ON THE DETECTION OF LUNG-TISSUE IN THE EXPECTORATION OF PERSONS AFFECTED WITH PHTHISIS.

234 decided cases of collapse continue to be treated with hypo- thematous diseases ; that, therefore, as urged already by Dr. dermal injections of quinine, and an average mortality of rather Johnson with regard to fever, particular care ought to be taken less than fifty per cent. is the result, the whole number treated during these stages with regard to diet, clothing, habitation, by this plan being, however, only twelve. It should be under- avoidance of over-exertion and exposure to cold and damp air. stood that these patients were excessively prostrated, and Dr. Weber further pointed out that the insidiousness of the that the prognosis given by all who saw them at the time commencement of this chronic albuminuria, as in four cases of admission was decidedly in the negative as to recovery. out of the five related, anasarca and admixture of blood with Mr. Harry Leach thinks that sufficient success has attended the urine were altogether absent. Lassitude, loss of strength, this treatment to justify a more extended trial. It is to be anorexia, swelling of the lymphatic glands, and eruptions of noted that of thirty-four strong injections used, only one has boils, being the principal symptoms, ought, therefore, always had the slightest tendency to unfavourable local results. Up to to lead to an examination of the urine, the more so as by an this date fifty-seven patients have been admitted, seventeen early discovery of the renal disease the chance of a perfect cure deaths have occurred, and four are now under treatment, but is much increased, as seen in two of the five cases reported. The treatment consisted in attention to skin and diet; in the all, with one exception, rapidly convalescing. The average sojourn of each patient in hospital has been four days, and of the administration of iron with acidulated acetate of ammonia, and whole number three only have suffered severely from consecu. occasional doses of elaterium to relieve the kidneys, and in the tive fever. Coasting sailors, as a class, are very hardy men, witt use of the hot vapour bath or the warm wet sheet. a great deal of what is commonly called vis vitæ, and convales ON THE DETECTION OF LUNG-TISSUE IN THE EXPECTORATION cence at this hospital, after secretion and elimination of urine OF PERSONS AFFECTED WITH PHTHISIS. The Dread have fairly recommenced, is very rapid indeed. BY SAMUEL FENWICK, M.D., nought authorities were requested at the commencement of tht TO THE CITY OF LONDON HOSPITAL FOR DISEASES epidemic to receive on the Belleisle any cases that might occu: ASSISTANT-PHYSICIAN OF THE CHEST, LATE LECTURER ON PATHOLOGICAL ANATOMY in the Deptford and Woolwich navy yards, but these estab IN THE UNIVERSITY OF DURHAM. lishments have hitherto been entirely free from cholera. The author states that he has included in his paper the results obtained from the examination by the microscope of the expectoration of 100 real or suspected cases of phthisis. The plan hitherto recommended of searching for pulmonary tissue in has been to spread it on a flat surface, and to pick out of it with needles any portions that might appear likely ROYAL MEDICAL AND CHIRURGICAL SOCIETY. to contain elastic fibre. He has, on the contrary, been in the habit ofliquefying the expectoration by boiling it with a soluTUESDAY, JUNE 26TH, 1866. tion of pure soda, and then placing the fluid in a conicalDR. JAMES ALDERSON, F.R.S., PRESIDENT. shaped glass, when every particle of elastic tissue falls to the bottom, and can be removed and placed under the microscope, In this way as is done in the examination of urinary deposits. REMARKS ON CHRONIC ALBUMINURIA, ORIGINATING DURING he has easily found part of a grain of pulmonary structure THE CONVALESCENCE FROM SCARLET FEVER AND after it had been mixed in bronchial mucus ; and he calculates OTHER ERUPTIVE DISEASES. to that part of a grain may be detected in anyexBY HERMANN WEBER, M.D., F.R.C P., that contain it. pectoration may PHYSICIAN TO THE GERMAN HOSPITAL. In 13 out of 23 cases in which tubercle was suspected to be THESE remarks do not refer to the well-known and easily re- in the first stage, lung-tissue was found in the sputum. In 7 cognised acute scarlatinal dropsy or desquamative nephritis of of the 23cases, there was no physical sign of tubercle, but its scarlet fever, but to a chronic form of albuminuria originating existence in the lung was suspected from general symptoms occasionally at a much later period, when recovery had appa- only; and in the expectoration from these there was no pulrently been established already for several weeks. The author monary tissue. In 16 cases there were stethoscopic signs leadrelated three cases of scarlet fever, unattended with albumen to the belief that tubercle was present ; and in 13 of them in the urine or any other symptoms of renal complication elastic fibre was found in the mucus coughed up. There were 24 cases in which auscultation and percussion during the first four weeks from the commencement. The subjects of the cases appeared quite well at the end of about indicated softening of tubercle in the lungs, and in all pula month, when they returned to their usual mode of living; monary tissue was present in the sputa. In 15 the physical but about three or four weeks later the general health became signs were of a doubtful nature, and 7 of these presented disturbed (loss of appetite and strength, headache, glandular microscopic evidence of ulceration of the lungs. In 35 cases the stethoscope indicated cavities, and in all swellings, boils, anaemia, and occasional sickness), and the there were fragments of lung-tissue in the expectoration. urine, as soon as the patients came under treatment, was found 2 cases the author had diagnosed enlarged bronchial tubes, highly albuminous. Perfect recovery took place in one case; while in another the general health became much improved, in neither of them was there any appearance of elastic but a slight degree of albuminuria has remained; and in the fibre in the sputum. In 69 cases he counted the numbers and third case death occurred seven years after the commencement size of the fragments of lung expelled. In one specimen, from broncho-pneumonia, with uræmic symptoms, the post- coughed up in twelve hours, 800 fragments were found; and mortem examination exhibiting waxy degeneration (amyloid) often 50 or 60 fragments were detected, where, from the of the kidneys. The author maintains that the connexion be- stethoscopic signs alone, no great destruction of lung could tween the scarlet fever and the renal disease in this class oj have been anticipated. cases is not the same as in the acute scarlatinal dropsy : while The proportion of bronchial tubes the author found ’to be the latter may be considered as a part of the scarlet fever least in the stage of softening, and greatest where the stethoprocess, the former, originating at a much later period, is pro- scope indicated cavities. The greatest proportion of fragments bably only so far connected with the scarlet fever as through of single air-cells was found in the first stage, and the largest it a greater susceptibility to the development of chronic renal proportion of large fragments of lung where cavities existed. disease is effected, in the same way as there results a tendency to The author concluded his paper by giving a number of pracother chronic affections, like glandular swellings, and eruption tical directions as to the best method of conducting the exaof boils. The author believes that the same tendency may be mination of the expectoration, in order to find with quickness caused also by other acute diseases, especially those of exan- and certainty any pulmonary tissue that may be present. thematous nature, and gave two cases in which chronic albuHYDATID OF THE LIVER, TREATED SUCCESSFULLY BY THE minuria took its origin in persons who had lately recovered INJECTION OF THE EXTRACT OF MALE FERN from erysipelas of the head and typhoid fever respectively, in INTO THE CYST. both of which cases, during the febrile state and during the convalescence, the urine had been quite free from albumen. BY F. W. PAVY, M.D., F.R.S., ASSISTANT PHYSICIAN AND LECTURER ON PHYSIOLOGY AT He referred also to a similar case occurring after typhus fever, GUT’S HOSPITAL. and described by Dr. Johnson in his work on Diseases of the Harriet V—, a woman of pretty healthy appearance, aged Kidneys. (London, 1852, p. 408.) The author was inclined to infer from such cases that twenty-one, admitted into Mary ward under the care of Dr. the many cases of Bright’s disease the origin of which Pavy Oct. 4th, 1865. When three years old she was squeezed amongst is uncertain, a not inconsiderable proportion may have been against a wall by a cart wheel, which struck her somewhere developed during the later stages of convalescence from exan- on the right side of the chest. No rib was fractured, and she

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