Document M4pgKYkjmN5DB6eZ1vREvYp87

-KC OlXCXX.j OWf. W, 3. WOOD <U\n S. R. 01OY3f*5 PUL2tOXARY , h. muioiu* " >'f congenital syphilis. There is much outstanding features of psittacosis-. eap* acascqpea*-F^y* T* l'.Urinous cedema, but no- purulent exudation on the pulmonary iaTolvemenlVit mushheremembered. Vs & >T. " i IM softening. The trachea and bronchi are that this is aiso true .of the more' sevs' csnee rdf.*3?-w. - j-.^rcnj. The bronchial glands are not enlarged. influenza. If, however, in doubtful aasiijrlmnndi j;` <pleen in both cases is. slightly enlarged; signs appear dunng the first-thxae ijef the. dlaanoei*! > -ilam^ed but not soft. The other viscera show of influenza is the more probable*- On tlmothar fis^dj ^'yviT'S' U,l(Miy swelling and congestion. An intramuscular an inflpenza-Uke disease; which *..peaistn;. far o*' fctAr I'cniuJTfcAoe of recent origin is present in the tthhaann ffiivvee ddaavyes wwiitthluonutt Tmhnoziarw^^mhll-e--t-t-io--a--w-- -^-^wTer^avt .Cn. .ImIoiuumI wall ,t Case 9. It is not at rhe site of a should lead to inquiries* inter afld,. cOrineriurig. aickvCw^iV? - ** injection. The bowel contents are fluid, and i t tiic ciecum are four small shallow acute ulcere, ,'iK. peritoneum over which is natural. The hisielocicai study of the changes in the lungs .h-uumrts more detailed investigation. Vet the preliminary stage in the examination already shows [vi'f.iiii peculiar features. (a in.(h cases the m^iw condition may be described ;t. a bruiicho*pneumoma. the cytology of the alveoli ia tit* actual areas of consolidation showing no mutual characters. Neighbouring areas of lung atv utictuatoua. In addition there are small foci ,.r uppurati<m and in some places there are areas r.iiiiulete mwmsis* InCase 3 (Pigs. HI. andXV.)one no reliable evidence is affordedby *a study of the caeim-' *'' .if the** arcus is at the periphery of the lung arid the of a thrombosed arterv at its apex suggests list it may be an infarct. However, thrombosed \.**-l* arc aea in other parts of the lung, without iidjiiccnt necrosis* A further peculiarity in this case (3) i, the prvseocc in the lung of plugs of coagulated H.-iteriul in many of the alveoli. These are of regular, *ii, nUir. >*r oval shape, and contain no cells except -iud ,Uv*iilsr epithelium bordering them. No .ftiH'tutvw exactly comparable with these have yet it, , ii xvu in the second cuse. here reported. They do suggesthowever, tliat it Ja ' not less than ten days. -f il- TTe desire to express our thanks to several of our's^ '?? coileaguee--to Dre. James Haxwefl, BL. 3. 'Xolaaos*,' ' ' ' and L. P. Qarrod for pathological' hzeestlgaZiansri . ' to Dr. 5. R. Cuilinaa for his preflxaaary report on .* the histological appearances in the lsmgerto Dr.RL L.' a Jjturdev 'of the Ministry cd for sundry- -. communications; and especially to Sr. Desmond- . Crwick for his careful analysis of the group of eight ' * caets recorded in the text, and his nuaiimiuu tomkq . General Remarks* use of his notes. ' *r .. ' * . Tin' s*tudy of the cases hitherto reported under ; lu* provisional name of psittacosis, together with. i in*** here recorded. the conclusion almost: irtv*istible tliat there is a septicsMuic fora of disease ; in human beings closely associated In causative1 fashion with disease in parrots and kindred birds. This conclusion is borne out alike by the clinical featiuv* of rhe disease, by the peculiar morbid: PUiaiOtfARY A2BESTOSZS, * a Bt w. BTTBTON WOOD, 2LR.OP.Lotcs^dja,-.,.. * %r y, Anatomical findings especially in the lung*---In i mstcLur to ocT>ra<zzBns. arr or toxnaw aovait sew utnl cases, and by the evidence of contact, direct or I DtsBascsorcsB sxAJtr axs lcxos. tecimume,a.^ indirect, with sick or dead parrots. ' * . * Amongst the clinical features in the series of cases litre noted the prevalence of epistasis during the 3. ROODHOUSB GLOTNB; MJ>. Tara,. pjg^ * i-tiriy <rage of the disease, the tendency to diarrhaa . FAtHotoow to tss aomnas.. with collapse, and the special liability to pulmonary complications towards the end of the first week are noteworthy. If the cases are to be accepted Axtbocss aabestoa and eabestoa prodacts have tiaen, as a group in which the infection is of the same order used in industry for a long time,- it is only duzinjr the* throughout, it is clear that the disease may be in last few yearn that pulmonary aebestoeis has men. 'oine instances extremely severe, carrying a very recognised as a serious industrial iisessn. .. ' am* prognosis, and in others quite mild* There Asbestos* which was known to tbo-aamint woddjla _ is a Is. *ome suggestion that age is a factor in prognosis, a -^C^UTUTg in "li****!* In isvnhiw.ll' with;* " in tiiat the severest cases have been in patients over iron, copper, calcium, or magnesium. It ia quarried1' :Ui y...n' <jf age. There appears to be no recorded or mined In various porta of the wodd* Italy sad the* - a.** "f a vere illness in a patient under 20 years of Mediterranean. South Africa. Rhodesia* Canada..' In w. *'** 5 in the present group, a boy of 11 years, its natural state it occurs in strands of long sQ*y 'is very mild, as was the case in a boy >A 7 years, fibres which are highly resistant to h?at* strong aoida*. !. in Dr. A. P. Thomson's series of 21 and These muses are usually broken up mriy j short lengths before exportation into this country'.' 1 i'I ' n-iMi'Hng the differential diarptoeie the acute* In this country the lengths are crushed and diamrei ( the -n.-wt with headache, general pains. grated and then either mixed with various substances, du->>~v;a. And insonmui very naturally suggest for hardening into slabs, pipes, boards* Ac., or carded.' mri'i-ny. Tn m-iih*-r disease have wo any diagnostic spun, and woven into various products like mass and rtt>-,i>.u .-iiln-r as regards physical signs, clinico- mattresses, or used as an inert diluent or filling of a :. findings, <>r bHCterioloiricai te*ts. Absence heat-resisting character. At certain stages in theee rf-ytoj. marks both diseases, at ail events in industrial processes dust consisting of fine asbestos :i -ariv *tatr*. Kpistaxis <>e delirium occurring fibres is generated. When examined microsooptcaily i'uiiig tho ilr>t few days should mis..* suspicion that by dark-ground illumination the asbestos fibre gives :h - eswi i* not influenza. Tho -irailarity bi-tween the the impression of a sharp, brittle metallic wire broken . mav bviously lv* so dost- that further off at various angles and ia different lengths* and; 'innwiedifl: an alone help t decide how- many being hishly retractile, has the appearance of the ass labelled ' influenza " properly belong to this giowing filament of on electric bulb. These fibres can i-ecently mdieil infection. * Although it is be found in the nose and mouth, and in the asbestos no doubt true to say with Dr. Thomson that the corns and minute akin lesions of the workers. On reaching the hmg the fibres set up a phsmaonokoaioeia 1 Tax Laxcc^^eb. 32nd. p. 3ml. pLi'P' 1 of a. characteristic variety. * 'F- A frp Kv-i2i ho I \ '* 446 ;-ii- ii*csr,l ona. w. a. wooo ato s. a. oiom: muoyixr anbbttobu. txancs I, i30 ` ' . The first fatal cm* of pulmonary aebaetoais recorded is often apparent. Corns due to the irritation caused \ we that of 2. Montague Murray.' who made * post- by asbestos fibres embedded in the superficial layc-rs of | - mortem examinationof*case at Charing CrossHospital the skin of the bands sr* oeeasionallv smmq. Tlie .ikin ll * ' in 1900. Tbs asst cm* xeeordsd wu by TV. B. Cook*.1 in other exposed poeitioiu--e.g^ the tecs of giri i -who published * short sot* in 1924 ssd reported the workers--may be nimiluriy afiuoted. v -' autopsy findings on the css* in 1927. In ths tangs of The physical signs in the lungsare those ofpulmonary \ * this ease Stuart McDonald * noted the prassnes of fibrosis, limited to. or predominant at. the fusu bases. tii i \ . osrtaia curious golden yellow bodies,havingthe appsar- The coarse creakings and crepitations oauailv* tw<* sacs of minute crustacean forms. This* bodies did datedwith fibroid change ore. howwer. replaced by fine f' '<. not stain with ordinary sailing dyss bat preserved dry crackles. These may arise in the pulmonary their golden brown coloor. They were wall sssn in parenchyma or be due to the movements uf slightly ' ; unstained sections and jar* * characteristic prusataa roughened pleural surfaces. A definite friction rub ` . bln* reaction with potassium feerooyaaide and L . dilute hydrochloric acid. Careful investigation ted f .. McDonald to believe that tbaas bodies were not ! - of- vegetable or animal origin, hi 1923 Sisson * | ' reported.four cases with autopsy findings from South . Africa, and noted also the golden yellow bodies, i ' : In 1929 2C. J. Stewartand A. C. Haddow 4 showed that< these curieoe bodies could be found in eh* job* expressed* post mortem. from the lungs of 4 caess of pulmonary aebestosis* and that they could ; .. also be* detected in the sputum by digestion with i r.* equal quantities of concentrated aatifoemia.* They also suggested the name aebestosis bodies for these . - structures, a same which we thinkshould now replace '< tjte former^7--tuune^ourious bodies. ;'-Tatar in 1929 oae.of ue (S. R. <9.)7 showed* by seene ed dark-ground illumination, that when the . - " ` golden yellow asbestos!* body wee dissolved in con *. - castrated suiphurio acidit had a oentrai core consisting - of a minute asbestos fibre. Asbestos fibres wera also demonstrated, in the nasal ~*-**irf* and. mouth of ;v- woeksra. 1.'- . ' :1 A considerable number of asbestos workers have JksteMotis bodlt* la oustslOcd a'crln* mX Imu. l{ now been ***"*** at Victoria Park, and a clinical Kv ^- record of 15 cases with radiograms was published in v 1929 by one of ue fW. Jj, W.).* Since this record was ./`published we have been able to bring the numbers up to 37 cases including 4 asbestos workers with doubtful may be heard over one or other axillary base. A* tlu* fibrosis is bilateral share U aldoui auy npprwirvbW cardiac displacement. " ' . together with lour xeoords of post-mortem - Sputum* two of which have been reported by Wood The sputum is chide and mucoid--frequently o * An exeefieat resomd of the work done thick as to resemble semi-coagulated albtmin. In. will be found in J. ?. C. Hastam's ' the latest stages small nnmmuies of pus appear. .ranees in Preventive Mediom*." It seem* Asbestoete bodies can be demouscratcd by Stewart's worth while, therefore, to piece on record at this technique. Hu sputum is mixed with, an equal ^ stage pur.findings up to date. ' quantity of concentrated antiformin and allowed to .*Qr;.-v'j i:"*T.h e*. , -.\ . - :+ , j1y* v-^w--n--i-* cardinal symptoms ere dyspnma end cough. stead. When the mixture has bceomc digested it is centrifuged and the supernatant thud pipetted off and a wet film of the deposit examined with a 1/3 objective TSte is- in many esses the earliest symptom (or asbestoete bodies. To demonstrate individual - hoticed^by ths' pattest*-* who complains of dfaht asbestos fibre* one of u*(S. B. G.l7 devised the following breathlessnesson burrring er going upstates or that his technique. clast "feels';.stuffy/*'He therefore discards aspirator-swum hitherto under protest. In the late The iptuua is IfpstsrT with 10 per crat. accitensis wbieh be* beta Altered through a candio to tvow* say f- stages wfitfcw flseaae Ayspncea may be extreme. A foreign bodies, the dinKtd oixture is rvurriXufod. the j- **.teslble tightness- of the chest " may csum great deposit cairined to demroy til cellular dvbri*. tsd a wet ... X?' I distress sad the slights** exertion give rise to tebourea preparation 0< the --deposit mounted ia coacestmted P *&' ' '.* i;y >\ fb..r..M....t.h..i.n..g... ComSaavmteWe symptom* and though I wtebwie iddud xaaia*d by d*rk:^rotmd illimiaatioa. Sv-Afe'<. if i*`-r T: ufbsruparlolyhmprgstsdsp-n--eb-mrji.osdasld^bIboti-ssaevitehresradnrdy omraawycacbomemmapbiausneWiendt by*th*'expectoration of a little vtemd phlegm. The '. sputum lnthte* as in other chronic pulmonary diseases. iI varies greesiy ia js*as*e, from 24 to SO or sure. It mows so btaaehisg but ttirnirimn bsa a fine *aw>Uhe dse rather saggsstive at the marts on a freshly cat plank. This saw-Uke edee dees 00a extend itaag the whai* length of : may. on- oocasion be streaked with blood. This is. the fibre. Sat the most merited chanetvfistie of a timti* U>... .however, exceptional, and the only trank hmmorrhags asbsecot fibre, when examined by rhls method. > its .. noted'.in our eerie* of eases- occurred in an asbestos marked rsfrsesiUtT. Camparises with a coas-rel film of *'* > r worSarwfadwseateosufiteringfrom sdntescsnt phthtms *wtthaTitatioff. hEanypettenta complain of anorexia, IP;Pp X 7-; `-r-iv lassitude* pains hi the chest, and lose of weight. The jagt.is a noteworthy (secure, for wasting may be progggtcra. and ia late stages of ths tifwu te sometimes ground-op asbestos is essential. The sputum sbonid always be examined tor tubercte beeifil a* well as tor asbestosis bodies end asbestos fitoss. Asbestos fibres, but no aebestosis bodies, have also bean found in nasal secretion and in the mouth-wash -- - .Physical'iSfyiut, by tha *aypv method. We have also found asiwstoe fibres in the tearymal secretion of one patient. *ray>- I,*' k it-*'4kf'*L y-..' > '*i nr,ir <iiaeass> is estn^tehsd 5h* skin has an . leaden: hue*. Cyanosis may be abssne* sufficiently evident-to cense a dusky com* ___ _ Hm cheat Is poorly ctsversdsad expansion te defective and. may be.redueed to one or teaa. /T>T*wEtke vital caappaacciittyy,; ooxf-o01ne of due mate patients was V. .only'1600.>>.. ./ T C__a__b_b_i_ng_-is. MMttB. a marked feature, but a slight . siiweellliinnggoofftfhcehJak'tildqnasbboarvse the proximal ends of the nails Dioqnorig. When the patient's occupation is known diagnosis should give rise to difficulty except In the earliest stages of the disease. The history of cough iknd dyspnoea* the signs of bilateral pulmooary tibroai*, the situation quality of the adventitious sounds, the radiological appearances, and the presence of aabost\5 bodtes In the sputum* combine to form a distinctive " vr~,/-. i ;**-' ' T*X LaycTT.J ,Vse&*3ateJ 0*3. W. g, WOOD XSD 3. JC QZtOTTTZ: PTJXJCOJfSAT A3BX*V0tu` ^-jlCeSCX * Jlait" clinical pietuiv. In the earlier stages of the diiaaea, however. a definite diagnosis mar be impossible. **iggetir,- symptoms mar be the product 0/ faar. piivaical 413ns may ba conAned to a few floating cnwiciaa at a lung baas, than may ba no sputum empyema cavity, , between, the layers - aunilar empty cavity diaphragmatic pletwa from the `upper waflg'oA which ,Wr~'4 Mpu1sQoMoMzeLd.f_l_i_. Ii I I 1 I II rt I in! 1 maili ' liltt I T1 svsUefeW for microscopical examination. and tho adhationatothejK^>rf<m^ be-- ha,m ___ , X ray ftnding* ba equivocal. The difficulty of dateet* Anally the who* pleural sao.^gi^y b* closed. with mg rhr *aritet radiographic signs is dealt with later. Several uf tha easts in oar series had boon under treatment fursuspeeted pulmonarytuberculosis. Prom ung#v--lie `tsee ___ bilad_e__n__ Imp * ten and contracted * On eectioa.they'grrv*. t he abort description it will ba realised that an uncom* the appearance of being herd. sad -- . ,, plicated raw of ubestosia should not ba mistaken a certain extent, tiriese. h--ii.-,*>.*; for one of tuberculosis. nor is such an tsor likely to ^antiy forming a Abroue network, in the teas. 1., ' *ci lw mada except by those who ignore tha significance Abrams is most marked at bases* bat oithouS r > "( sputum testa. But the damonscrarton of tubercle the apices may appear dear, to the mated om on-' I'Aciili is tha sputum of an aabestos worker may ba a section they an generally found to contain a eonawar* scare* of difficulty. In three of our cases it seemed able amonat of Abroos Hirr, The baml probable that tuberculosis had supervened in hags one eara seem by us gave rise, ta a staking honey*-A already damaged by *#!<?, In two of thaae tubercle combed appearance. The braMhi are^dflated'amibacilli were found in tha sputum, and in one, reported thare may Jae smell bronchieetetio cavftiec.> Section " !***where,* in tha fans shortly before death. bronchitis. bruneho^pBeumonm, end are found aa terminal areata. . . peenmooia *' *'*. gadfoprophic Appearances. Jfedseetiiial /17jrnrff fn itttt naaaa ftieae tisTe* been vx W-i In au advanced and <ffl(rompHffa*y`* case of pul* small, pigmented, and hard, with irreefneie? " mooary aaoattoais tha radiogram is pathognomonic. calcareous ****"*! SnlargM meillMduer msade'i Tha picture is that of a fine Abrosis affecting the have been described by other wntaca. JTo ^*^^**1 d lower half or two-thirda of the lung Add*. At flat importance have been found elsewhere in the body, sight tha affected areas may exhibit a diffuse bare with the exception- of ruheionlnsis and. terminal r*wembliag ground glass. Closer inspection reveals broncho-pneumonia. .. ^ itr > areas of Use mottling and linear shadows which* *t . * * 'J^r : i J towards the bases, may ba draped like coarse cobwebs. lfteroeoapiu Appeeraaore ef fAe-Zunp^ ^ I'- The heary granular shadows typical of certain other pnemaonokoniuass* a.g., gold-miner's phthisis1 ere The following are the chief* changes t* .>* .* ** absent. The root shadows radiating downwards are very obvious, and where those cut the left edg* of the ntrdiae shadow they civs it a shaggy appearance. The costal angles are obliterated. The lateral margins 1. The bmebiolee ebow deecpaeaeCSow of epithelium sad. sameiiirnes eomoUte of the Bwoe 'mwnhnne.^ Beneath this these may he panMoe tissMtwlth 'seek lorasd eepUlariee. The hroaehMee ere ssBWUsded.' by 5 thick layem of dhraua tiinue whfeh man- irneeinniriT ' i tha lungs may show thickening of tha parietal comptw eod coaoietely cbliterate the-teaee. 'Sagamtimm . ]<Joura, and tha dome of the dlaphca^i is obscured. these is csSslec insltzatisn oi the pMibmachlel timn^a Above the clavicles thickening and puckering of the 2. Endarteritis of smeller laeaehea of the puheedary epical pleura may ba apparent. These are the appearances of advanced disease, and all gradations ar encountered between them and the flat fine mottling* and stristione of incipient *">'* Safer* artery has been described, seme of them being thrombosed There is slso > Isrge Inmsss nf mnmlrs tlmna einrmil ilia ecteriolee. - - .-* 3. Thickening of the iateriebelsw eMSicttra'dseSa, - 4. Thickening of subplsnesl nmneeHie timna. *- * * nice to control dims is imperative, for the natural 5. All these cenaectiv* tissue areas show flhwhlsste end tendency is to And abnormalities where no departure often smaA eseea of round cells. . ', from the normal is present. The skiagram of a healthy 3. The pnlmonery alveoli may shew deagnamatioa of' individual, if slightly out of focus or under-exposed, may show faint mottling especially in the lower areas ' the lung fields, and as it is necessary to allow for possible imperfections in the Aims of chests of asbestos workers, the control Aims should not W selected from alveolar ceils or may be fflod with Isieajrytss ; other alveolZ mMayf bfelOoBbltittefirlallttefdf ebfByraiiawuineemetnl.ve Hseee.aaA*o\then, , ag, ai.n, ; ?. Onessiosial giant rails may befeii.bebiiktaart act beaeromed that these are tuberouloue in oeigia beoanae foreign giaos cells fotsn readily, aad' the ssbenneis gfaat ceil may : lie radiologist s show-case. Allowance must also aaUr be fnisraken for tha tubercle gaaas eelL This is a. made for the haze produced by the mammary gf iflm importance. .* .1 riaude in the cheat radiograms of healthy women. 8. Scattered throoghoot the lang. more or fees iadle* ertminatsiy. is a considerable aaanas of'emerphnua. hsew* Prognosis. It is too early in the study of this disease to say rvrr mueh on this subject, but mice the aebestosis K- -dies aupear in the sputum the course of the disease wcuid seem to be progressively downward. >'or dote -action ''t exposure to further infection avail to pinoect. This Is often found phagecyted by alveolar ceils.' 9. The mroeact of the pathognomonic aebestaeu bodies. These are found in the famcBa of the branshioiee- witb desqeameted oroachiel epithelium Mod them. in. alveoli, afaia with deenuamated alveoier ceils azesmd them, and also *nattered indiscriminately in the dhrous times. Sometime* the bodies appear to bo phagecyted iitck its spread. Beach ultimately ensues from ' -ncho*oneuinonie or tuberculosis. T\* Ashcsforis Berfisr. , '* ' i>f ih*13 ca.v*s reported by one of us <W. B. W.) in Urns are golden yellow bodies varying te length . ud. three have now died, two of bronvho'pueumoaia from 21 to 60 p, and in breadth from 12 to 24 p. At a:.i '.net <>f pulmonary tuberculosis. flrat sight they have a supesffeial rreemtilenfe to minute crneftceens with a bulbous head, segmenT-srl Treatment. body, aad a long tapering tail. The substance of this 'yuti/iosetie treatzaeat is disappointing, for w* golden yellow body is apparently homogeneous except ' -- no means of relieving tha drspaaa which is the for a central linear thickening, suggestive of a dbre , - >*otA chi*-f complaint. Prophylaxis w thus all* running through the length of the oody When the rurx.rtint. and the only hope foe the future of the body is dissolved in concentrated sulphuric acid under . ir..rk*r lies in the adoption 01* proper means dark*ground the highly retractile - aguinst the risks attendant on the asbestos ribre which forma the cor* can easily be natatt-a ( tho fibres. Appearances. seen. Wba* the golden yellow material Is whleh* is deposited round this asbestos flbre in the- tiamrs-- for the aebestosis bodies have not been found In vitro ' 7h vihcsral pleura is generally uniformly --is not yt clear. Whatever it is. it has considerable u.'.Wifcvd. This thickening may be mot* marked at powers of resistance. Sometimes there is.a bulbous i-- h*** wha*m tle-ra may also be signs of recent heed at both aods of the aebeetoete body giving it- pi -.irihy. in one iumm seen there was a small spurious a curious dumb*bell appearance, sod-the head may ( &lv- thaw subsidiary bosaee oa it -or maybe. brakaa off altogether or splintered la coaiV bits... The --gwwi* -r.'S. h4 g.j* may bo eloooiy contiguous ilka. thooo of a-cruattosaa, or they may bo separated. by'a dear* tetasrnL-end they on aot infrequently tregnentetfcyThay^afy ia . Axe aad may bo rectangular or oraLOrrtoionotty't mm*p ibapail forma of the'asbestosis body without HlV. wiyeooatrietieaa on foand.' Also what appear ' eady foans coo- bo detected. , Tbooo look " thickened fibres with- o slightly balboa* hood, * ,4 . " *A . they cAon on of unusual length,' nthor suggesting tboa anoo th* nbeetoeis body ia fatty fozmod.it toads to got fragmented. Tbo bodies do aot state wxth,the S8SF-oiFrof<$Is a. cdmpnJaosgu,procedui**^*Uj; ml ordteazy aniline dysa* bat can-be'-tetetfr otatead with pcacstteaen ja 4runl.,a|aaa.>cg7jwqu&tetcd.tvitk.^ the onasxaa bine reaetioa aaod lor. detecting iaoa m ahdominol, puiaaeoua, oad.afrve tronblea that tekre4^ 2hoy'oansl>tiat'tooaeifomte mm .and* to woak acid*, oad wo' ha-*e found them, in sections. to malet weak deealcflytag Said, for maay. mm-- days, Wo ban also fooad team to ^exiat oad autolysia ia sputum for at. least a week.' ` poiaontegvoad' the.-medical .osseaidaat V ^sttSed. te^gSTteg . a death-- .citetifittsceiyiW TqgtrXrZ Once saoa tbo oaboatoaia body can bo readfly oaked: to easy oub ,the pathologsca^. add' ebcndaol 'C^' rwrun iasil, oad wo know of no other sabotaacw-fouad, urmtigationa, aad our findings tnpy be'^ftBtf.haafaL-'i'-*^-' Hx hamaa histology with which- it caa.be geofuaed*^ for future nfai-ince^-'* < + "' * ,V - 2I-M|>&h.-- *'. 5ugpcdsd Cfaioijftiifiow Stnym of &v&uinmir'5?: tneepd'tpate cdamoa.hn'.anguneQkttji'faade:' * up' ia the.'loan.of h. ppsrdar J ' deftwrit's. . .-. ' . i'v ont.*of anaaiouis o-rinymtiaii -ws&aouum oarhmsot*; oaboatoaia - folia into ` group B *t!T of oad finely1'groundsulphir^^Whekpnparadaoeo'zdiag fiteessss u< Bs&ga'x ' <daegSeetida;*H 'o-the-dinct3oaa,*the iHpjrfnirfnbgii'!fiaij.iijjJslirarftp* Thra*atagsa can bo defined ;(1) the presence of aabeetos oenti bfesotehie oceanic.'.-It.iaTywerer, s62tf^to^a^\'7' fibres te aaaai socxotioa or ia tha merely AmAWHnn mAAQA btf 1 $$>?$?- ? -H U { if' ' < mm ''>- t-. fe-x. ? 4- -** 3 'Hh'-, . zr ~ <2) tha pruamm of ooboatoaia bodieswhichIs e tign of a tissue rwepoace to tho duet** Ohthw typical without, thai oddltiotraf aar aJkatfTT^ 'Symptoms, signs, aad X ray oppoazaacta which on, .. The' actual, detaila.:o<'.<nibaas^tepteff.'voi^Un`; V te addition, door oridoaoa of tha diaaaad imapootrro difienf..pacta. iTha ' oonnltiona--under^ which.- thw* /- of tha hading of tebsstoaic bodies.- -, - . , <* oaceased manl woe reported to' banre-wuraad Oboioaaiy (1) ia ao owldaBoo of diooooal'bat wooaa fottowh*' Whan 500*3aeep^wze^,tO~f>e.Spped,' 8ft- n., accoot (2) oo a sin tbaa dinsM ia "*"- -Tf, tn, pocad"podaeU; cfCshaap dip W3S*bbtaiad /rom'-tbe- aboaaco of sputum diagBoais moat bamadaoa (9) aloaa. eetata-Hjflflbr stowe.., "1Ifieendarq<'Theee wem*hleehed. wiWhim. rtf COQHI. rtt 4 open, .with a kniidb.. .The >aatnia.af three pockets, with pulmonary fibrosis of subaos. wen emptied.' into' a..twoftoflmo bucket ;^woteerwas, quoatfy hoooaiiag employed te aa asbestos factory,j added oad the .-powder oaftiuisga disaohnsd.withi ybd * we coaaidar tha radiogram would bo ***<** to aid of *0 stidk *;?be mixture wan then, tipped data o> .... distinguiah this typo of case from true pulmonary 200^al2oa*batlL.. Tha prooedoae-waa. repeated^natil'. .* '2^ asboatooia* . ^ -the'neceesarydensityof the booh.wnaAttained.' Aaeach.'^v ' * Lastly, thus is tha ouateioo of pulmonary tubor^ pocket was emptieditwns pboniafvths ground-When . rt ouloaia oa o complication. Doss tha *vr<"T,**1i?nfi o beanof packets bad cojlectedftaiywen buanwtl One. dlaaaaa light up quiescent tuberculosis or dooa.tubazr culoaia become rmpiantad on pulmonary oabosfoaia aa bach p guided thair way^32ixuugh- f-Ke bath'to -. ` *a terminal ivtot ? It ia impoeaibk to ^**aa*r this ite eat. by naaaa.nf..pronged- ftinVir; The.-dHppmg. %w -question, bat it is worth while noting that' whan steep drained offlorhaUanSbar^teoae^peQ.or -- pulmonary tuborculoeia doss occur te thaaa eaaaa it la then transferred .to'oooCher !pen:'Ior.Aarthae._____ w.r., .. liable to be of on anomalous type. . ' .. - ` We on indebted to tha Medical StafC of tha for to use thair cues, to the StafZa >. ` ital the If the.doy'woa hot'the sheep draedbtt in ^-4.hburw^ .it wea dul 'and showerr mourq- wem'-ceqoired. The dried^hlphuSozaesic sointdnn could, be'eoea aad felt oa^the sheep, for seyecai ^At> the~cloer '? "' u Badiological oad Pathologieal Departmanta, oad.laat`but not "least to Dr. C. Leonard WQUama, the day's dipping, :the ninfrit bath. wna>Jafh-over^ officer of health for fv much throughout. Btfi byCorte, WV4, ant. j ^jst prepared'a yellow fouzn.appeared on tbp^urfooe. cilki: W:i"W.iw.iL.i0Si. " 3. McDonald, senere: ibi. 1WT. u.. ifiaf. 4. qfaamn. Tw.; rbid.. is.ly.sas. '"' .-i This. waa: remowed, by-o*bro<-''Tha . broom, after . - . ; use,*-wai swilled out andleft- by the bash fon-fhtum - , l^uae. '2w>ne of tha~meh Iworw- oeeihlla giorea,. or t Joar. Sote d4*o^-}.^iflfj'?o*l >gtsignneanntt*n;.r.Then were ao printed iMhstrruucctcioioQoSa .{ baouttlerpracoutfonatharronsfioddtokohuordarto .* ^ r. Gioyne. a. R;j_^terne. lilt, s., i#...* ^ . '* ' '{ protect'thamaelTM from the sotettoa, bufi they- wen ? S. wood. W, Benan: BAdU'j%hap^. Ms.3i^L; 4ar, Mr.tj'i.u'.el. il *to^.i-dj iadindnally not-*to. a.1l1lo^--w may^.of..1th--e fluid*.t-o----g--e-o->? n.. 157. ~ _ ** I < *-any sons, or-into'thair-mouths. 1'SLey were . ?' 10. : ocnahdreaeee te Psew--reMediae*.; 1 Opined to wnek.theiaihanaa before- eedag-* Wotec^ 11. BrtdSSrj: c!: Brit. Med. low., lm, te,"a, UU. roa pwrided ter the -pwnqe*rbabthefe wtke 'neither ^ - i ^ i, 2; !i__* `'iii-i" AtShi* loea-tbeie wee*soon.1 eged4St wbe bod:bei-o .* Tosaszns Bssmocsio^ Hosrrroi^ -- Thte 1 sceobeid siece borbeodw. .On June27th. and-MM-J-t- '** : '.laasitutiea is so pxoseat b eami ia teapecery .pnod.s...n...i.a....1..b..w...p..e..r..d..i.p..p...e..d 12S sheeps The bachhed bee*nEeBeMd.7ap Leeds owing te tbo dlfflculty of obeeialag e mere suitoble baa ith* fora beilifi. Thedippteg of tbesasoeMe^ane bniidlag, but the Tortsbin Optical Soeiscy is now hoping t bear. ;.'0s Jaly Uthhegot up wiiT to look ofterbiaahMa- to raise d30,000 (or tbs erection of its own hospital. It bee J ssd had foe DMoldoSt soaie bxd.bi prepared fraej- Mmir' been sqnipped sadmoinfained hitbertoet tbs post ofaedleal I r..i.e..i..'e..t.-..b...i.t..i..s..u.#S_p_U_s_d -*.ba. %pre__W__o_ev_d__ay__.-__T_h__e'^waai&dee af :' ^A,a'4t4?' msn sad opeicioak Th# prafenioael stod is onpoid, tad I tbhe bbesesSSwaos-'tbtea-pet.sai-de in:^ewiud-eacupboard' ia she ' .-,*> V? as prsse&ttbs hospitalisopen oas afternoon sod firssrpainge Toodenuiuthe Ured is. jmsil'.-Toeadar. Jair Lfltb, wbm it " * w<ekt whieb does aot meet tbo ^