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that he had studied the matter sufficiently to be con- vinced of the unreliability of the sign from a diagnostic point of view. There Buy Rocaltrol are various muscles all over the body which when tapped will exhibit this phenomena in emaciated patients, and it is especially well marked over the biceps and deltoid. It is not often observed in other diseases than phthisis, because in them the physician is not likely to tap the chest. He believes that it is purely muscular, and that it can be devel- oped in many other localities than the chest, and in many other affections besides phthisis. As to the ordi- nary physical signs in the early stages of the disease, the most that we can make out by them are con- densation, thickening, consolidation, and local bron- chitis. The special significance of these conditions it is not always easy to determine, and the chances of error have always to be taken into consideration. While all the signs have their value — ^palpation perhaps the least of any — they are all liable to mislead at times. There are, however, some others of importance to which allusion has not been made. In cases of doubt it is sometimes very useful to employ percussion during inspiration, during expiration, and in the interval. He is inclined to lay more stress on irritation of the Rocaltrol 0.25 Mg bronchi than Dr. Hudson had done. Rales in the smaller bronchi, limited to supra- and infraclavicular spaces, are of great significance. When there is evi- dence of consolidation, it will not do to trust to one examination, since not infrequently pneumonias occur at the apex of the lung. Such pneumonias run a characteristic course, and are apt to leave untouched the anterior portion, involving the posterior and middle part of the upper lobe. At the present time he said he is not willing to make a positive diagnosis without resorting to the microscope. The character and num- ber of bacilli present in any given case are of great importance in establishing the kind of phthisis from which the patient is suffering. Such microscopic ex- aminations should always be conducted witl^great de- liberation and care, and by. the best methods, as there are a number of sources of error which are liable to mislead. Dr. Janeway also spoke of the great impor- tance of careful inquiry into the past history of the patient. The signs of early phthisis may be present, and yet a thorough investigation of the case show that they are simply evidences of a bygone disease which had existed several years before in the lungs. PATHOLOGICAL SOCIETY OF PHILADELPHIA. Stated Meeting, April 33, 1883. The President, E. O. Shakespeare, M.D., IN THE Chair. NOTES ON THE MORBID ANATOMY OF PNEUMONIA. Dr. Osler read a paper summarizing his experience while pathologist at the Montreal General Hospital. Of 105 autopsies in cases of lobar pneumonia of which notes were available, five were discarded for various reasons. The mortality at the hospital is high on account of the large percentage of grave cases which are admitted; very many in persons debilitated and dissipated. Of the hundred cases seventy were males and thirty females. Of ninety-four instances in which the age was given, there were eleven case under twenty years; twelve between twenty and thirty; eighteen between thirty and forty ; twenty-one between forty and fifty ; twelve between fifty and sixty years ; and twenty cases over sixty. In fifty-one cases the right lung was af- fected ; in thirty-two the left ; in seventeen both. Other details were given of the various lobes affected. The heaviest lung weighed was 72"^ oz., and in eight in- stances the affected organ weighed over (>)i oz. In about fifty per cent, of the cases there was red hepa- tization ; in thirty per cent, mixed red and gray ; and in about twenty per cent, gray hepatization. The con- dition of the pleural air passages, bronchial glands, and unaffected portions of the lung tissue, was described. Among the terminations there were four instances of abscess formation ; three cases of gangrene ; and one in which there was a process of fibroid induration beginning in the lung. This case was a man aged 55, admitted with pneumonia of the right lung five days after the initial chill. Resolution did not occur, and he died in the fifth week. Post-mortem : The right lung was found solid, grayish in color, and in many areas the tissue had a smooth, homogeneous, translucent aspect, and in these a fibroid change was going on ; the alveolar walls were thickened, and the fibrinous Digitized by Google S66 NEW YORK SURGICAL SOCIETY. [Medical News plugs in the air-cells seemed undergoing transformation into conne(;tive tissue (a slide was shown illustrating this). There were no caseous portions and no tubercles. As to the other organs, the frequency with which large, firm clots were found in the heart was specially dwelt upon. In only 35 instances was the spleen much enlarged. In i it weighed 21X oz. In 25 per cent, there were marked fibroid changes in the kidneys. Of the complications, there were 5 cases of pericarditis and 16 cases of endocarditis. In 8 instances the men- inges of the brain were inflamed, in 5 of them asso- ciated with ulcerative endocarditis. In 5 instances there was acute croupous or membranous colitis, and in I instance croupous gastritis. Dr. Tyson, in the discussion of Prof. Osier's paper, said that his had been rather incredulous of the termi- nation of croupous pneumonia in fibroid induration, but the specimen exhibited by Dr. Osier demonstrates con- clusively that such a condition exists. The facts pre- sented in the paper are such as are not generally collated. Collective reports of autopsies in cases of particular forms of disease are of great value in the study of pathology. Dr. Formad Rocaltrol Calcitriol asked Dr. Osier, why his was not a case of acute phthisis. Croupous pneumonia is a very com- mon accident in acute phthisis. It is croupous pneu- monia which causes death, which is well shown by recent investigations of Mercur, of the University of Pennsylvania. Dr. Formad did not believe that croup- ous pneumonia can last five weeks. Dr. Shakespeare said that the remarks of Dr. Osier about the frequent existence of very firm clots in the right heart, extending into the ventricles, can be corroborated by any one who makes autopsies of cases of pneumonia Calcitriol Rocaltrol at hospitals. He had seen them Rocaltrol 0.25 in cases of phthisis quite as extensive and firm, reaching into the vessel going to the affected part of the lung. It is interesting to note the systemic involvement of these cases of croupous pneumonia, and the affection of in- ternal organs as well as lungs in the process which has been regarded as a local disease. We have to do with a general wide-reaching affection rather than local inflammation. The opinion was advanced by Dr. Osier that the exudation in the air-cells organized, that the process in the organization of croupous exudate is similar to that in the clot in arteries after ligation, and that comparison was the point which Dr. Shakespeare wanted to bring out. Dr. Shakespeare said that he did not believe that a blood-clot in a vessel ever organizes, and his opinion is based on facts detailed in an investigation, which he has published, on the healing of arteries after hgature. The vessel healed not by the agency of the white cells caught in the meshes of the reticulum, but by prolifera-
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