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THE MILK FEVER EPIDEMIC IN ABERDEEN.
657
dressing the limb. The apparatus is also convertible, wooden rods, into an bv a very simple arrangement ofwhich will be found of elevator of the entire bedclothes, vapourgreat service in the application ofalsohot-air and over the be placed baths (Fig. 4). The cross-bar can
Symptoms.—The patient, the subject of this disease, who, in most cases, has been up to the moment of seizure enjoying the best of health, is suddenly seized all over the body with This state of matters a cold sensation and frequent rigors. lasts in some cases for twelve or sixteen hours, and for a time all attempts on the part of the physician or of the FIG. 4. patient’s friends are fruitless to restore to the patient his natural feelings of warmth. During this cold stage or period during which rigors occur the skin is hot and dry. The pulse becomes rapidly and greatly accelerated, and in two cases under my observation amounted to Another striking feature in this 135 beats per minute. ailment is the sudden rise of the temperature of the body to 103° F’. In two cases the temperature rose to 105° F., and remained at that high figure for nearly twelve hours. Variations of temperature do not occur as in some other cases of fever, it being as high in the morning as at night. The patient complains of intense thirst, great prostration, pain in the head, neck, back, and limbs, and sickness, which is usually accompanied by fits of vomiting and violent retching. The matter vomited has at first been the contents of the stomach and afterwards mucus mixed with bile. Pain in the head is a prominent and early symptom, bed for a rest in cases of lung or heart disease, in which the but the character of this pain varies. Sometimes it is patient is unable to lie down, and a wooden stand can be described by the patient to be of a bursting nature, at other adjusted on it to hold an inhaler, or other vessel. The times as if the parietes of the cranium were being drawn elevator can be used as a splint rest, and it will be found together and the eyes drawn inwards. The pupils of the useful in all cases in which a limb requires elevation (Fig. 5). eyes do not appear to be affected in any way. In one case the sensation of weight in the head was so great that the FIG. 5. patient was unable to move the head on the pillow. Perhaps the most striking feature in this complaint, along with the sudden appearance of rigors, the quick and great rise of the pulse and temperature, is the rapid and painful’’ swelling of the glands and muscles of one side of the neck, and in the cases I have seen it has been the left side of the neck that was affected. In one case the glandular swellings extended down the neck to within two inches of the clavicle. These swellings of the glands and muscles are very painful under pressure. Sore-throat is also complained of by the patient., and on examination I found only the tonsil on the affected side of the neck inflamed and slightly swollen. The amount of inflammation and swelling of the tonsil, the surrounding tissue, and the mucous membrane, was not at all in ratio to the amount of pain complained of. Two patients experienced a feeling of great tightness about the œsophagus and trachea, and in these cases difficulty of swallowing was present, but I could not discover any sufficient cause to account for it. In another case difficulty of breathing was experienced for several hours, which, however, subsided by causing the to inhale the steam of hot water. The shivering, Special iron wire splints fitted with shifting bars and patient movable hand and foot pieces, form a part of the apparatus, the pain in the head, the sickness, the swelling of the glands and by means of a sliding metal rest they can be adjusted and muscles of one side of the neck, and the soreness in the on the cross-bar at any convenient height. This method of throat, usually appear in rapid succession. The tongue is elevation will be found very convenient in practice, and is coated with a yellowish-white far, while its edges appear to natural. The urine is very acid, highespecially adapted for the treatment of injuries and fractures, be more red thanand loaded with urates ; no albumen was wounds of the hands and feet, amputation cases, and many coloured, scanty, in any of the samples which I examined. The other diseases in which absolute rest and elevation of bowels are usually constipated ; diarrhoea has not been the limb are essential. present in any of the cases under my observation. The Southsea. patient feels very uneasy and restless. Sleep is disturbed, of short duration, and unrefreshing. Delirium has been THE MILK FEVER EPIDEMIC IN ABERDEEN. present in some cases. After the patient has been
present
sharfly purged, and diaphoresis thoroughly established, the pulse and temperature fall somewhat rapidly, the painful glandular and muscular swellings decrease, the Ix the city of Aberdeen an epidemic of a novel character sickness and vomiting abate, and in two or three A relapse has mysteriously appeared in our midst, which has been days the patient may be said to be convalescent. of all the symptoms has occurred, in mo&t of the cases under properly or improperly named, _pro tempore, the Old Mill my notice, a day or two after the patients were convalescent; Reformatory Milk Fever. The reason why it has received and, in such cases, it was always the glands and muscles of this appellation is from the fact that all the persons affected the opposite side of the neck from those first affected which with the ailment, the symptoms of which will be presently became painful and swollen. One patient who was in a to being attacked with this delicctie state of health described, have been partaking of milk supplied from the complaint has had three previous but the symptoms during relapses, dairy in cunaexion with that institution ; and no one has as BY J. M. GORDON
PIRRIE, M.D.
the relapses have been les severe those those at, the onset of far as I am aware, who has not used the disease in all the ca,"es under my noti’-e. The treatment I adopted, and which was successful in the cases under my the above-mentioned milk. The first case of this epidemic which came under my care, was frequent purging, the administration of saline dianotice occurred on April 1st. Since then fifty-eight families phoreties until diaphorests was well esta.b!i;-hed, and, after the more urgent symptoms had abated, I found the greatest iu Aberdeen, comprising over two hundred individuals, have benefit to follow the administration of quinine along with the been affected with this peculiar ailment. Three cases have most nourishing food, accompanied by a well-regulated terminated fatally. amount of stimulants. A sample of the milk in question
yet been affected,
so
658 On the 27th paracentesis thoracis was performed in the sixth put into Professor Brazier’s hands on Tuesday, the 5th April, to be chemically examined, and the following is his interspace at the anterior axillary line, and about one ounce of blood-stained serum was withdrawn. (This was report :"The sample of milk chemically considered appeared to not examined with the microscope.) be one of fair average quality. The proportion of water On Dec. 4th paracentesis was repeated in the fifth inter. and of saline matter was by no means abnormal, and gave space at the anterior axillary line. No fluid was withdrawn. no reason for suspecting any admixture or adulteration On the 31st the right side of the chest looked large and therewith. The only thing that attracted my attention was rounded; cyrtometer tracing showed marked difference be. the somewhat rank odour possessed by the milk, and which tween the two sides. Right, eighteen inches and a hali: manifested itself the more by allowing the milk to rest for left, sixteen inches and a half. Below mamma the right did a time in a vessel half full and loosely covered. If, as I not move with respiration ; intercostal spaces could be have been led to believe, the milk in question has been scarcely distinguished with the fingers. The heart’s apex blamed for giving rise to a series of sicknesses, the investi- was one inch outside the nipple line in the fifth interspace. gation as to the cause must be handed over to the patho- Vocal vibration was absent over all the right side, except logist or physiologist or both to determine, rather than the at the extreme apex, where it was much diminished. Veins enlarged in the right axilla. Slight oedema. On chemist." order of the a By proper authorities, thorough investigation percussion at the right apex, from the clavicle to the secontl is now being carried on regarding the origin of this epidemic, rib the resonance was high-pitched, boxy. Below the and it is to be hoped that the cause of this serious disease second rib there was dulness, which extended fully one inch to the left of the sternum, and was continuous with the area may ere long be conclusively determined beyond all doubt. of cardiac, dulness. The right back was dull, except a little Aberdeen. high-pitched resonance at the supra-spinous fossa, and there
was
of
obscure resonance in the vertebral groove. The dull area presented a feeling of solidity to the fingers, and considerable resistance to percussion, hardly suggestive of a OF large fluid effusion. At the left back the resonance was normal. On auscultation at the right apex, front and back, there was some vesicular breathing, with prolonged expiration. Below the second rib in front the breathing-sounds BRITISH AND FOREIGN. were. for the most Dart. absent. Feeble bronchial breathinsbehind down as far as the base. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum was heard all over the et dissectiorum historias, tum aliorum tum proprias collect as habere, et The signs were similar in the right axilla ; no bronchophony; inter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Proosmium. heart sounds audible over the whole of the right back and side. There was no pleural friction ; light side vesicular CITY OF LONDON HOSPITAL FOR DISEASES breathing; vocal resonance rather increased. The heart sounds were clear; no pericardial friction; no evidence of OF THE CHEST, VICTORIA PARK. any pressure on vessels or nerves of thorax or oesophagus. CASE OF SECONDARY INTRA-THORACIC CANCER; During the last few days a small irregular lump, fixed and NECROPSY. painful, had appeared at the inner border of the right mamma. (Under the care of Dr. THOROWGOOD.) Sputa for the last fortnight abundant, frothy, of light LOUISA B-, aged forty-three, married, was admitted amber colour; microscopic examination revealed epithelial elements, but nothing specially distinctive of the intraon Nov. 8th, 1880, and the following history taken :-She thoracic disease. Treatment, which consisted in the adhad had twelve children, eleven born prematurely and dead; ministration of small doses of iodide of arsenic, liquid extract the other died in childhood from bronchitis. Six or seven of ergot, and, lastly, pills of Chian turpentine, exercised no years back she first noticed a lump in left mamma, which influence over the extension of the disease, and after much continued slowly but painlessly increasing for three or four increase of dyspncea the patient died on January 22nd 1881. years ago, when tearing pain supervened in that region. The examination was made fifty hours after She went into the German Hospital at Dalston, and had the death post-mortem Dr. S. West and Dr. Lawrence Humphry, notes by breast removed in June, 1879. About a fortnight before being taken by Mr. Batson. Moderate height ; not much admission into Victoria Park Hospital she noticed a small emaciated ; no rigor mortis. Right side of chest markedly hard lump close to the cicatrix on the left side, and at the bulged. In site of left mamma a long healthy cicatrix. same time two or three lumps in the right axilla. About the Above this was a small hard nodule, which, on secSkin over right mamma was soft medullary cancer. beginning of August, 1880, she first found her breathing to tion, adherent ;; the mamma and surrounding tissues were be oppressed, the dyspncea coming on rather suddenly. adherent to the chest-wall ; numerous small hard nodules Cough, with muco-purulent sputa and night-sweats, came upon the sternum and ribs. On removing the skin on, but no haemoptysis. She had suffered a great deal of and making a section of the mamma these nodules pain under the upper part of the sternum, and at the right were found to be cancerous. On opening the abdomen the lower part of the chest in front. She had been in bed since liver was found enlarged and depressed, the whole peritothe end of September, gradually getting weaker. Appetite neum and omentum were thickly sown with small nodules, very bad. Was getting much thinner, and the dyspnoea most numerous along the attachment of the large intestine, but also abundant in the mesentery. The lumbar glands increasing. On November 9th she was examined by Dr. Thorowgood, were slightly enlarged. In the pelvis all the organs were and the following notes were taken :-The patient has a matted together, especially posteriorly, where the nodules cachectic appearance ; there is a small nodule in the site of were most numerous. Both ovaries were converted into the old cicatrix over the left mamma; one or two enlarged cysts, the left two inches in diameter and loculated. Liver glands in the left axilla; several enlarged glands in the right weighed 4 lb. 5oz., and contained a few secondary deposits axilla, and above the right clavicle. No oedema of feet; of very small size. Along the suspensory ligament the under the left clavicle percussion-note fair ; breathing harsh, cancer had spread, but remained almost entirely in the with prolonged crowing expiration, heard all over the left capsule. The kidneys and spleen were congested. The front. Under the right clavicle resonance good to the second left suprarenal capsule contained several nodules, the largest rib, where dulness commences and continues to two fingers’ in the medulla. The diaphragm on the right side stood very breadths below the level of the ribs. Respiration is bronchial, low and was slightly convex downwards. The left lung wamixed with sonorous and subcrepitant rates. At the level bound down by loose adhesions, consequent upon pleurisy, and of the third rib sounds are weak, and at the right nipple which was due to small disseminated nodules in thevisceral inaudible, also in the right axillary line. The liver appears pleura, chiefly on the posterior surface. There were no nodules depressed below ribs and is very tender. Posteriorly, the in the lung. The heart was displaced to the left ; no fluid in left back is resonant, and the respiratory murmur loud and pericardium ; heart normal. From the pericardium, exstrong. At the right supra-spinous fossa breathing is heard, tending upwards to the top of the sternum, occupying the but cough resonance not increased. Crepitation in the right whole of the mediastinum, was asolid mass, extending through vertebral groove, at the right base the respiration nil, vocal the intercostal spaces to become continuous v.-ith the nodule, described in the skin. This was clearly cancer. It bad vibration nil. was some
A Mirror
HOSPITAL
PRACTICE,
lung
dressing the limb. The apparatus is also convertible, wooden rods, into an bv a very simple arrangement ofwhich will be found of elevator of the entire bedclothes, vapourgreat service in the application ofalsohot-air and over the be placed baths (Fig. 4). The cross-bar can
Symptoms.—The patient, the subject of this disease, who, in most cases, has been up to the moment of seizure enjoying the best of health, is suddenly seized all over the body with This state of matters a cold sensation and frequent rigors. lasts in some cases for twelve or sixteen hours, and for a time all attempts on the part of the physician or of the FIG. 4. patient’s friends are fruitless to restore to the patient his natural feelings of warmth. During this cold stage or period during which rigors occur the skin is hot and dry. The pulse becomes rapidly and greatly accelerated, and in two cases under my observation amounted to Another striking feature in this 135 beats per minute. ailment is the sudden rise of the temperature of the body to 103° F’. In two cases the temperature rose to 105° F., and remained at that high figure for nearly twelve hours. Variations of temperature do not occur as in some other cases of fever, it being as high in the morning as at night. The patient complains of intense thirst, great prostration, pain in the head, neck, back, and limbs, and sickness, which is usually accompanied by fits of vomiting and violent retching. The matter vomited has at first been the contents of the stomach and afterwards mucus mixed with bile. Pain in the head is a prominent and early symptom, bed for a rest in cases of lung or heart disease, in which the but the character of this pain varies. Sometimes it is patient is unable to lie down, and a wooden stand can be described by the patient to be of a bursting nature, at other adjusted on it to hold an inhaler, or other vessel. The times as if the parietes of the cranium were being drawn elevator can be used as a splint rest, and it will be found together and the eyes drawn inwards. The pupils of the useful in all cases in which a limb requires elevation (Fig. 5). eyes do not appear to be affected in any way. In one case the sensation of weight in the head was so great that the FIG. 5. patient was unable to move the head on the pillow. Perhaps the most striking feature in this complaint, along with the sudden appearance of rigors, the quick and great rise of the pulse and temperature, is the rapid and painful’’ swelling of the glands and muscles of one side of the neck, and in the cases I have seen it has been the left side of the neck that was affected. In one case the glandular swellings extended down the neck to within two inches of the clavicle. These swellings of the glands and muscles are very painful under pressure. Sore-throat is also complained of by the patient., and on examination I found only the tonsil on the affected side of the neck inflamed and slightly swollen. The amount of inflammation and swelling of the tonsil, the surrounding tissue, and the mucous membrane, was not at all in ratio to the amount of pain complained of. Two patients experienced a feeling of great tightness about the œsophagus and trachea, and in these cases difficulty of swallowing was present, but I could not discover any sufficient cause to account for it. In another case difficulty of breathing was experienced for several hours, which, however, subsided by causing the to inhale the steam of hot water. The shivering, Special iron wire splints fitted with shifting bars and patient movable hand and foot pieces, form a part of the apparatus, the pain in the head, the sickness, the swelling of the glands and by means of a sliding metal rest they can be adjusted and muscles of one side of the neck, and the soreness in the on the cross-bar at any convenient height. This method of throat, usually appear in rapid succession. The tongue is elevation will be found very convenient in practice, and is coated with a yellowish-white far, while its edges appear to natural. The urine is very acid, highespecially adapted for the treatment of injuries and fractures, be more red thanand loaded with urates ; no albumen was wounds of the hands and feet, amputation cases, and many coloured, scanty, in any of the samples which I examined. The other diseases in which absolute rest and elevation of bowels are usually constipated ; diarrhoea has not been the limb are essential. present in any of the cases under my observation. The Southsea. patient feels very uneasy and restless. Sleep is disturbed, of short duration, and unrefreshing. Delirium has been THE MILK FEVER EPIDEMIC IN ABERDEEN. present in some cases. After the patient has been
present
sharfly purged, and diaphoresis thoroughly established, the pulse and temperature fall somewhat rapidly, the painful glandular and muscular swellings decrease, the Ix the city of Aberdeen an epidemic of a novel character sickness and vomiting abate, and in two or three A relapse has mysteriously appeared in our midst, which has been days the patient may be said to be convalescent. of all the symptoms has occurred, in mo&t of the cases under properly or improperly named, _pro tempore, the Old Mill my notice, a day or two after the patients were convalescent; Reformatory Milk Fever. The reason why it has received and, in such cases, it was always the glands and muscles of this appellation is from the fact that all the persons affected the opposite side of the neck from those first affected which with the ailment, the symptoms of which will be presently became painful and swollen. One patient who was in a to being attacked with this delicctie state of health described, have been partaking of milk supplied from the complaint has had three previous but the symptoms during relapses, dairy in cunaexion with that institution ; and no one has as BY J. M. GORDON
PIRRIE, M.D.
the relapses have been les severe those those at, the onset of far as I am aware, who has not used the disease in all the ca,"es under my noti’-e. The treatment I adopted, and which was successful in the cases under my the above-mentioned milk. The first case of this epidemic which came under my care, was frequent purging, the administration of saline dianotice occurred on April 1st. Since then fifty-eight families phoreties until diaphorests was well esta.b!i;-hed, and, after the more urgent symptoms had abated, I found the greatest iu Aberdeen, comprising over two hundred individuals, have benefit to follow the administration of quinine along with the been affected with this peculiar ailment. Three cases have most nourishing food, accompanied by a well-regulated terminated fatally. amount of stimulants. A sample of the milk in question
yet been affected,
so
658 On the 27th paracentesis thoracis was performed in the sixth put into Professor Brazier’s hands on Tuesday, the 5th April, to be chemically examined, and the following is his interspace at the anterior axillary line, and about one ounce of blood-stained serum was withdrawn. (This was report :"The sample of milk chemically considered appeared to not examined with the microscope.) be one of fair average quality. The proportion of water On Dec. 4th paracentesis was repeated in the fifth inter. and of saline matter was by no means abnormal, and gave space at the anterior axillary line. No fluid was withdrawn. no reason for suspecting any admixture or adulteration On the 31st the right side of the chest looked large and therewith. The only thing that attracted my attention was rounded; cyrtometer tracing showed marked difference be. the somewhat rank odour possessed by the milk, and which tween the two sides. Right, eighteen inches and a hali: manifested itself the more by allowing the milk to rest for left, sixteen inches and a half. Below mamma the right did a time in a vessel half full and loosely covered. If, as I not move with respiration ; intercostal spaces could be have been led to believe, the milk in question has been scarcely distinguished with the fingers. The heart’s apex blamed for giving rise to a series of sicknesses, the investi- was one inch outside the nipple line in the fifth interspace. gation as to the cause must be handed over to the patho- Vocal vibration was absent over all the right side, except logist or physiologist or both to determine, rather than the at the extreme apex, where it was much diminished. Veins enlarged in the right axilla. Slight oedema. On chemist." order of the a By proper authorities, thorough investigation percussion at the right apex, from the clavicle to the secontl is now being carried on regarding the origin of this epidemic, rib the resonance was high-pitched, boxy. Below the and it is to be hoped that the cause of this serious disease second rib there was dulness, which extended fully one inch to the left of the sternum, and was continuous with the area may ere long be conclusively determined beyond all doubt. of cardiac, dulness. The right back was dull, except a little Aberdeen. high-pitched resonance at the supra-spinous fossa, and there
was
of
obscure resonance in the vertebral groove. The dull area presented a feeling of solidity to the fingers, and considerable resistance to percussion, hardly suggestive of a OF large fluid effusion. At the left back the resonance was normal. On auscultation at the right apex, front and back, there was some vesicular breathing, with prolonged expiration. Below the second rib in front the breathing-sounds BRITISH AND FOREIGN. were. for the most Dart. absent. Feeble bronchial breathinsbehind down as far as the base. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum was heard all over the et dissectiorum historias, tum aliorum tum proprias collect as habere, et The signs were similar in the right axilla ; no bronchophony; inter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Proosmium. heart sounds audible over the whole of the right back and side. There was no pleural friction ; light side vesicular CITY OF LONDON HOSPITAL FOR DISEASES breathing; vocal resonance rather increased. The heart sounds were clear; no pericardial friction; no evidence of OF THE CHEST, VICTORIA PARK. any pressure on vessels or nerves of thorax or oesophagus. CASE OF SECONDARY INTRA-THORACIC CANCER; During the last few days a small irregular lump, fixed and NECROPSY. painful, had appeared at the inner border of the right mamma. (Under the care of Dr. THOROWGOOD.) Sputa for the last fortnight abundant, frothy, of light LOUISA B-, aged forty-three, married, was admitted amber colour; microscopic examination revealed epithelial elements, but nothing specially distinctive of the intraon Nov. 8th, 1880, and the following history taken :-She thoracic disease. Treatment, which consisted in the adhad had twelve children, eleven born prematurely and dead; ministration of small doses of iodide of arsenic, liquid extract the other died in childhood from bronchitis. Six or seven of ergot, and, lastly, pills of Chian turpentine, exercised no years back she first noticed a lump in left mamma, which influence over the extension of the disease, and after much continued slowly but painlessly increasing for three or four increase of dyspncea the patient died on January 22nd 1881. years ago, when tearing pain supervened in that region. The examination was made fifty hours after She went into the German Hospital at Dalston, and had the death post-mortem Dr. S. West and Dr. Lawrence Humphry, notes by breast removed in June, 1879. About a fortnight before being taken by Mr. Batson. Moderate height ; not much admission into Victoria Park Hospital she noticed a small emaciated ; no rigor mortis. Right side of chest markedly hard lump close to the cicatrix on the left side, and at the bulged. In site of left mamma a long healthy cicatrix. same time two or three lumps in the right axilla. About the Above this was a small hard nodule, which, on secSkin over right mamma was soft medullary cancer. beginning of August, 1880, she first found her breathing to tion, adherent ;; the mamma and surrounding tissues were be oppressed, the dyspncea coming on rather suddenly. adherent to the chest-wall ; numerous small hard nodules Cough, with muco-purulent sputa and night-sweats, came upon the sternum and ribs. On removing the skin on, but no haemoptysis. She had suffered a great deal of and making a section of the mamma these nodules pain under the upper part of the sternum, and at the right were found to be cancerous. On opening the abdomen the lower part of the chest in front. She had been in bed since liver was found enlarged and depressed, the whole peritothe end of September, gradually getting weaker. Appetite neum and omentum were thickly sown with small nodules, very bad. Was getting much thinner, and the dyspnoea most numerous along the attachment of the large intestine, but also abundant in the mesentery. The lumbar glands increasing. On November 9th she was examined by Dr. Thorowgood, were slightly enlarged. In the pelvis all the organs were and the following notes were taken :-The patient has a matted together, especially posteriorly, where the nodules cachectic appearance ; there is a small nodule in the site of were most numerous. Both ovaries were converted into the old cicatrix over the left mamma; one or two enlarged cysts, the left two inches in diameter and loculated. Liver glands in the left axilla; several enlarged glands in the right weighed 4 lb. 5oz., and contained a few secondary deposits axilla, and above the right clavicle. No oedema of feet; of very small size. Along the suspensory ligament the under the left clavicle percussion-note fair ; breathing harsh, cancer had spread, but remained almost entirely in the with prolonged crowing expiration, heard all over the left capsule. The kidneys and spleen were congested. The front. Under the right clavicle resonance good to the second left suprarenal capsule contained several nodules, the largest rib, where dulness commences and continues to two fingers’ in the medulla. The diaphragm on the right side stood very breadths below the level of the ribs. Respiration is bronchial, low and was slightly convex downwards. The left lung wamixed with sonorous and subcrepitant rates. At the level bound down by loose adhesions, consequent upon pleurisy, and of the third rib sounds are weak, and at the right nipple which was due to small disseminated nodules in thevisceral inaudible, also in the right axillary line. The liver appears pleura, chiefly on the posterior surface. There were no nodules depressed below ribs and is very tender. Posteriorly, the in the lung. The heart was displaced to the left ; no fluid in left back is resonant, and the respiratory murmur loud and pericardium ; heart normal. From the pericardium, exstrong. At the right supra-spinous fossa breathing is heard, tending upwards to the top of the sternum, occupying the but cough resonance not increased. Crepitation in the right whole of the mediastinum, was asolid mass, extending through vertebral groove, at the right base the respiration nil, vocal the intercostal spaces to become continuous v.-ith the nodule, described in the skin. This was clearly cancer. It bad vibration nil. was some
A Mirror
HOSPITAL
PRACTICE,
lung