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In Hutchinson's purpura thrombotica, an erythema, darkened by hæmorrhage, occurs usually on the legs, and may lead to local sloughing from the circulation to portions of the skin being cut off. I have seen one or two mild cases on the legs, but have not seen sloughing take place.

This brief account of hæmorrhagic forms of eruption brings me to an end of scarlatiniform and erythematous eruptions proper. I have purposely not included Bazin's disease -erythema indurativum-in the above list. as there is now no doubt as to its tubercular nature, and it does not at all closely resemble other erythematous eruptions clinically.

FOREIGN BODY IN LUNG.

BY G. C. BELCHER, M.B., D.P.H.

THE following case may be of interest, as it offers some unusual characters, both in the manner of the earlier symp toms and subsequently.

A young man, aged twenty-five, married, visited me, complaining of sickness, which had lasted for over a week, and was gradually getting worse. The patient was a fine specimen of healthy manhood-always led a careful life; his occupation—an artisan-was neither laborious nor injurious. There was nothing in his appearance to suggest any serious condition. I examined him very carefully, and, with the exception of a slightly furred tongue and some epigastric tenderness, I discovered nothing other than that which may be caused by some gastric catarrh, and I treated him accordingly. Two days afterwards I was called to visit him at home. When I arrived, he certainly seemed worse in every way. His wife told me he had been gradually getting weaker; the vomiting had been constant, especially when he took anything, when it became more excessive; she also stated that there was a very troublesome cough, which came on spasmodically, accompanied with a little yellow phlegm. There was a marked change in his condition: face was dusky; eyes sunken; looked very ill; pulse rate and respiration increased; temperature, 101.5 degs. F. The tenderness in the epigastrium was somewhat more marked; tongue still furred; bowels well open; no marked signs in the lungs; heart healthy, but quickened. I prescribed appropriate remedies, and gave particulars as to his diet. The following day he was about the same. Next time I called, two days after this, his wife informed me he had "vomited" (?) a lot of blood, and was still bringing it up. Upon careful inquiry, I ascertained he had coughed the blood up, and his sputum was still slightly brownish in colour. I examined his lungs this

time most carefully, thinking that the case may be one of early phthisis; but the physical signs were very indefinite. Next day I made out the following conditions :-Right side there was more slightly diminished movement than on the left; vocal fremitus not altered; percussion note less resonant on right side than on the left, but this I find not unusual in a normal chest; few râles after coughing discovered in the right infra-clavicular region; vocal fremitus increased slightly; breath sounds diminished. I examined the sputum most carefully, but with a negative result; the vomiting had ceased. I was inclined to believe that the case was one of an early phthisis, though, taking the clinical symptoms as a whole, they did not correspond to the general characters of such; and one hesitated to inform his friends that he was suffering from the early stages of consumption.

Two days after I again visited him, and was surprised to find the patient wonderfully better, and they unfolded a story which explained his rapid improvement. The wife then explained to me that on the previous day he had had a violent fit of coughing, and that whilst coughing, something (?) came up into his throat, which when he looked at he found was a small piece of bone; and since then he had made wonderful improvement. She then showed me the bone, which was some 12 m.m. in length, 9 m.m. wide, and 5 m.m. thick, of an irregular shape, something of the following shape,

weighing in its dried state 20 grains, covered with blood and mucus. Immediately he saw it, he called to mind the following facts. Some three weeks ago, one week or so before he saw me, he was eating some boiled mutton, and during the meal he choked-in his language, "something went the wrong way "-he coughed very violently for some time, but presently the choking sensation abated, and he felt better, and thought he had swallowed it (!); and when he was taken ill, never for one moment associated his

illness with this occurrence of choking; in fact, he had forgotten all about it until he saw the bone which he had coughed up, and then it dawned upon him that the bone going the wrong way had caused the choking, and that it had been lodged in his lungs ever since that time. From this time he made an uninterrupted and complete recovery.

The chief points of interest seem to me to be: That a foreign body with irregular and sharp edges such as this bone should have been tolerated in the lungs for more than a week with practically no signs; one would have expected more characteristic symptoms immediately following the entry into the bronchial tubes; and that the first symptoms of such occurrence to have presented themselves as these did, viz., persistent vomiting and epigastric tenderness when that region was palpated. Of course, had the history been forthcoming at the onset, one could have understood the later symptoms and physical signs; though. if we look into the case more closely, we can associate the vomiting and epigastric tenderness with the lung affection, as being a referred visceral pain.

According to Dr. Head's tables, the lungs are innervated by third and fourth cervical, and the third, fourth, fifth, sixth, seventh, and eighth dorsal nerves; the stomach by the fourth cervical, sixth, seventh, eighth, ninth (and tenth (?)) dorsal nerves; and we must assume that the referred visceral symptoms were caused by the irritation produced by the foreign body in the lungs, and that can only be explained by the close association of the spinal origin of both stomach and lung innervation. Yet at the same time it is most remarkable that the presence of such a body as described should have been in the chest for a week or so and give rise to few, if any, symptoms; and still more so that the man in such a condition should be ignorant of the fact.

PRACTICAL THERAPEUTICS.

THE

TREATMENT OF BRONCHO-PNEUMONIA. BY DOUGLAS STANLEY, M.D., M.R.C.P.

THE treatment of broncho-pneumonia is frequently attended by difficulties. Further, a treatment not absolutely adapted to the case may allow of an unduly prolonged course, and, as a result, the health of the patient may be undermined for a considerable time. The following remarks apply to the disease as it occurs in childhood.

It is, in the first place, necessary to have a clear idea of the process going on in the lungs. This process may be chiefly bronchiolitis. There may be slight catarrhal pneumonic changes in the pulmonary tissue adjacent to the inflamed bronchioles, but giving rise to no consolidation ascertainable by physical signs. Or, there may be consolidation of extensive portions of lobes, or even of the greater portion of a lung. It is necessary to estimate the lung value on these lines.

Again, the associated conditions require to be weighed. Broncho-pneumonia may be due to an ordinary "cold" process; it may be part of a specific disease; it may occur in a debilitated or rachitic child. Therefore, a routine treatment of broncho-pneumonia will fail in many cases. So it is necessary to make a careful physical examination, not merely of the lungs, but of the whole of the respiratory system, and then to estimate the amount, if any, of cardiac embarrassment. Lastly, certain complications may be present, requiring a separate or modified treatment.

Presuming that the symptoms and signs indicate chiefly a bronchiolitis-that evidence of extension to the lung tissue

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