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Appendix.
NOTES ON CASES.
Abscess of Lung.— Death.
A Mercantile Marine Engineer, aged 48, was admitted to Hospital suffering from pleurisy of the left base. The signs were well marked and the disease ran the usual course during the next few days the effusion reaching up to the level of the angle of the scapula.
In about ten days' time this was all re-absorbed, and on examination the friction rub was still present along the base associated with patches of dulness, tubular breathing and coarse crepitations. The sputum was muco-purulent with- out any traces of blood at any time.
On the 15th day the sputum became most offensive and continued so up to the end. The lung signs cleared up except in one patch about the size of the palm of the hand where coarse sounds were present with dulness on percussion.
Shortly after the stools became frequent with much tenesmus, the stools con- sisting almost entirely of bloody mucus. Neither ambæ nor tubercle bacilli were found.
From this onwards the disease fluctuated considerably, most of the symptons disappearing for a spell and the patient was able to get up and lie in the verandah. On the 46th day, however, a bad turn occurred and the patient took to his bed and died on the 51st day.
No tubercle bacilli were at any time found in the sputum.
The temperature chart was always above norinal but ran no particular course, being at times of a remittent and at others of an intermittent type, the highest registered being 103°.
Post-mortem.-Left lung affected. No fluid in pleural cavity. Base of left lung showed a localised pleuritic thickening. The lower lobe contains two cavities about the size of a marble communicating with one another full of most fetid puri- form material, the cavities being lined with a thick pyogenic membrane. Patches of grey hepatisation were scattered over the lung round about the abscess cavity. Smears from the pus showed no pneumo-cocci nor tubercle bacilli but were full of ordinary micro-organisins. The other organs were healthy.
Remarks.-Non-pyæmic lung abscess is so extremely rare that this case is worth recording. The patient was in no special way unhealthy and it is very difficult to account for so serious a complication to an ordinary attack of pleurisy. The absence of tubercle bacilli and pneumo-coccus is also worth noting.
Case of Chorion Epithelioma.*
The patient was a Russian, aged 36 years, a multipara, who was admitted to hospital on March 1st. She had had a normal labour three months previously at Port Arthur, the child being alive and well. 14 days after the confinement me- trorrhagia and fever began and continued up to the time of her admission to the Government Civil Hospital. On examination the uterus was found to be fixed but was not much enlarged. The patient was very cachectic and had lost flesh. A soft mass protruded from the os which was patulous. The growth bled easily and the vagina had to be pluggel for some hours after the examination. A piece was removed and examined by Dr. WILLIAM HUNTER, Governinent Bacteriologist, whose report is attached. During the patient's stay in hospital the temperature was of a continued type, ranging between 100° and 102° F. but occasionally rising above this. The bowels were freely opened and the stench around the patient was very offensive. Operation being considered to be out of the question the patient left the hospital a month after and eventually departed for Europe.
Report by Dr. HUNTER.-Microscopically the piece of tissue submitted to me for examination was not unlike placental tissue. It was soft and spongy and full of blood. Histologically the tissue was found to be made up of areas of free hæmorrhage, blood sinuses, and a peculiar parenchyma. No definite stroma was found. The greater portion of the mass was composed of extravasated blood and
* Published in the "Lancet" Oct. 21, 1905.
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