•^. v>,-- .%, .0, V] '/ /A IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I H-iia t 1^ IIIM M 1.8 Photographic Sciences Corporation ^. // {/ y^:%' ^M^i . ^^S f^. Vi fA 1.25 1.4 16 -* 6" ». 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 % f^. ks r^ CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques Technical and Bibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. □ Coloured covers/ Couverture de couleur I I Covers damaged/ n D □ n Couverture endommagde Covers restored and/or laminated/ Couverture restaurie et/ou peiliculiue [~~| Cover title missing/ Le titre de couverture manque □ Coloured maps/ Cartes giographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) □ Coloured plates and/or illustrations/ Plancjhes et/ou illustrations en couleur Bound with other material/ Relii avec d'autres documents Tight bMding may cause shadows or distortion along interior margin/ La re liure serrie peut causer de I'ombre ou de la distorsion le long de la marge intirieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajouties lors d'une restauration apparaissent dans le texte. mais, lorsque cela itait possible, ces pages n'ont pas 6t6 fiim^es. Additional comments:/ Commentaires suppl^mentaires: L'Institut a microfilm^ le meilleur exemplaire qu'il lui a itd possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dsns la methods normaie de filmage sont indiquis ci-dessous. □ Coloured pages/ Pages de couleur □ Pages damaged/ Pages endommagdes r~~| Pages restored and/or laminated/ □ -i" This item is filmed at the reduction ratio checked below/ Ce document est film6 au taux de reduction indiqud ci-dessous. Pages restaur^es et/ou pelliculies Pages discoloured, stained or foxei Pages d6colories, tacheties ou piqudes Pages detached/ Pages ddtachies Showthrough/ Transparence Quality of prir Qualiti indgale de I'impression Includes supplementary materit Comprend du matdtiel supplimentaire Only edition available/ Seule Edition disponible rri Pages discoloured, stained or foxed/ rri Pages detached/ ril Showthrough/ I I Quality of print varies/ I I Includes supplementary material/ n~| Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partieilement obscurcies par un feuillet d'errata, une pelure, etc., ont it6 filmdes d nouveau de faqon d obtenir la meilleure image possible. * 10X 14X 18X 22X 26X 30X ■'i v/ ■s 12X 16X 20X 24X 28X 32X ■V; «; lis u ifier ne ige The copy filmed here hes been reproduced thenks to the osnArosity of: Medical Library McGill University Montreal The imeges eppeering here ere the beet queiity possible considering the condition end lktJibili^^ of the orlginsi ccpy end in Iceeping with the filming contrsct specificstions. L'exempleire flimA fut reproduit grflce i la ginArositi de: Medical Library McGill University Montreal Les images suivantee ont 4tA reproduites avec le plus grand soin, compte tenu de la condition et de le nettet6 de rexemplaire fiimA, et en conformity avec les conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or Illustrated Impres- sion, or the bacic cover when appropriate. All other original copies are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the last page with a printed or illustrated impression. ,^' Les exemplaires originaux dont la couverture en papier est imprimte sont filmis en commenpant par le premier plat et en terminant soit par la derniire peg3 qui comporte une empreiiite d'impression ou d'illustration. soit par le second plat, salon le cas. Tous les autres exemplaires originaux sont fllmte en commenpant par la premiere page qui comporte une ampralnte d'impression ou d'illustration et en terminant par la dernlAre page qui comporte une telle empreinte. «, . The laat recorded frame on each microfiche shell contain the symbol —i^' (meaning "CON- TINUED"), or the symbol V (meaning "END"), whichever applies. Un dee symboles suivants apparaftra sur la dernlAre image de cheque microfiche, seion le cas: le symbols — *> signifie "A SUIVRE", le symbols y signifie "FIN". Maps, plates, cherts, etc., may be filmed a^ different reduction ratios. Those too large to be entirely included in one expoaure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartea, planches, tableaux, etc., peuvent dtre fiimte A doe taux de reduction diff^rents. Lorsque le document est trop grand pour Atre reproduit en un seul cliche, il est fiimi d partir de Tangle supirieur gauche, de gauche d droite, et de haut en bes, en prenant le nombre d'imeges nAcessaire. Les diagrammes suivants illustrent la mdthode. ta ure. ^ ] 1 2 3 ,'f -: .'j.'- ft'. ■.*■ ■% il.V *■«,'■ m M- ^ lii '1'^' V iM, 1 2 3 4 .. 5 6 •;^^ # • AM(EBIC ABSCES^ OF THE LIVER m BY F. a FINLEY, M.B. (Lon.), and M.D., (McGill). Lecturer in Medicine. McQ'lI University, and Piiysioian to Mont. General Ho.'pital. AND J. G. ADAMI, M.D., Professor of Pathology, MoQill University, Pathologist to Montreal (reneraliEIospital. {Reprinted from the Montreal Medical Journal, April, 1894.) S 'y^i! W 'W ■!^«P"i«P t^:- Wl: '■•,*■; # ■w. ■ff* ^m. m m: m f , ft. # :^<; ,*^" ■!3?^ #■ ,i^. -....^S:. ^1 M.r ^#' "^ft. ■t;- M ■ *■ ::££»: ^y sesT! .«-v. . T - / / •#• '•^1 ■t^ ..•♦,)? ^»Sl» ',' , •■4 '■W'f ■^i AM(EBIC ABSCESS OF THE LIVER.* By F. (J. FiNLEY, M.B., (Lon.) M.D., Lecturer in Medicine, MoGill University, Physieian to Montreal General IHospital. ▲NO J. G. Adami, M.A., M.D., Professor of Pathology in MoGill University, Pathologist to Mont. General Hospital* The patient, a negro, aet. 37, was admitted to hospital upon January 31st, 1894, complaining of pain in the right side and weakness. The chief facts relating to his medical history were that he had lived for eleven years in Te.xas, that he had acted as cook on a vessel trading between Quebec and South America, and that he had also spent some time in Australia. He had never suffered from diarrhoea for more than a day or two at a time, and had never had dysentery. He had, however, two febrile illnesses, each lasting about three months, some years previously. The present illness jegan a month previous to admission with febrile symptoms and diarrhoea. Some pain in the right side and weakness, together with nausea and vomiting were also present, but he had not taken to bed before his admission to hospital. On examination the temperature was 101|, the tongue was coated : there was no jaundice. The intercostal spaces over the liver were full, and there waa marked tenderness in the right epigastric r.-^gion. Hepatic dulness began at the 5th rib, extending down for about 6 inches. Posteriorly there was dulness from the argle of the scapula downwards. Friction could be detected over the right infra- mammary region. The abdomtn was oi;herwise normal. The urine was of a deep sherry co':, 42 oza. in 24 hours ; it con- tained no bile, albumen or sugar. During the ten days that the patient was under observation the temperature remained almost constantly at 102, and there were no chills or sweats The hepatic dulness during this period rose to the 3rd rib, and pus was withdrawn by the ♦ Head before the Medico-Chirurgiciil Soeioty. Febr my 23'-d, 1S94. ...S*'. i^ 4' ^i, ,«^. . ^it^-. '.'I m h *" m '-#■ aspirator. Upon February 12th, Dr. Bell, after preliminary aspiration, opened the abapeaa posteriorly in the 9th space and resected the rib, allowing about 50 oz. of pus to escape. The patient did fairly well for some days, but sank rather rapidly and died upon February 18th, six days after the operation. Numerous actively moving amoebae were found in the pns, together with much debris and a few leucocytes and red blood '- corpuscles. ' . The stools were examined for amoebae during life with a negative result. It is unnecessary to give all the details of the autopsy which was performed upon the day of death. Suffice to say that upon external examination there could be seen a wound in the ninth interspace and posterior axillary line in the right side ; this led ■through the region of the resected ninth rib to the liver, and from it could be expressed whitish necrosed tissue together with some pus. i Upon Opening the thorax the right lung was found firmly adherent over all its surface, and greatly contracted and , diminished in size. The adhesions were firm and close. It was found that the incision into the right lobe of the liver had passed through the diaphragm, but in consequence of the firm nature of the adhesions between diaphragm and costal wall, the pleural cavity presented no signs of acute recent disease, and had apparently been in no wise disturbed by the passage across of the contents of the hepatic abscess. The liver, which weighed 2650 grm , was greatly enlarged, both upwards and downwards. It extended three finger breadths below the costal margin ; was of a fawn colour, and presented here and there upon the upper surface of the lobes frequent small white patches — necroses or abscesses — averaging 2 mm in diameter. The falciform liga- ment was well to the left of the ensiform cartilage, the right lobe being especially enlarged. In the substance of the right portion of the right lobe was a large abscess, with thick necrosed walls and irregular and shreddy internal surface. This extended fiom the under surface of the organ to within 2 cm of the upper and outer surface of the lobe ; its breadth from side to "i»!r- .-?'■ W^ , 1 .%■ % ■'^-: % W0 mm Wi M- # •^. »*<- ul? M. side wag 12 cm., and from above downwards it was 15 cm. (6 inches) across. Throughout the rest of the right lobe there were scattered a few other secondary abscesses ; the largest of those was 15 mm. in diameter. The intestines were markedly congested. In the jejunum were a few subcutaneous haemorrhages. Upon examination of the large intestine no signs could bo made out of any dysenteric lesions. Close to the ileocaecal valve was a small whitish patch, which gave rise to the suspicion that there was a cicatrix, but upon closer examination the .nost that could be discovered was that here the raucous membrane was softened and thin, with no ulcerous or old inflammatory conditions. Here, then, as not unfrequently occurs, the amoebic abscesses of the liver were present without any indication of dysenteric intestinal lesions, either during life or at the autopsy. It is to be noted, however, that the hepatic flexure of the colon was in close contact with, and, in fact, adherent to that portion of the under surface of the right lobe of the liver, which was undergoing necrosis. Beyond that the heart presented the condition of early peri- • carditis, and that the kidneys showed some acute parenchyma- tous nephritis, (he condition of the other organs does not call for remark. Stained sections of the liver and slough showed the presence of amoebae ; these were best shown by staining with methyl- blue and were faintly stained by haematoxylin. In the abscess cavity and its walls were numerous masses of vstreptococci. : These were evidently of secondary growth, for the abscess contents were singularly free from pus cells, being mainly i formed of broken down cheesy matter. Microscopic examina- tion of the walls of the colon showed no evidence of necrosis. In this case therefore, the presence of fever, of hepatic enlargement, pain and tenderness, suggested the presence of '^ purulent inflammation in the neighbourhood of the liver. That this was so was confirmed by the result of aspiration. Whether the abscess was sub-diaphragmatic or in the liver substance was determined by the discovery of the amoebae in the removed ;^- j}^'' v:- f^ '4 m « ■:^ m- 6 fluid. These indicated clearlj that the origin of the disease was in the liver itself. The failure to find amoebae in the faeces was explained at the autopsy by the absence of any dysenteric ulcers or necrosis in the colon. This case gains an additional interest from the fact that so far as we know, it is the first recorded in Canada in which the amoebae coli have been demonstrated in an hepatic abscess, if not in the living body generally. C 4 o o riMlM ;l i ili ' l (ni li m >irl >w)i l i ii«i »i ii III ■ « D C o o ,.■ ■'. llfc OMl l lH ll t .li