Calendar: 1898-1899 Page 791

FACULTY OF MEDICINE clix He had suffered from cough for over four months About three-and-a-half months before admission he had li brought up" by vomiting about half-a-cupful of bright red blood and small quantity on the evening before his admission His cough had become gradually worse There had never been much expectoration the coughing was in fits which were becoming more violent and prolonged During the night of Feb 17th the cough was unusually severe and he found his neck swelling under the strain of the cough The emphysema extended over the whole of the chest front and back the tissues of the neck were so puffed out that the prominence of the chin was scarcely visible and the swelling had spread over the face to the level of the lower eyelids With no evidence of injury to larynx or ribs physical examination gave no information as to the state of the lungs beyond the fact of uniformity in note and sounds over all parts The heart sounds were pure the apex beat slightly displaced outwards the pulse regular 70 per minute respirations 32 with orthopnoea He had vio'ent spasms of coughing during which his face became darkly congested some vomiting of milk occurred and he expector- ated small quantity of frothy mucus In the course of the next few days the emphysema gradu- ally diminished the temperature wras fairly uniform varying throughout between 100 nd 102 The pulse rate was seldom over 100 or under 90 and the respirations ranged between 34 and 40 per minute By this time dull area had been observed at the base of the right lung behind extending upwards to the level of the ninth rib Above this the right lung was slightly hyper-resonant Rhonchi were general over both lungs but little sound of any kind was audible at the right base By Feb 27th this dulness had extended about an inch higher and signs of effusion suggesting exploration thick creamy pus was withdrawn by syringe from the pleural cavity ח י י 1י י ad t' $f Vomiting had now disappeared but breathing was more laboured congestion of face and extremities greater end the general condition worse