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blood-vessels were normal in appearance. On microscopicexamination the most striking changes noticed in all thesections was the enormous amount of blood present, which.could be seen in large quantity beneath the capsule of thepancreas, in the interstitial tissue between the lobules,between the acini themselves around the ducts, andin the fat cells and intercellular spaces of the peri-

glandular connective tissues. A good many patches of* fat necrosis were seen in the interlobular and peri-glandular

tissues. The glandular acini immediately adjacent to theseareas were in various stages of necrosis and beyond theseagain the cells of the acini showed cloudy swelling andtheir nuclei were faintly stained and indistinct. Apartfrom these areas there was very little evidence of any- parencbymatous inflammation, the nuclei and protoplasmof the cells staining well with the various reagents. The

pancreatic ducts were not obstructed; the cells presented anormal appearance. In the fibrous tissue of, and around the,ducts a good deal of blood was seen. The fat necrosis pre-sented the usual features characteristic of that condition.Sections stained with methylene blue showed a few rod-shaped bacilli in the blood throughout the organ. There- were no bacilli in the pancreatic ducts. Sections of thenerves and ganglia from the pancreatic duodenal plexuswere examined, but nothing abnormal was found. Culti-vations were taken from the centre of the body ofthe pancreas with strict precautions to prevent the

possibility of any accidental contamination and a pure- culture of the bacillus coli communis resulted. The patho-logical process in this case appeared to be a primary acuteinterstitial inflammation associated with the presence of thebacillus coli communis and characterised by extensive

haemorrhage as stated above and by secondary necrosis andinflammation of the parenchyma in the immediate vicinityof areas of fat necrosis. The distribution of the bacilli sug-gested the blood-vessels as the probable channel of infection.Two other cases were mentioned in which bacteriologicalexaminations were made by Mr. Pakes, demonstrator of

’bacteriology at Guy’s Hospital, the bacillus coli communisbeing obtained in pure culture from the pancreas in both’instances. A similar fully reported case by Dr. Moore wasreferred to in which a pure culture of the bacillus coli com-munis was also obtained and in which the channel of infec-tion was thought to be the lymphatic spaces. (Microscopicalspecimens were shown demonstrating the above-mentionedobservations.)

Dr. NEWTON PiTT and Mr. JACOBSON communicated a

paper on Five Cases of Acute Pancreatitis. Case 1. AcuteHæmorrhagic Pancreatitis.-A man, aged forty-two years,temperate, had three attacks of severe abdominal painwith vomiting, each lasting about an hour, in August andSeptember, 1898. On Nov. 12th he had another attack ofintense pain with vomiting and constipation. The pulsewas 120 and the abdomen was rigid. On the 14th he hadsevere diarrhoea, his temperature was 100° F., and there wasa swelling in the upper part of the abdomen. He was seen

by Dr. John Young of Stamford Hill who took him to

Guy’s Hospital. The man was extremely ill and difficult toexamine. A retro-peritoneal tumour with impaired resonancewas found above the umbilicus, the motions were normal incolour, but the man was so ill that it was thought better todefer any operative interference. On examination the urinewas found to contain albumose; there was marked leuco-cytosis (22,500 per cubic mm.), and the tumour lay behindthe stomach pushing forward the duodenum and greatlydistending the former. The evidence pointed to a pan-creatic cyst or an abscess in connexion with either

pancreas, gall-bladder, or gastric ulcer, or a rapidlygrowing sarcoma. As the tumour was increasing in sizeMr. Jacobson decided to open the abdomen and foundextensive fat necrosis and a tumour with the lesseromentum, intestines, and stomach matted to it. The

oozing from every part when disturbed was excessive andthe firm feel of the mass prevented any radical treat-ment. The abdomen was closed and the patient diednext day. Post mortem there was found an abscess

cavity some 4 in. across, in front of which was the stomachand lesser omentum and behind lay the sloughy pan-creas. Case 2. A Retro-gastric Pancreatic Abscess. -A

middle-aged woman was seen by Dr. Pitt some years agofor intense abdominal pain and vomiting. She was foundto have a large abscess behind the peritoneum pointing in theright loin where it was opened. Most of the pancreas had

1 Medical Chronicle’ August, 1898.

disappeared ; the abscess occupied its site. It was now clearthis was a case of acute pancreatitis. Case 3. Acute Heamor-rhagic Pancreatitis.-A woman, aged seventy years, was seenby Mr. Fuller of Streatham on Oct. 16th, 1898, for intenseepigastric pain with sickness and collapse occurring after anunusually good breakfast. The pain was not relieved by thevomiting. There was a constant desire to defecate, which wasnot relieved by an enema which brought away a constipatedmotion containing particles of fat. There was slighttympanites which steadily increased until death, forty-eighthours later. The patient was said to have had a similarattack eighteen months previously. At the necropsy acute

hæmorrhagic pancreatitis was found, with fat necrosis of theomentum. Case 4. Acute Suppurative Pancreatitis.-Thepatient was a man, aged fifty-three years. Hs was an alcoholic.On Nov. 12th, 1863, at 2 A.M. he took a draught of cold water;at 3 A.M. he was seized with intenjse epigastric pain withvomiting. The symptoms subsided on the 17th. On the 24tha pulsating tumour imperfectly resonant on percussion wasnoticed above the umbilicus ; this became less distinct in theknee-elbow position and the pain ceased. The vomitingreturned at the end of January and he died on February 8thfrom exhaustion. At the necropsy it was found that theomentum formed a black puckered mass ; the stomach wasgreatly distended ; the lesser sac of the omentum containeda well-defined abscess above and behind the stomach. The

greater part of the pancreas was healthy, but some distendedducts communicated with the abscess. Case 5. AcuteNecrotic Pancreatitis.-A man, aged sixty years, had hadsevere abdominal pain and vomiting for three months,the attacks recurring every three or four days. For four

years he had had attacks of gastric pain from time totime. On admission under the care of Dr. Habershonthere was a tender pulsating tumour in the upper part ofthe abdomen. The patient vomited frequently and diedfrom exhaustion. At the necropsy some early peritonitiswas found; a minute opening was also found in the meso-colon leading to an abscess cavity behind the stomachand filled with a brown fluid. At the posterior partof the abscess 2½ in. of necrotic pancreas was found.There were numerous nodules of yellow concrete matterin the wall of the cyst (probably fat necrosis).-The PRESIDENT related a case in which the symptoms mighthave been due to a milder form of the same disease. A man,fifty years of age, was seized with umbilical pain and after-wards a tumour formed extending from the ensiformcartilage to the umbilicus. Vomiting and diarrhoea werepresent and the patient wasted rapidly. Ascites was presentbut after the fluid was removed by aspiration it did notreturn. The tumour could be felt much more distinctly afteraspiration and three weeks later the abdomen was explored.A cystic tumour was found behind the stomach which

Mr. Langton aspirated and five pints of blood-stained fluidwere drawn off. The cyst evidently involved the pancreas.The patient made a fair recovery but died suddenlyfrom intestinal hæmorrbage two years later. Post mortemthe pancreas was found to be nearly entirely destroyed andthen it was also found that the cicatrix of the contractedcyst had involved the portal vein, thus accounting for thehæmorrhage.—Mr. BOWLBY said that several causes of thiscondition were recognised-injury, infective inflammation,and he thought probably embolism. The sudden onset andthe necrotic state of the pancreas would be explained by sucha causation. He asked if the condition of the pancreaticartery in this case had been investigated. He mentioned acase in which a woman, aged forty-one years, was suddenlyseized with symptoms pointing to intestinal obstruction. He

opened the abdomen 48 hours later but found no obstruction.The omentum, however, was dotted over with areas of fatnecrosis. The pain was relieved by laparotomy but on thethird day she suddenly became delirious and died comatose.Although there was no necropsy he had little doubt that shesuffered from acute pancreatitis.

OBSTETRICAL SOCIETY OF LONDON.

The Development of the Graafuan Follicle.-Uterine Fibroids.--Congenital Tumour at the Internal Os causing Hydro-mstra.-Incarcerated Ovarian Dermoid Tumours durinyPregnancy,-Placenta Pravia and Fibroids.-The Actionsand Use of Forceps.A MEETING of this society was held on Dec. 7th, Dr.

C. J. CuLLiNGwoRTH, 1’resident, being in the chair.

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Dr. HUNTER gave a demonstration of specimens illustratingthe Development of the Graafian Follicle and exhibited aseries of ovaries preserved in formalin in which the colourswere well maintained.

Dr. LEWERS showed (1) a large Solitary SubperitonealFibroid Tumour of the Uterus (9½ lb.) successfully removedby laparotomy with intra-peritoneal treatment of ;the stump;(2) a Uterus with Multiple Fibroids (81b.) successfullyremoved by supravaginal hysterectomy with intraperitonealtreatment of the stump. He said that as regards the history,symptoms, and signs cases of large solitary subperitonealfibroids differed remarkably from the common cases where theuterus was the seat of multiple fibroids. In the first case thepatient, married ten years, had had five children and twomiscarriages, the last ten months prior to operation. Men-struation had never lasted more than two days and for tenmonths prior to operation there had been complete amenor-rhoea. The uterus was in no way deformed except at theplace where the tumour was attached and the cavity was ofnormal length. In the second case the patient, married fiveyears, had not been pregnant. Menstruation was profuseand there had been constant metrorrhagia for three monthsbefore operation. The uterus was deformed and the soundpassed ’7 in. or 8 in.

Dr. HERBERT SPENCER read a short ’communication onthree cases of Congenital Tumour at the Internal Os Utericausing Hydrometra in Newly-born Children. Two of the

specimens had been briefly described in the catalogue of thegynæcological specimens in University College Museumpublished in 1891 and were, as far as he was aware, thefirst recorded instances of the occurrence of this tumour.The tumour was a small sessile, pea-like body situated at thesummit of the anterior median column of the cervical arborvitas and gave rise to dilatation of the cavity of the

body by obstructing the outflow of mucus. Dr. Spencerthought the tumour might later in life produce pain atmenstrual or at other times and might perhaps explain theoccurrence of certain polypi at the internal os uteri whichwere furnished with glands lined with several layers of

epithelium-a condition which he had met with in thissituation in newly-born children. He directed attention to arecent publication by Dr. Friedlanderl on a similar con-dition in young girls.

Dr. HERBERT SPENCER showed a small MultilocularDermoid Tumour of the Right Ovary which being incarce-rated in the pelvis he had removed by laparotomy at thefourth month of pregnancy. Pain which had been presentbefore the operation at once ceased on removal of thetumour and the patient had five months later been success-fully delivered of a living child at full term.

Dr. HERBERT SPENCER also showed for another prac-titioner a small Ovarian Dermoid Tumour which had beenincarcerated in the pelvis at the time of labour. Forcepsand afterwards version had been employed with the resultthat the tumour was ruptured and the patient died from septicperitonitis three days after delivery.-Dr. JOHN PHILLIPSsaid that he had met with a case in which the cyst hadobstructed labour and necessitated its incision and suturing Ito the vaginal walls before delivery could be effected. A

year later the patient was seized with a rigor and abdominalpain and at the operation a large suppurating dermoidcyst was found with a coil of hair adherent to the oldscar in the vagina. The patient made a good recovery.Dr. Phillips had recently had an impacted dermoid compli-cating early pregnancy which had been successfully re-

moved.-Dr. GILES mentioned a case of an ovarian dermoidremoved during pregnancy. He first saw the patient whenshe was three months pregnant and decided to wait and seewhether with the progress of pregnancy the cyst would riseout of the pelvis ; as this did not happen the cyst wasremoved by abdominal section and the patient was expectingher confinement shortly.

Dr. BoxALL showed a Uterus with Interstitial Fibroidsfrom a case of placenta prasvia centralis. The patient diedforty minutes after delivery from acute and post-partumhaemorrhage. In her previous confinement three years ago alarge fibroid was noticed in the lower pole of the uterus onthe left side and an abscess formed and burst into the vagina,the sinus in which still remained. The fibroid had shrunkconsiderably since the previous labour.A paper by Dr. PONDER on the Actions and Use of Forceps

gave rise to some discussion.

1 Archiv für Gynäkologie, 1898.

OPHTHALMOLOGICAL SOCIETY.

Renal Retinitis.-Sympathetic Op7tthalmia beginning fourteendays after Excision of the Injured Eye.-An UnusualForm of Marginal Keratitis.-Pitlsating Exophthalmoswith Visible Tumour. Symmetrical Choroiditis in thc-Early Stage.-Atrophy of the Choroid with Sclerosis of theChoroidal Vessels.-Mymo-sarcoma of the Orbit.-Con-genital Absence of the Clzoroid.-Tzzmour of the Iris.-Injury to the Cornea.A CLINICAL meeting of this society was held on Dec. 8th,

Mr. H. R. SWANzy being in the chair.Mr. NETTLESHIP showed a microscopical drawing of Rena

Retinitis. Pigmentation of the retina was known to occurin cases of renal retinitis where the disease was either severeor of long standing; it was generally seen near the periphery,but if the case lasted long enough it was also found near thedisc. The case from which the drawing was taken had beenobserved during life and the pigmentation had been noted.After death the eyes had been examined. A number of ova)or round cells, with amorphous debris the remains of an in-flammatory exudation, were found in the retina between thebacillary layer and the hexagonal pigment layer in differentplaces; these foci contained pigmented cells derived fromthe pigment epithelium, probably by proliferation.Mr. HOLMES SPICER showed a case of Sympathetic Oph-

thalmia beginning Fourteen Days after Excision of theInjured Eye in a boy, aged ten years, who was struck in theleft eye on July 4th by a piece of sardine tin ; there was ajagged wound of the cornea not involving the ciliary region ; 7the anterior chamber was filled with blood and the deeperparts could not be seen. A week later, July 12th, a piece ofentangled iris was removed from the wound by iridectomy the lens was found to be wounded. The eye remainedpainful and much congested and iritis set in and it was.excised on July 25th, three weeks after the injury. The

patient remained in hospital till August 6th. Two days laterthere was slight ciliary injection of the right eye. Fourteendays after excision he was taken into hospital again. Tensionwas - 2, and the vision equalled ;r6jj; the pupil was welldilated; there was no deposit on the back of the cornea; Tthere was much floating matter in the anterior part of thevitreous ; there was no optic neuritis. He was treated withatropine and mercurial inunction. The tension had nowbecome normal and the vision was g.

Mr. JOHN GRIFFITH and Dr. C. S. BLAIR showed a caseexhibiting an Unusual Form of Marginal Keratitis. The con-dition had existed for several years and was associated witheczema of the face ; the keratitis was symmetrical, attackingthe inner and outer margins of each cornea close to thelimbus. The lesions were slightly raised, vascular, and inthree out of four limited by a curved line of opacity. Itbore some resemblance to phlyctenular keratitis, but its per-sistence, absence of ulceration, and want of symptomsexcluded this disease. It resembled spring catarrh, but thepalpebral conjunctivæ were quite healthy.

Mr. W. J. CANT showed a man, aged thirty-six years,having Pulsating Exophthalmos with Visible Tumour who.was kicked on the outer part of the left eyebrow eight years.ago. Eighteen months ago he had pain over the right eye-brow with vomiting; the sight became dim and he haddiplopia. Gradually a swelling appeared at the upper innerangle of the right orbit and he was conscious of a loudwhistling sound in the head; as the swelling increased thesight returned and the diplopia ceased. The vision of theright eye equalled and Jaeger 1, and there was proptosis to,the extent of 8 mm. There were large tortuous veins.on the ocular conjunctiva and a pulsating moveable tumourdiminished by pressure on the carotid ; a loud bruit could beheard over the region of the tumour. There was no diplopia;the pupil acted normally ; the retinal veins were enlarged,tortuous, and pulsating. He had been treated with rest, lowdiet, iodide of potassium, and digital compression withconsiderable benefit.Mr. HARTRIDGE showed a man, aged twenty-three years,

with Symmetrical Choroiditis in the Early Stage who first.had dimness of sight five months ago; the sight had been,progressively failing since. The family history and the

personal health were good and there was no history ofsyphilis. The vision of the right eye equalled ’.’6and of theleft 16’]. Both optic discs were swollen and blurred ; therewas a large choroidal haemorrhage on the outer side of each