age of 85. Has worked in mines since the age of 14; in lead and tin until 15 years ago, when he came to America, and since then has worked in copper, zinc and plumbago mines. Has enjoyed good health during the greater part of his life. Is a moderately temperate man. About three months ago noticed a slight cough, which has persisted ever since. He has failed gradually in health and strength, and has not been able to resume work. On March 3rd, came to Lennoxville where he remained twelve weeks, and then came to Montreal. Has attended the out-door department of the Hospital for three weeks.
April 18th.—Examined for the first time.
An elderly, moderately emaciated man; appears to prefer the sitting posture. Face and hands a little suffused, as if capillaries were over-full.
Chest.-On inspection right side somewhat sunken in front, and does not expand so freely as the left. On percussion, dulness for three fingers' breadth below right clavicle, clear over 3rd and 4th ribs, dullness again below, merging with that of the liver. Clear note at left apex in front and over both bases behind. On auscultation, cavernous breathing at right apex, with a loud click at end of inspiration. Expiration is prolonged and accompanied by whistling râles at the left apex and at the bases. Breath sounds are feebler in left than in right scapular region. Expectoration viscid and glairy. Heart's impulse cannot be felt, dullness much diminished. Sounds normal. Pulse 90, feeble ; temperature normal. Bowels regular; urine dark-coloured.
During the evening he sank rapidly, respirations became shorter, heart's action feeble, and he died about midnight
Post-mortem. In abdomen, liver depressed, reaching nearly to the navel. In thorax, left lung extends over beyond the middle line ; no adhesions on this side ; right lung universally adherent. Heart. – Right chamber full of blood and clots ; 20 ozs.
. escaped on removal of the organ. Right auricle large ; tricuspid orifice dilated, measuring over 15 Ctm. in circumference. Right ventricle dilated and hypertrophied ; chamber measures from pulmonary ring to apex 15 Ctm., wall, about middle, 7 m, in thickness. Left ventricle appears of normal size. Valves healthy. Weight of organ 445 grms. .
Lungs.-Moderately dark in colour. Left crepitant, except at one area behind. Pleura covering the lung uniformly dark, except at the posterior part of lower lobe, where it is thickened and of an opaque-white colour. Entire upper and anterior part
of lower lobes emphyeematous. A number of small firm spots can be felt, and these on section of the organ are seen to be dense fibroid areas, excessively pigmented. Except in these spots, and about the vessels and bronchi, the lung tissue is not of a dark, but rather of a slate-grey colour. Behind in an elongated area, extending through both lobes, measuring 18 by 6 Ctm. and 4.5 Ctm. in depth, the lung tissue is converted into a firm fibrous mass of inky blackness. On section it cuts with resistance, surface smooth, but in places there are small irregular spaces as if the tissue were breaking down. They could not be traced in connection with bronchi and contain dark-coloured fluid.
Right lung.–Pleura very much thickened over antero-lateral regions, not so much so at posterior part and about the root. At the lower and front part there is an encapsulated pleurisy, about the size of the palm of the hand, containing 5 to 6 oz. of clear fluid. On section of the organ a cavity, the size of an orange,
halffilled with purulent matter, is found at the apex, occupying chiefly the posterior part. It has very thick walls, especially in front, where the pleura is greatly developed. Very few trabculæ exist on the walls and none cross the cavity. extension from it passes downwards and forwards towards the middle lobe. The extreme apex and the entire anterior margin are composed of dense, firm, excessively pigmented fibrous tissue, which also surrounds the cavity in its lower and anterior parts. Middle lobe is emphysematous, lower lobe crepitant ; on section numerous fibroid and pigmented areas as in other lung. At its anterior margin it is compressed by the encapsulated pleurisy above referred to. No caseous masses in either lung. Mucous membrane of bronchial tubes thickened; they contain a good deal of secretion. Bronchial glands pigmented and hard, none caseous. Nothing of special note in the other organs.
Remarks. This case supplements in an interesting manner the one I reported in this journal in 1875, in which the disease was in an early stage; and fully sustains the statement then made—from an examination of three specimens—that “in its essence the disease would appear to consist of an overgrowtha hyperplasia—of the fibrous tissue of the lungs induced by the chronic irritation to which they are subject by the inspired particles of carbon, a veritable cirrhosis, or, as it might appropriately be called, the black cirrhosis of miners." The detailed histological description will appear in the forthcoming Pathological Report of the Hospital.
II.-Acute Bright's Disease in a child. Remarkable per
sistence of blood-corpuscles and casts in the urine after disappearance of Albumen.
Reported by Mr. Andrew Henderson, R. B., æt. 5, an inmate of the Ladies' Benevolent Home for the past two months ; previous to which time he had suffered great privations. Admitted to Hospital April 1st, with dropsy. Ilad been ailing for a few days before admission, but, owing to the illness of the Matron of the institution, no satisfactory account could be obtained of this period of his illness. According to Dr. Wilkins there were no evidences of diphtheria or scarlet fever. When admitted there was general dropsy ; urine scanty, bloody and albuminous, specific gravity 1040 ; and pain in lumbar regions, Heart's action much increased. Temperature 101o. Vomited a good deal.
April 3rd.—Urine 12 oz., sp. gr. 1030 ; contains blood and albumen. Temperature, 1019.
5th.-Swelling of arms and face almost gone. Urine 15 oz. Less álbumen. Heart's action not so violent.
7th.-Case transferred to Dr. Osler. Urine 24 oz., clear, light-coloured, no albumen. Temperature 999.
9th.—Examined carefully. Skin soft, no signs of desquamation. Throat normal. Dropsy has entirely disappeared. Nothing special observed in examination of heart, lungs and digestive organs. Urine 26 ozs. contains no albumen, but blood corpuscles and casts exist in the sediment.
12th.—23 ozs. of urine ; no albumen. Fine granular casts, and blood corpuscles ; latter not in sufficient numbers to colour the urine, four or five can be seen in each field of the microscope.
18th.—Urine examined each day. Casts persists in considerable numbers. No albumen. Blood corpuscles not noticed to-day.
23rd.—23 oz. of urine; no albumen. Sp. grav. 1008, very clear and watery-looking. Blood corpuscles but no casts.
24th.—20 oz., dark and more natural-looking in colour. Albumen in small amount for the first time since the 5th.
27th.-20 oz., sp. grav, 1010. Blood corpuscles and casts still to be found. No albumen.
29th.--Still a few blood corpuscles to be found in each field of the microscope. No casts.
May 8th.—Urine has been normal during past week. Patient removod to the Home quite well.