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^ 
 
 AMBULATORY LOBAR PNEUMONIA. 
 
 BY / 
 
 G. GOKDON CAMPBELL, B.Sc, M.U, 
 Demonstrator of Medicine, McGill University ; Assistant Ptiysician, Montreal 
 
 General Hospital. 
 
 Reprinted from the Montreal Medical Jowmai, January, 1897. 
 
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AMBULATORY LOBAR PNEUMONIA. 
 
 BY 
 
 G. Gordon Campbell, B.Sc, M.D. 
 
 Demoustrator of Medicine, McGill University, Assistant Physician, Montreal General 
 
 Hospital. 
 
 This case is of interest mainly from its rarity, the disease itself 
 presenting no unusual features. In hospital practice, where the great 
 bulk of patients conies from the poorer classes, it is not unusual to 
 meet with acute pleurisy with effusion in the out-patient department. 
 Several times I have been consulted for " shortness of breath and 
 slight cough " of a few days duration and found one pleural cavity 
 almost completely filled with fluid. Pneumonia, or at least that form 
 which sets in abruptly with a severe chill, met with during adult life 
 is extremely rarely encountered in an out-patient hospital practice. 
 The following are briefly the particulai's of the case. 
 
 N. M.,aged 49, born in Ireland, a wood carver by trade, came to the 
 Out patient Department of the Montreal General Hospital on Oct. 
 23rd, 1896, complaining of cough with slight expectoration and gen- 
 eral malaise. Inquiry into the history of the disease revealed the fact 
 that it had been induced by a severe wetting which he got on Oct 
 18th. On the morning of the 1 9th he rose as usual at 4 a.m., but 
 shortly after had a severe chill lasting one hour and followed by pain 
 in the side. During the day he took to bed and at night cough and 
 expectoration set in. During the follovang day, Oct. 20th, he 
 remained in bed, but on the 21st got up and sat about the house "not 
 feeling '" as he expressed it " quite able to go to work." On the 23rd 
 feeling that he was not improving he came to the hospital, a distance 
 of over a mile from his home and walked a part of the way. 
 
 The personal and family history contained nothing of interest. He 
 had been a hard drinker in his early manhood but had been temper- 
 ate for a number of years. 
 
 On examination the temperature was found to be 101.5°, the pulse 
 120. The right lung showed dulness from the spine of the scapula 
 down, and at the side and front, corresponding very closely with the 
 lower lobe. Over the dull area there was inten.se dry blowing- 
 breathing and broncohphony. The vocal fremitus was slightly if any 
 increa.sed. A diagnosis of acute lobar pneumonia was made and the 
 patient advised to remain in the hospital. To this however he 
 
 1 Read before the Montreal Medico-Chirurgical Society, Nov. 20, 1896. 
 
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 demurred not feeling as he said that he was " ill enough for it.' 
 After the grave nature of the disease was explained to him, he con- 
 sented to be admitted but insisted on going home first, which he did. 
 The same afternoon, Oct. 23rd, he was admitted to the wards under 
 Dr. Molson and to his resident physician ]3r. Mitchell I am indebted 
 for the further history of the c»xse. The temperature shortly after 
 admission, rose to 103° and remained between that and 10 P until 
 death occurred cm Oct. 28th,. the tenth day of the disease. The ex- 
 pectoration was rusty, viscid and contained pneumococci. The urine 
 contained no albumin. On the 26th, two days I'fore death, an area 
 of consolidation was detected in the base of the left luncf. 
 
 The autopsy, made b}' Dr. Wyatt Johnston, revealed : Acute lobar 
 pneumonia, total grey hepatization of the right lung with commencing 
 red hepatization of the left lung. Acute bronchitis ; chronic right 
 and acute plastic left pleuritis ; old apical tuberculosis; spleen large 
 and firm ; hogsback kidneys with mixed nephritis and some fatty 
 degeneration ; slight cirrhosis of the liver ; very marked dilatation 
 and hypertrophy of the heart ; polypoid white thrombus of the right 
 ventricle; and slight pulmonaiy embolism.