IMAGE EVALUATION TEST TARGET (MT-3) // ^ .^^ // v^ A 1.0 ^tam S itt lii i2.2 " 2? HA ■" Sf li£ 12.0 I.I Hiotograi^c Sciences Corporalion 23 WIST MAIN STRin WI9STIR,N.Y. 14SM (71«)S72-4S03 CiHM/ICMH Microfiche Series. CIHIVI/ICIViH Collection de Canadian Institute for Historical Microraproductions / Institut Canadian da microraproductions historiquas Tachnical and Bibliographic Notaa/Notaa taehniquas at bibiiographiquaa Tha Inatituta haa anamptad to obtain tha baat original copy availabia for filming. Faaturaa of thia copy which may ba bibliographicaliy uniqua. which may altar any of tha imagaa in tha raproduction. or which may aigniflcantly changa tha uaual mathod of filming, ara chaclcad balow. □ Coiourad covara/ Couvartura da coulaur □ Covara damagad/ Couvartura andommag^a □ Covara raatorad and/or laminatad/ Couvartura raataurAa at/ou pallicul4a □ Covar titfa miaaing/ La titra da couvartura manqua □ Coiourad mapa/ Cartaa g^ographiquaa an coulaur D D D D Coiourad inic (i.a. othar than blua or black)/ Encra da coulaur (i.a. autra qua blaua ou noira) r~n Coiourad plataa and/or illuatrationa/ D Planchaa at/ou illuatrationa m* coulaur Bound with othar matarial/ Rali4 avac d'autraa documanta Tight binding may cauaa thadowa or diatortion along intarior margin/ LaroHura aarria paut cauaar da I'ombra ou da la diatoralon la long da la marga intiriaura Blank laavaa addad during raatoration may appaar within tha taxt. Whanavar poaaibla. thaaa hava baan omittad from filming/ II sa paut qua cartainaa pagaa blanchaa ajoutiaa lora d'una raatauration apparaiaaant dana la taxta. maia. loraqua cala Atait poaaibia, caa pagaa n'ont paa At* fiim^aa. Additional commanta:/ Commantairaa aupplimantairaa: L'Inatitut a microfilmi la maillaur axamplaira qu'il lui a At* poaaibia da aa procurer. Laa ditaila da cat axamplaira qui aont paut-Atra uniquaa du point da vua bibliographiqua, qui pauvant modifiar una imaga raproduita. ou qui pauvant axigar una modification dana la mithoda normaia da filmaga aont indiquAa ci-daaaoua. D D D D D D D D Coiourad pagaa/ Pagaa da coulaur Pagaa damagad/ Pagaa andommagiaa Pagaa raatorad and/or laminatad/ Pagaa raataurAaa at/ou palliculiat Pagaa diacolourad. atainad or foxad/ Pagaa dicoloriaa, tachatAaa ou piquiaa Pagaa datachad/ Pagaa ditachAaa Showthrough/ Tranaparanca Quality of print variaa/ Qualiti inigaia da I'impraaaion Includaa aupplamantary matarial/ Comprand du material auppWmantaira Only adition availabia/ Saula Mition diaponibia Pagaa wholly or partially obacurad by arrata alipa. tisauaa, ate. hava baan rafllmad to anaura tha baat poaaibia imaga/ Laa pagaa totalamant ou partiallamant obacurciaa par un fauillat d'arrata. una palura. ate. ont M fiimAaa A nouvaau da fapon A obtenir la maiilaura imaga poaaibia. Thia itam ia fiimad at tha raduction ratio chackad balow/ Ca document aat fiimA au taux da rAduction indiquA ci-daaaoua. 10X 14X 18X 22X 26X »X y 12X lex 20X a4x 28X 32X Tfw copy film«d h«r« hM lM«n raproduetd thanks to ttM g«n«rosity of: MMical Library McGill Univanity Montraal Tho imagos appearing hara ara tha baat quality poasibia conaidaring tha condition and laglbiiity of tha original copy and in Icaaping with tha filming contract spacifieationa. Original copiaa in printad papar covara ara flimad baginning with tha front eovar and anding on tha MMt paga with a printad or illustm ad impraa- tion, or tha bacic covar whan appropriata. All othar original copiaa ara flimad baginning on tha first paga with a printad or illuatratad impraa- sion, and anding on tha iaat paga with a printad or illuatratad impraaalon. L'axamplaira flimA fut raproduit grica i ia g4n4ro8it* da: MMlical Library MoQill Univtrsity Laa imagaa auivantaa ont 4t4 raproduitaa avao la plua grand aoin. compta tanu da la condition at da la nattatA da raxamplaira flImA, at an conformM avae laa conditiona du contrat da fllmaga. Laa axampUiiraa originaux dont la couvartura wi papiar aat imprim4a aont flimte an comman^nt par la pramiar plat at an tarminant aoit par la damlAra paga qui comporta una omprainta dlmpraaaion ou dllluatratlon. soit par ia sacond plat, salon la eaa. Toua laa autraa axamplairaa originaux aont filmte an commandant par la pramlAra paga qui comporta una amprainta dimpraaaion ou dllluatratlon at an tarminant par la damlAra paga qui comporta una taiia amprainta. Tha Iaat racordad frama on aach microfleha shall contain tha symbol -^ (moaning "CON- TINUED"), or tha symbol y (moaning "END"), whichavar appiiaa. Un daa aymboiaa auhranta apparattra sur la dami^ra imaga da chaqua microfleha, salon la caa: la symbda -*>signifla "A 8UIVRE", la aynvtola ▼ aignifia "FIN". Mapa. piataa, charts., ate., may ba flimad at diffarant reduction ratioa. Thoae too large to be entirely included in one exposure are filmed beginning in the upper left hand comer, left to right and top to bottom, aa many framae aa required. The following diagrama illustrate the method: Lea cartae, planchae, tablaeux, etc., peuvent Atre flimte i dee taux da rMuction diffAranta. Loraqua la document eat trap grand pour Atra raproduit en un soul cliehA, il eet flImA A partir da I'angia aupMaur gauche, do gauche A droite, et do heut en bee. en prenant la nombre d'imegee nAcessaire. Lee diagrammee suhranta llluatrent ia mAthoda. 1 2 3 1 2 3 4 5 6 K .;~^ V/v^ T". & BROMCHIECTASIS TERIIMATIHG IH PREUiONIA, SIMOLATING PULMOHART AND LARTH6EAL TUBERCULOSIS. BY F. G. FINLEY, M.D., Anaistant Professor of Medicine and Associate Professor ot Clinical Medicine, McGill Tlniversity ; Physician to the Montreal General Hospital. {Reprinted from Montreal Medical Journal, February, 1898 ) ' -u F.-C'JLry :> y ^' ^■ r, iy\ j-i J BRONCHIECTASIS TERMINATING IN PNEUMONIA, SIMU- LATING PULMONARY AND LARYNGEAL TUBERCULOSIS. BY. K G. FiNLEY, M.D., ABsistant Professor of Medicine and Associate Professor of Clinical Medicine, McGill University ; Physician to tlie Montreal General Hospital. C. O., male, set. 19, was admitted to the Montreal General Hospital on February 23, 1897, complaining of cough, loss of flesh and spitting of blood. He had measles and whooping cough in childhood, and since the age of 8 years has suffered from cough, which has continued with more or less severity since. In September last it became worse, and he began to lose flesh. In January he suffered from a pain in the left side, which was extreiiiely severe arid catching at flrst, and lasted eight or ten days. On the day previous to admission, he spat up two or three drachms of clotted blood, and a little later a small quantity mixed with sputum. Examination. — The patient is of medium size, fairly nourished' and not anaemic and the temperature normal. There is a slight lateral curvature of the spine, the convexity being to the right in the dorsal region. The right side of the chest is rather larger, measuring 16f to 18 in., whilst the left is only 15| to 17 in. The percussion note is slightly dull on the left side in front and in the axilla, whilst it is hyper-resonant over the riglit lung. The breath sounds are slightly feeble over the dull area, and there are here a few scattered single crepitant rdles. The heart is of normal size ; a harsh systolic murmur is present in the pulmonary area, but there is no pulmonary accentuation, There is also a systolic murmur in the left supra-clavicular area. Until February 28th the expectoration was small in quantity, the tempera- ture did not rise above 99°, and there was slight sweating. On February 28th the temperature rose to 102J, the cough became severe and the expectoration copious, and a few days later extremely fetid. From this time there was a steady downward progress. The tem- perature was remitting, rising from 102° to 104° at night and falling to 99° and 101° in the morning. Ho became pale and lost about three 2 lb& weekly in weight. The expectoration increased, varying from 8 to 14 oz. daily, continuing extremely offensive. Profuse sweating was also noted. Coarse crepitant rdles developed on l)oth sides, and on March 12th, there was a dullness from the 4th to 6th rib, and in the lower axilla on the right side. Blowing breathing and broncho- phony were present over the dull area. Evidence of consolidation ulti- mately spread over the whole posterior surface of the right lung. Dr. Birkett examined the throat and reported marked ansemia of the soft palate and atrophic rhinitis and superficial ulceration of both the cords. The sputum was examined repeatedly for tubercle bacilli, but they were never present. Marked prostration of strength, slight wandering, and, on the night of his death (April 3), wild delirium preceded the fatal issue. Autopsy — Performed by Dr. Wyatt Johnston, April 4, 1897. Anatomical IHagnoaia.— Chronic putrid bronchitis and bronchiectasis with multiple dissecting pneumonia ; great enlargement of bronchial glands ; chronic catarrhal ulceration of larynx ; cloudy swelling of kidney. Somewhat emaciated young man. Rigidity present in all parts ; lividity slight. Abdomen. — Well marked anaemic areas over surface of liver ; organ shows some furrowing on the surface ; veins lying at bottom of these furrows. No evidence of gummata. Microscopic examination of liver tissue shows nothing special. Spleen — Large, rather soft, one accessory spleen size of a cherry. Kidneys— iMTge, moderately injected, typical cloudy swelling, but little opacity on M. E. Inteatinea—Shovr nothing special. Stillate injection along rugae of the stomach. TAorceo;.— Universal adhesions of both sides. Left lung.— 650 grams, partly collapsed, on separation greatly injected ; a few consolidated areas; bronchi much. dilated, witli thickened walls; foetid yellowish- brown contents. At base some consolidation irregularly distributed, but always in the vicinity of the small pocket containing the grumous foetid material just mentioned. It is difficult to establish whether these pockets result from necrosis or bronchial dilata- tion. Bronchial glands enlarged to size of walnuts, gray, succulent, soft and oedema- tous. Bight lung.—lS20 grams, greatly enlarged, practically solid throughout, and very heavy ; pleura adherant throughout ; pleural surface studded with grayish yel- low elevations resembling tubercles, but seem to be collections of yellowish pasty matter in minute cavities. Similar pockets filled with pasty matter are distributed through the lung, involving greater portion of the tissue. On washing the surface these stand out as small rounded sacs with shaggy inner walls, not showing granu- lation tissue or lining membrane, though often surrounded by Arm, indurated areas. On microscopic examination these spaces show no signs of tubercles, and are lined by altered, and to a large extent, necrotic epithelial cells, which are large and loaded with fat granules, and have a somewhat villous arrangement like hypertrophic epithelium in bronchiectatic cavities. The interior of the cavities consists alniost entirely uf cells ; shows little or no elastic tissue. The intervening space between 8 tho Hinall cavities showy extreme cunsolldation, witli tliiclcening of the walls of the nlvooli and some tibroid change. Contents of cavities show no tubercle bacilli. Trachea and bronchi show a rough, reddened, thick mucosa. Larynx at posterior angle shows two round ulcers with undermined areas. No sign of tubercle. Bronchial glands unite, and form a mass as large as an apple.'almost diffluent in places. Microscopic examination of glands shows no cells except various leucocyte forms. /Tea/'t— Valves reddened ; coronitries free ; substance healthy. Brat'n— Vessels filled. Otherwise nothing special. Testes, nothing special. The course of tlie disease was thus a chronic bronchitis and bron- chiectasis, terminating in foetid bronchitis and septic pneumonia. The relation of the onset of tlie disease to whooping-cough and measles could not be determined, as the patient was unable to fix the dates at which he suffered from these maladies. The clinical resemblance to tubercular pneumonia was very close ; the sweating, remitting temperature and prostration, the extensive spreading consolidation of the lungs, the ulceration of the vocal cords, are all features which are familiar in such a condition. The result of sy.stematic examination of the sputum was, however strongly against such a conclusion and pointed to a non-tubereular consolidation. I