s^. \>s^ \^ > " .>^ ^ IMAGE EVALUATION TEST TARGET (MT-3) 1.0 1.1 S 144 "^ Z US, 12.0 IL25 HI 1.4 ^ ** t'^s.l Photographic Sciences Corporation 23 WBT MAIN STREfT WIBSTIR,N.Y. M5»0 (716)«72-4S03 CIHM/ICMH Microfiche Series. CIHIVI/iCIViH Collection de microfiches. Canadian Imtituta for Historical Microraproductions / institut Canadian da microraprodwctiona liistoriquas \ \ Taehnieal and BIblioflraphic NotM/Notas tachniquaa at bibliographiquaa Tha Inatituta haa anamptad to obtain tha baat original copy availabia for filming. Faaturaa of thia copy whici) may ba biMiographieally uniqua, which may ahar any of tha imagaa in tha raproduetlon, or which may algnifieantly ehanga tha uauai mathod of filming, ara chaelcad balow. □ Colourad covara/ Couvartura da coulaur nn Covara damagad/ Couvartura andommagAa □ Covara raatorad and/or laminatad/ Couvartura raataurta at/ou palliculAa □ Covar titia miaaing/ La titra da couvartura manqua r~| Colourad mapa/ D D D D Cartaa giographiquaa an coulaur Colourad inic (i.a. othar than blua or black)/ Encra da coulaur (i.a. autra qua biaua ou noira) □ Colourad plataa and/or illuatrationa/ Planchaa at/ou illuatrationa mt coulaur Bound with Mliar matarial/ Rail* avac d'autraa documanta Tght binding may cauaa sliadowa or diatortion along intarior margin/ Laraliura Mrrte paut cauaar da i'ombra ou da la diatoralon la long dc la marga inlArlaura Blank laavaa addad during raatoration may appaar within tha taxt. Whanavar poaaibia. thaaa hava baan omittad from filming/ II aa paut qua cartainaa pagaa bianchaa aioutAaa iora d'una raatauration apparaiaaant dana la taxta. mala, loraqua cala Atait poaaibia, caa pagaa n'ont paa 4t* filmAaa. Additional commanta:/ Commantairaa supplAmantairaa: L'Inatltut a microfilm* la maillaur axampiaira qu'il lui a itA poaaibia da — procurer. Laa dAtaiia da cat axampiaira qui sont paut-Atra uniquaa du point da vua bibliographiqua. qui pauvant modifiar una imaga raproduita, ou qui pauvant axigar una modification dana la mAthoda normaia da filmaga aont indiquAa ci-daaaoua. D D Colourad pagaa/ Pagaa da coulaur □ Pagaa damagad/ Pagaa andommagAaa □ Pagaa raatorad and/or laminatad/ Pagaa raataur«aa at/ou pallicuiiaa E Pagaa diacolourad. ataincd or foxad/ Pagaa Pagaa dAcoioriaa. tachatiaa ou piquiaa Pagaa datachad/ Pagaa ditachiaa Showthrough/ Tranaparanca Quality of prir Quallt* inigala da i'impraaaion Includaa aupplamantary matarii Comprand du matirial aupplAmantaira Only adition availabia/ Saula Mition diaponibia I I Pagaa datachad/ rn Showthrough/ r~n Quality of print variaa/ pn includaa aupplamantary matarial/ rn Only adition availabia/ Pagaa wholly or partially ob?icurad by arrata alipa, tiaauaa, ate. hava liaan rafilmad to anaura tha baat poaaibia imaga/ Laa pagaa totaiamant ou partiallamant obacurciaa par un fauiliat d'arrata. una palura. ate. ont 4t4 filmiaa i nouvaau da fapon A obtanir la mailiaura imaga poaaibia. Thia itam ia fiimad at tha raduction ratio cttackad balow/ Ca document aat film* au taux da reduction indiqu* ci-daaaoua. 10X 14X 18X 22X 2BX aox y 12X 16X aox a4x 28X 32X Th« oopy fUmad bmn has bMn raproduoMi thanks to th* ganarMity of: MMlinI Library MeGill Uniwnity Montraal Tha imagaa appaaring hara ara tha baat quality poaaibia conaidaring tha eondition and lagibility of tha original copy and in icaaping with tlia ftlmlng contract spaeifieatlona. Original copiaa In printad papar oovofs ara fllmad L^aginnlng with tha front covar and anding on tha laat paga with a printad or illuatratad impraa- •ion, or tha bacic covar wlian appropriata. Ail otiiar original copiaa ara filmad baglnning on tho first paga with a printad or illuatratad impraa- slon, and anding on tha last paga with a printad or illuatratad imprassion. L'axamplalra fHmA f ut raproduit grica A la gin4roaiti da: Mwlical Library IMeQill Univtrrity Laa imagaa auhrantaa ont 4tA raprodultaa avac la plua grand soin. eompta tanu da la condition at da la nattati da I'axamplaira flimA. at an eonformiti avae laa conditiona du contrat da filmaga. Laa aicamplalraa originaux dont la couvartura wt paplar aat imprimia sont film4s an comman9ant par la pramlar plat at an tarmlnant salt par la damlAra paga qui compi rto una ampralnta dlmpiaaaion ou dlHustratlon. soit par la sacond plat, s alon la caa. Tous laa autraa axamplairaa originaux sont fHmis an commandant par la pramlAra paga qui comporta una ampralnta dimpraaaion ou dlHustratlon at an tarmlnant par la damlAra paga qui comporta una taiia ampralnta. Tha laat racordad frama on aaoh microficha shall contain tha symbol — ^ (moaning "CON- TINUED"), or tha symbol V (moaning "END"), witichavar appiias. Un daa symbdaa suhmnts apparaftra sur la damMra Imaga da cliaqua microficha, salon la caa: la symbdo *» signifia "A 8UIVRE", la aymbola ▼ signifia "FIN". Mapa. platas, charta, ate., may ba fHmad at diffarant raduction ratios. Ttioaa too iarga to ba antiraly included in otm axpoaura ara fllmad baglnning in tha uppar laft hand comar, laft to right and top to bottom, aa many framas aa raquirad. Tha following diagrams liluatrata tha mathod: Laa eartaa, planchas, tablaaux, ate., pauvam Atra fllmte i daa taux da rMuetlon diffArants. Lorsquo lo dorumant aat trap grand pour Atra raproduit an un saul clictiA, 11 aat film* A partir da I'angla aupArlaur gaucha. da gaucha A droKa. at da haut an baa. an pranant la nombra d'imagaa nAcaasalra. Laa diagrammaa suivants llluatrant la mAthoda. 12 3 1 2 3 4 5 6 !!?1* !.'<*. * f RBPRINTBD FROM THE " MONTRBAL MEDICAL JOURNAL." JULT. 1890. RETROSPECT OF PATHOLOGY. By Wyatt Johnston, M.D., Demonitntor of FntholoRy, MoOiU UniTenity. Diphtheria. — A number of important papers have recently been published on the bacteria found in connection with this disease. Since Loeffler announced the occurrence of a specific bacillus in all cases of true diphtheria, the matter has received special attention at the hands of bacteriolo^sts. A point of special interest was to ascertain the nature of primary croupous laryngitis, and to learn if the local membranous inflammations occurring in the intestine, bladder, skin, etc., were really diph- theritic in their nature. Paltauf and Eolisko ( Wiener Med. Wocherueh.f No. 8, 1889) found Loeffler's bacilli present in the cases of membranous croup which they examined, and therefore regard both croup and diphtheria as infective. In local diph- theritis in other situations they were unable to find these bacilli. The bacilli, when present, were always accompanied by strepto- cocci and staphylococci. R. Wurtz and H. Bourges (Archives de Med. JSxp., May, 1890) examined the bacteria present in nine cases of diphtheritis accompanying scarlatina. Of these, in seven the diphtheritic condition appeared early (precoce) and in two late (tardive). In the seven cases where it appeared early streptococci were found, occurring in chains, resembling, but not absolutely iden- tical with, those found in erysipelas. In six of the cases they were accompanied by pyogenic staphylococci ; none presented Loeffler's bacilli. In two cases where the diphtheria set in late (6th and 9th day), Loeffler's bacilli were found in both instances. T. M. Prudden of New York (Amer. Jour. Med. Sei.f May, 2 1889) examined 24 cases of diphtheria in children, either primary or in connection with suppuration, scarlatina, measles, etc. He did not find Loeffler's bacilli in a single instance, although the examination on this point was directed wich the greatest car?. In two cases of scarlatinal diphtheria staphylococcus aureus alone was found. In the remaining 22 cases streptococci were found in both local lesions and the viscera. Where the condition was complicated by pneumonia, chains of cocci were found in great abundance in the exudation. These cocci were absent from the throat and tonsils of 81 healthy children not exposed to infection, but among 40 children in good health, but living in a hospital where the disease was epidemic, the cocci were found in twelve instances. Inoculation with these organisms did not produce in animals any disease furly analogous to the diphtheria occurring in the human subject. In the researches already quoted it will be noticed that there is a diversity of opinion as to the nature of the pathogenic agent in this disease, and the experiments on animals do not appear conclusive. The induced disease was always a sort of septicaemia, the local manifestations being far from characteristic and the inoculated organisms being found after death in the blood and internal organs. Some recent experimental researches are far more satisfactory from being in harmony with what we know of the disease in man. Boux and Yersin (^Annales de VInst. Pasteur^ Dec, 1888) in- vestigated 15 cases, and found Loeffler's bacillus present in all of them. With cultures of the bacilli they were able not only to induce typical pseudo-membranous inflammations in animals, but these inoculations were followed by paralyses corresponding to those occurring after diphtheria in man. Further, they were jable to obtain by filtration a toxic substance from their cultures capable of producing this paralysis without the aid of the living bacteria. This poison was thought to be of the nature of a diastase or ferment. A small dose of the poison given subcu- taneously produced local inflammation (without pseudo-mem- brane) followed by congestion and hemorrhages in the internal organs, especially the kidneys. The paralytic action of the 'f».*:j>= / nng )f a )CU- lem- irnal the i 8 poison where very flmall doses were given was often greatly delayed, which may serve to explain the late onset of the cor- responding symptoms in man. These results have since been confirmed and extended by y. Babes of Bucharest ( Virehow*» Arehiv^ Bd. 119), who found Loeffler's bacilli present in all cases. He was able also to pro- duce typical diphtheritic inflammation in rabbits by inoculation in the conjunctiva, either with pure cultures or simply with small particles of diphtheritic membrane. Pure cultures, filtered through a Pasteu^Ghamberland porcelain filter, yielded a clear fluid free from mici'o-organisms, but containing a toxin differing from any hitherto described, and apparently analogous with the substance found by Roux. Injection of 30 com. of this fluid subcutaneously in rabbits caused death in 24-48 hours with symptoms of progressive paralysis of the muscles, respiration and heart. When 5-10 com. only were injected, the animals lived for several weeks, but usually died with symptoms of a paralysis not unlike that of rabies, commencing by a weakness in the hinder extremity and leading in a few hours to complete paraplegia, followed shortly by paraly8;s of the heart and res- piration. The autopsies showed parenchymatous degeneration of the liver and kidneys, with proliferation of nuclei about the minute blood-vessels. He did not succeed in producing a false membrane by injections of the filtered bouillon cultures, nor with any of the cocci found associated with Loeffler's bacillus. The cocci simply produce inflammation with necrosis, and so prepare the way for the action of the specific poison, in animals which had been inoculated with the bacillus, it was only found after death in the immediate neighborhood of the inoculation, corresponding exactly to what had been observed by Loelfler in human diphtheria. An attempt was made to secure immunity by protective vaccination, but without success, as animals which had survived appeared only to acquire a very slight degree of immunity limited strictly to the very site of the previous inocula- tion. Lastly, a series of therapeutic and prophylactic experiments were tried, the rabbits' cornese being treated with various anti- septic agents, either before or after inoculation. It was found, contrary to the suppoaition of Roux and Yemin, that oarbolio aoid in 20 per cent, solution was not only unable to check the formation of pseudo-membrane, but actually, through its irritat- ing effect, predisposed to it The same was found to apply to 10 per cent, citric and 6 per cent, acetic acid. On the other hand, 1-4000 sublimate and 1-1000 permanganate of potassium, 1-6 alcohol, 1-50 chloral, and 1-20 boracic aoid were unirri- tating and sufficed to check the formation of membrane. E. Klein of London, whose views were previously at variance with Loeffler's, has recently examined 22 cases of typical pha- ryngeal diphtheria, finding a bacillus identical with that of Loeffler in every case. In 12 cases he found a bacillus almost identical in appearance and oiode of growth, but devoid of pathogenic properties. Organization of Thrombi. — R. Beneke of Leipzig has pub- Ibhed some important results obtained in investigating this obscure subject. It is well known that the blood retained in a vessel between double ligatures may remain fluid for weeks or even months if the operation has been done aseptioally, and even if a clot has formed, the length of time which elapses before it be^ns to organize is very variable. Beneke, without going deeply into the cause of the blood remaining fluid, has studied the conditions which attend the organization of the thrombus. He considers that it is the effect of the intervascular pressure on the cells composing the vessel wall which determines its occurrence or otherwise. When the vessel remains distended with blood between the double ligatures no organization occurs ; and, microscopically, the walls of the vessel retain their normal appearance even in the immediate vicinity of the ligatures. On the other hand, if the vessel is collapsed at the time of the ligation, a condition favorable to proliferation of the connective tissue of the vessel wall with the vasa vasorum, at the spot at which orgamzation commenced there was always an overgrowth of the intima, which appeared to take an active part in the process. — (ZiegUr't Beitrage, vol. mi.) How far may a Cow he TubercuhuB before her Milk becomes Dangerous as an Article of Food f — The elaborate researches wmm made on this sabjeot by Dr. H. C. Ernst of Boston have recently been published in full ( Transactions American Association of PhjfsicianSj vol. iv). These investigations have been made on a scale and with an amount of precaution rarely met with, and are on that account most trustworthy. It had hitherto been sup- posed that as long as the udder of a tuberculous cow remained free from the disease the possibility of infection from consumption of the milk was practically nil. It was conceded, of course, that tttberoulo-mastitis might be present to such an extent as to infect the milk without giving any external evidences during the life- time of the animal, though even this was disputed. Dr. Ernst's experiments have led to the startling conclusion that the milk may be highly infectious where no disease of the udder is dis- coverable after death even with the aid of the microscope. The investigation consisted in microscopic examinations, inoculation of rabbits and guineapigs, and feeding experiments with calves and pigS. The feeding experiments were performed on a farm specially set apart for the purpose by the Massachusetts Society for Promoting Agriculture. To avoid the possibility of accidental infection the whole place was thoroughly disinfected and kept scrupulously dean during the experiments, all utensils being sterilized by heat. Microscopical Examination — 114 samples of milk, taken from 36 cows in various stages of tuberculosis, but all free from affection of the udder, gave positive results in 17 sfl.rnple8 from 10 different cows. Tubercle bacilli were actually ei^n in the milk of 27 per cent, of the cows examined. To eusure this result about 20 cover-glass preparations had to be examined on each sample. Inoculation of 49 rabbits with samples from 13 cows gave positive results in 10 per cent. Inoculation of 54 guineapigs with samples from 14 cows gave 42.8 p.c. of positive results. In the feeding experiments in 13 calves, 41 per cent., and with 5 pigs 40 per cent, became tuberculous. At the time of writing tho paper almost all the cows from which the samples were taken had been killed, and though all showed the presence of tubercle in some part of the body, not one showed tuberculosis of the udder. Dr. Ernst concludes that the milk from a cow e affected with tuberenloeii in any part of the hody may oontain the viraa whether the udder is affected or not. Unfortunataly that part of the research most interesting from a scientific point of view, vis., the exact anatomical condition of the udder, appears not to have received the same amount of attention given to the preliminary details, and the statements on this point are anything but satisfactory. The practical point that milk may be capable of conveying tuberculous infection when no disease is recogniz- able in the udder is, however, proved beyond doubt. On Hypertrophy of the Heart in Bright* $ IHseaae. — H. F. Formad of Philadelphia, in the course of 800 autopsies in cases of Bright's disease, found the heart hypertrophied in 62 per cent, of the cases, the left ventricle alone being affected in 84 per cent, and both ventricles in 28 per cent. The condition associated with the greatest degree of hypertrophy were (1) fatty and con- tracted kidney (late parenchymatous nephritis) occurring in 29 per cent, of the cases of general hypertrophy of both ventricles and 26 per cent, of those where the left ventricle alone was affected, and (2) red granular kidney in 44 per cent, of cases of left and 26 per cent, of symmetrical hypertrophy. The greatest degree of enlargement was found in cases where heart disease was also present, though cases of venous induration were not included. The average size of the heart was. 10 oz. in acute Bright's disease, 15 oz. in large white kidney, 14 oz. in fatty, contracted kidney, and 17 oz. in red, granular kidney. Arterial changes (endoarteritis and periarteritis) were found only with the red granular kidney. Gases of senile atrophy were excluded, as were also cases of amyloid kidney. It is stated, however, that with amyloid kidney hypertrophy of the heart occurs as often as in any of the other forms, the absolute weight remain- ing low because of the originally defective development of the circulatory system in these individuals. An apparently small heart occurring in a scrofulous subject may really represent a considerable degree of hypertrophy. — (2Van«. Assoc, of Amer. Phys.^ vol. iv.) The Connection between Morbid Conditions of the Stomach and tftoseofthe Nervous System. — P. Cuffer (Bevue de MSde- mmt ointy April 1890) denoribes four oases of oanoer of the stomMh where symptoms of bulbar paralysis appeared. He thinks that in addition to temporary reflex cerebral conditions, a permanent organic lesion of the medulla oblongata can be produced through an ascending neuritis of the pneumogastric. No reports of autopsies are given to confirm these views. P^^il^ff^-