LUNG TISSUE-FENWICK.

LUNG TISSUE IN THE EXPECTORATION OF PHTHISICAL PERSONS.

27

BY SAMUEL FENWICK, M. D.,

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 sputum has been to spread it on a flat surface, and to pick out of it with needles any portions that might appear likely to contain elastic fibre. He has, on the contrary, been in the habit of liquefying the expectoration by boiling it with a solution of pure soda, and then placing the fluid in a conical-shaped glass, when every particle of elastic tissue falls to the bottom and can be removed and placed under the microscope, as is done in the examination of urinary deposits. In this way he has easily found one-hundredth part of a grain of pulmonary structure after it had been mixed in bronchial mucus; and he calculates that one four-thousandth to one six-thousandth part of a grain may be detected in any expectoration that may contain it.

In 13 ont of 23 cases in which tubercle was suspected to be in the first stage, lung-tissue was found in the sputum. In 7 of the 23 cases, there was no physical sign of tubercle, but its existence in the lung was suspected from general symptoms only; and in the expectoration from these there was no pulmonary tissue. In 16 cases there were stethoscopic signs leading to the belief that tubercle was present; and in 13 of them elastic fibre was found in the mucus coughed up.

There were 24 cases in which auscultation and percussion indicated softening of tubercle in the sputa. Ia 15 the physical signs were of a doubtful nature, and 7 of these presented microscopic evidence of ulceration of the lungs.

In 35 cases the stethoscope indicated cavities, and in all these there were fragments of lung tissue in the expectoration. In 2 cases the author had diagnosed enlarged bronchial tubes, and in neither of them was there any appearance of elastic fibre in the sputum. In 69 cases he counted the numbers and size of the fragments of lung expelled. In one specimen, coughed up in twelve hours, 800 fragments were found; and often 50 or 60 fragments were detected, where, from the

28

ACUTE OSTEO-MYELITIS-FAYRER.

stethoscopic signs alone, no great destruction of lung could have been anticipated.

The proportion of bronchial tubes the author found to be least in the stage of softening, and greatest where the stethoscope indicated cavities. The greatest proportion of fragments of single air-cells was found in the first stage, and the largest proportion of large fragments of lung where cavities existed.

The author concluded his paper by giving a number of practical directions as to the best method of conducting the examination of the expectoration, in order to find with quickness and certainty any pulmonary tissue that may be present.—Lancet.

ACUTE OSTEO-MYELITIS.

Third Amputation, at the Shoulder Joint-Recovery.

BY PROF. J. FAYRER, M. D., OF CALCUTTA.

Prof. Fayrer remarks that this case is of great interest in a pathological, as well as surgical, point of view: "It illustrates what I have so frequently pointed out as the great tendency here, on the part of bones, when divided, to take on an unhealthy action, to pass rapidly into a state of suppuration, involving the whole of the [cancellated structure, and rapidly inducing constitutional mischief, which, if not checked by the removal of the affected bones, is likely to terminate fatally by toxæmic changes. This form of diffused osteo-myelitis may occur, as the case proves, whilst all around it is doing well. In each of the instances in which it occurred in this case, the soft parts of the stump were doing so well as to have almost healed. It will be observed that the symptoms indicating the disease in the bone were not the immediate or direct sequel of the operation, but supervened at a period of several days later, when the general condition of the patient was favorable. They were ushered in by violent rigors and consecutive sweats, with rapid pulse and hurried respiration. Amputation on each occasion was performed as soon as the symptoms had fully declared themselves, and fortunately in time to anticipate any of those structural changes in the lungs which experience has taught us are but too certain to follow when the source of the mischief cannot be removed. It is very satisfactory to see how perfectly successful the last operation

ACUTE OSTEO-MYELITIS-FAYRER.

29

proved, notwithstanding its magnitude, the weak condition of the patient from incipient blood-poisoning, loss of blood and the shock of former operations; and it seems to me to prove that disarticulation is often safer than amputation through the bones, where it can be practiced. For here, after two amputations in same limb, performed through. the continuity of the bones, osteo-myelitis followed each. The third operation, disarticulation at the shoulder joint, proved successful. It is probable that had I amputated at the elbow joint, instead of just above it on the first occasion, when osteo-myelitis appeared, the patient might have been spared the necessity of an operation subsequently at the shoulder joint; but I thought that cutting through a part altogether sound, and above the next joint, would probably result more favorably, and hoped that osteo-myelitis would not attack the sound bone, and accordingly I amputated above the joint. I now feel so satisfied of the advantages, in a pathological point of view, of amputation at the joint, over that through the shaft of the bone, that I shall hesitate on any future occasion to cut through a bone when there is a joint near the injury at which the limb may be divided. Such a rule cannot, of course, be made absolute; but I suspect if it were of more general application, the mortality after amputation would diminish. Imperfect hospital construction and local hygienic defects have, no doubt, much to say to it, but cannot be the sole causes. The question still requires further investigation, and I am convinced that if a section were made of the bone of every amputated limb, and the lungs and other viscera examined in fatal cases, it would be found to be a more frequent cause of mortality than is, perhaps, supposed, I now feel better able to account for the loss of many amputations in the field service, where death. was attributed, sometimes, perphaps, rather vaguely, to other and uncertain causes. Were all such to be carefully examined, and the same minute inspection made as that practiced more than twenty years ago by the pathologist, who threw the first real ray of light on the cause of death after surgical operations (I need hardly say I refer to Dr. N. Cheevers), I feel certain that suppuration in the bone would be found to take a higher place as a cause of the blood-poisoning, surgical fever, or pyæmia-call it which you will-which raises the death figure of surgical operation statistics so high. No one can read the report of M. Roux's experience and practice in the St. Maundrier, at Toulon without feeling that this may be the case; and I am sure that no one

can witness what occurs there, without feeling that his experience must lead him to opinions similar to those of the eminent French surgeon, and suggest similar practice. I can most conscientiously say that I had arrived at and recorded similar views before I had either heard of or seen his report. My experience of seven years in this great Surgical Hospital has not only led me to, but has confirmed me in them.''

SCIENTIFIC TOYS.

It is evident that the sports of children no longer satisfy the child. the modern five-year old young person is so far ahead of a child who completed his first lustrum any time in the last century, that he turns with contempt from the simple toys of a generation to whom science was unknown. This change may be traced to various causes; and possibly one of the most influential is attributable to that charming little work on the science of sport which is now known to have been written by the late Dr. Paris, when he was president of the College of Physicians. Science in earnest has, since he wrote, made a profitable business by supplying philosophy in sport. Any scientific recluse wishing to ascertain the progress of society in the direction to which his own studies tend may possibly gain information from the lectures of the Royal Institution, but is just as likely to obtain what he wants by making a tour of the toys-hops. If the word "science" mean that which is known, and if the term "knowledge" indicate that which is demonstrated and understood, then a child who comprehends the true story

of

any half-dozen of the new scientific toys would be a serious antagonist to tackle in a discussion. It is probable, however, that the rising generation is content with the charming results, and inclined to fight shy of all explanations. This is lucky for pastors and masters, who might be rather bothered by close questioning, unless possessing the ingenuity of that paterfamilias who shirked the responsibility of explaining the meaning of hydrated sulphocyanide of mercury by gravely informing the inquisitive urchin that Pharaoh's serpents belonged to the venomous kind of snakes, and therefore should be avoided. This plaything has had its day in this country, although the number sent to China and Japan is said to be enormous. There is some reason to fear that boys and girls, as they grow up, may still retain the belief that toy-makers invent all these new scientific playthings. Content with the

result, they accord a sort of half belief to the imaginative statements which accompany the toy; so that it is probable there are many thousands of young folks to whom it is a matter of faith that some relation exists between Pharaoh and the serpents produced by setting fire to a bit of mercurial salt, which was first discovered a thousand years after Pharaoh was forgotten.

There are numerous modern toys which, in reality, only present in an attractive form results attained by abstruse scientific investigation"non sine Dis animosus infans." That delicious moment of expectant observation which accompanies the moistening of one of those bits of mysterious white paper sold as magic photographs, is a practical source of daily enjoyment to many children. But the beautiful picture which then comes to view conveys to them no information about the history of its appearance, for this child's delight, this play-room toy, is in reality a very complex chemical process, where the printed image is first removed by bichloride of mercury, and then revived by hyposulphite of soda.

Another eminently popular toy just now-the "rainbow bubble "— is a passing result that was obtained in the course of certain abstruse experiments on the refraction of fluid media. It is of exquisite beauty, but its resources as an amusement are not half developed. Thus, it is easy to blow one bubble within another by simply thrusting a fine glass tube, charged with the fluid, through the material of the bubble itself, and then blowing an inside sphere. So also the finger, similarly moistened, may be introduced, and the bubble left to hang on a digit, like one of the fruits in Aladdin's garden.

Again, the in-door fire-works, that are such a screaming delight to the rising generation, represent years of study. The paper, which, crumpled, lighted, and thrown into the air, blazes like a meteor, is but a mitigated proxyline; one of the many results of the discovery of gun-cotton by Schonbein. More curious still are the little matches which throw out beautiful star-spangles, and are known as Japanese fire-works. These are due to a composition which involves the most delicate processes of the pyrotechnic art, and has been known for nearly two centuries as "spue fire." Its perfection depended upon the extent of the trituration of the simple materials, for if the nitre was too minutely powdered, the effect ceased. The Japanese have afforded a clue to the mystery, as these matches show that it was