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the case could be determined. When the adherent partswere separated from the liver the right lobe was seen topresent a very remarkable appearance. The liver to theright of a vertical section through the notch for thegall-bladder was extensively diseased, while the re-

mainder was apparently healthy. The gall-bladder,although it had formed adhesions to the liver, was

itself unaffected by disease. It contained a few smallgall-stones, but its mucous membrane and that of itsduct were quite healthy. The portal fissure and the vesselsthere were also normal. The diseased part of the liver wasshrunken to about two-thirds of the normal size. Its cap-.sule was thickened and its edge rounded off. The globularmass already referred to was situated in the lower part,immediately to the right of the gall-bladder. It was aboutthe size of a Jaffa orange. The capsule of the liver was- quite continuous over it. Most of the surface of the affectedpart of the liver unoccupied by the tumour was studdedwith yellow prominences, varying in size between a shilling-and a threepenny piece. On making sections through thelarger and smaller tumours, it was found that the formercontained in its interior a soft pultaceous mass of a

purple colour, consisting of broken-down caseous materialmingled with altered blood. The cavity left after theremoval of this matter was one which was separated fromthe surface in its lower half only by a layer of tough con.nective tissue. Posteriorlythis wall was hard and calcareous.The cavity wall in the upper half was ragged and reticulated,being formed by the liver substance itself. The smallermasses, which were quite as numerous in the interior as onthe surface, were found to consist of soft yellow caseousmaterial surrounded by connective tissue walls. Thecontents of these masses readily escaped from the cutsurface, giving the appearance of cavities. Microscopic’examination showed the disease in the liver to betubercular. Quite typical tubercles, with giant cells andsurrounding small-celled tissue, were abundantly seen inthe circumferences of the masses whose centres had under-,gone the softening degenerative process. Great care wastaken in looking for actinomycosis, but frequent and variedexamination failed to find any trace of the ray fungus.This form of tubercular disease of the liver was extremelyrare. A few cases had been shown at the Society in whichmasses, probably tubercular, had been found; but none inwhich the disease was so extensive as in this case. ByGerman writers a rare form of tubercular disease of the bile-ducts was described in which the entire organ becomeshoneycombed with innumerable cavities filled with bile-stained softened matter. There seemed no evidence that in*this particular case the disease had extended by means ofthe bile-ducts.-Dr. THOROWGOOD referred to a similar case-exhibited last year, which was the only instance of suchaffection he had met with in the liver. It showed multiplesmall abscesses.-Dr. VOELCKER had seen two cases in’children. In both there were cysts containing mucousmaterial stained green, and both were the subjects ofgeneral tuberculosis. He had been unable to observe anytransition stages between these cysts and the commonereolid tubercular masses.

Mr. H. BETHAM ROBINSON described a Duct Carcinomaof Breast which was removed, in June, 1889, from a marriedwoman aged forty-six. She had had no trouble with thebreasts until a little over three years before, when shenoticed a hard lump in the left breast, just above and tothe outer side of the nipple. This did not inconvenienceher until three months before admission, when it rapidlygrew and became painful. There were several nodules of ahard elastic growth in the upper and outer part. The skinwas free and not altered ; there was no eczema of nipple orreola. The growth was attached to the nipple, but thelatter was not retracted. There was no enlargement of theaxillary glands. There was slight discharge from the nipple.’The right breast was healthy. On section, the tumourappeared like a cystic thyroid ; it was composed of nodules,which seemed gelatinous, supported by a fibrous framework,the former bulging on section. The growth was lobulatedand well defined, and pigmented from blood staining.There were cysts in it, containing a thick, greenish-brownfluid, and in some places blood-clot. Microscopically therewas seen at the margin of the growth a cystic condition ofthe breast. The smaller ducts were dilated, but the veinsdid not appear to be much altered. The dilated ductswere lined with a columnar epithelium, the cells of whichwere proliferating, and in their interior the cells appeared

spheroidal, and were undergoing mucoid degeneration. Theducts and acini were surrounded by a dense fibrous tissue.The larger spaces showed large papillary processes coveredwith several layers of epithelium passing into the interiorand branching in all directions, so that the cyst space wasalmost completely filled up. Besides general dilatation ofthe bloodvessels, there was extravasation of blood into theconnective tissue and into the cysts. The connective tissueshowed no marked round-celled infiltration. From exa-mining the sections there was evidence as to the startingpoint of the disease-namely, in a cystic condition whicharose in connexion with involution in the gland. Micro-scopical appearances did not suggest any marked mali-gnancy, and the history of most of the cases went to provethat such was the case. It was quite the exception to getenlargement of the axillary glands; local recurrence wasnot so rare, but secondary growths appeared to be rare. Itwas now one year since the operation, and the patient wasquite well and free from any recurrence.--Mr. WILLIAMSsaid that the ordinary tubular cancer described by Billrothwas diffused through the breast.-Mr. ROBINSON repliedthat the cancer referred to was acinous carcinoma, whereasthe duct cancer was described by Billroth as cysto-adenoma.The following card specimens were shown :--Dr. LEDIARD : Coloured Photograph of Epithelioma of

Scalp. .

Mr. ROBINSON : (1) Dermoid Cyst ; (2) Sebaceous Tumourof Scalp ; (3) Epithelial Tumour of Soft Palate.

Dr. HEBB : Gangrene of Uterus.Mr. J. H. TARGETT : Congenital Cyst of Testis.Mr. SHATTOCK: (1) Polypi of Lymphatic Tissue from

Child’s Rectum ; (2) Cystic Squamous-celled Carcinoma ofScalp arising in Sebaceous Cyst.

OPHTHALMOLOGICAL SOCIETY.

Corneal Tttmour (? Fibroma) in a Man aged seventy-tzco.--Optic Nerve Atrophy in Smokers.-Art1jicíal Maturatt’onof Immature Senile Cataract by Trittlmtion.AN ordinary meeting of this Society was held on the 1st

inst., Dr. J. Hughlings Jackson, President, in the chair.Dr. BENSON (Dublin) read notes of a Tumour which was

attached to the upper portion of the left Cornea of a BlindGlaucomatous Eye. It measured 5 millimetres in its longestdiameter and was 2 millimetres in thickness. It was adherentto the surface of the cornea above the centre by 2 or 3 milli-metres of its thin edge. The eye was said to have beenblind for many years, but a few days before the patientcame under observation he had knocked it against some-thing, and since the blow had suffered intense pain. Therewas no evidence of recent injury to the eye. The growthwas dissected off the cornea, and was found to consist offibrous tissue with bloodvessels and cells, the whole beingcovered with epithelium, except at the margin, where itwas separated from the cornea. It had a dull, lustreless,grey colour, and was lenticular in shape. The speaker men-tioned the great rarity of corneal tumours of any kind, andexpressed his inability to account for the existence of thegrowth in his case. A model, microscopic sections, andphotographs were shown.Mr. LAWFORD read a paper on Optic Nerve Atrophy in

Smokers, based upon nine cases in which the symptoms inthe early stage so closely resembled those of toxic ambly-opia that the diagnosis made at first was that of tobaccoblindness. All the patients were men and smokers, usuallyconsuming a large quantity of tobacco. Treatment byabstinence from tobacco and the administration of nervinetonics led to no improvement; indeed, in most of the casessight became progressively worse. The general featurespresented by these cases were gradual failure of vision withcentral negative scotomata for form and colour. The oph-thalmoscopic signs were slight pallor of the temporal halfof the discs, without visible alteration in the retinal vessels.The chief distinction between these cases and those ofordinary tobacco amblyopia was found in the peripherallimitation of fields of vision, which was almost always dis-covered if sought for ; whereas in tobacco cases the boun-daries of the fields were in most, if not in all, instances normal.None of the patients under the author’s observation had sym-

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ptoms of spinal disease, but one man, aged fifty-one, becameinsane some months after his sight failed. Mr. Lawford wasof opinion that tobacco was certainly a factor in the causa-tion of the optic nerve disease.-Mr. ADAMS FROST saidthat he was familiar with cases similar to those just de-scribed. He looked upon them as cases of tobacco neuritis,in which secondary atrophy supervened. He had long heldthe opinion that if vision deteriorated beyond a certainpoint in tobacco amblyopia, recovery did not take place,and in such instances he was accustomed to give an un-favourable prognosis.--Mr. EDGAR BROWNE (Liverpool)considered the cases cited were undoubtedly instances oftobacco poisoning. They occurred in persons of unstablenervous constitution, though this was not displayed other-wise than in the behaviour of the optic nerves; an

instance of three brothers quoted as being affected in a similarway bore out this impression. Many cases showing nocontraction of the field recovered ; on the other hand,those in which the disease was severe and of long standing,and in which the fields were limited did not do so. He hadrecently under his own care two brothers-smokers-whosuffered from amblyopia; in one the disease progressed andthe field of vision became contracted, in the other improve-ment occurred. He was not aware of any instances ofsimilar optic nerve disease in non-smokers.-Dr. HILLGRIFFITH said he was familar with cases similar to thosedescribed by Mr. Lawford. He did not regard them ascases of tobacco neuritis, for he held that disease of opticnerves from tobacco was always followed by recovery ondiscontinuing the drug. He thought some such cases

might be explained by the coincidence of progressiveatrophy of optic nerves and tobacco amblyopia, as in onecase under his care in a patient with locomotor ataxy.-Mr. DOYNE (Oxford) said he had found that cases oftobacco amblyopia which were likely to improve alwaysexperienced great temporary benefit in vision from theinhalation of nitrite of amyl. He thought the use ofstrong tobacco interfered decidedly with the digestion andassimilation of food by its action on the alimentary tract.Many cases of tobacco amblyopia suffered from loss ofappetite.-Dr. BRONNER (Bradford) alluded to the similarityin the effeec of alcohol and tobacco on the optic nerves, andof the gaps which still existed in our knowledge concerningtoxic amblyopia. He was accustomed to forbid theuse of tobacco in all cases of optic nerve atrophy.-Mr. LAWFORD replied briefly to the remarks made upon hispaper.Mr. M’HARDY read a paper on the Artificial Maturation

of Immature Senile Cataract by Trituration. He said thatfull five years’ experience with the artificial ripening ofimmature senile cataracts, practised with increasing fre-quency and confidence, had convinced him of the truthof the following proposition : Complete ripening ofimmature senile cataracts may be safely and almostcertainly secured in from eight days to eight weeks by pre-liminary iridectomy, with trituration of the lens throughthe cornea and pupil, done with judgment, experience,and care ; the ultimate results (surgical and visual) of ex-traction operations in such cases are quite equal to theresults of similar operations for senile cataracts which havebeen allowed to fully mature spontaneously ; and, further,the removal of such artificially matured cataracts is entirelyfree from those risks, drawbacks, and often impaired ulti-mate results which follow from the removal of immaturesenile cataracts. He thought that a large debt was due toForster for the initiation of this procedure. By memorandafrom his first twenty-five and last 100 cases the authorfurnished details regarding his past experience with andpresent practice of the procedure, and emphasised therebyhow its safety and success grew with the operator’s ex-perience.The following cases and specimens were exhibited :—

Mr. TATHAM THOMPSON : (1) A Case of Cystic Detach-ment of the Retina; (2) Rupture of Choroid ; (3) DepressedFracture of Orbital Roof.Mr. BRAILEY : Gouty Cyclitis.Mr. HARTRIDGE: (1) Cyst in Anterior Chamber; (2)

Changes in the Iris in Glaucoma.Mr. W. J. COLLIES : Monocular Kerato-iritis.Mr. LAXG : Pemphigus of the Conjunctiva.Mr. TREACHER COLLIXS : Sections of Cornea from a case

of Xercphthalmia.Mr. HARTLEY: Granuloma of Iris.

EPIDEMIOLOGICAL SOCIETY.

The recent Epidemic of Irrfl2cenzcc.A MEETING of this Society was held on April 23rd,

Sir Thomas Crawford, K.C.B., M.D., President, in thechair.

Dr. JACQUES BERTILLON, Chief of the MunicipalStatistical Department of Paris, introduced by Dr. Mouat,gave in French an address on the recent Epidemic ofInfluenza in France. The following is a short résumé ofa most important and interesting communication. He

began by stating that any estimate of the mortality causedby the epidemic based on the number of deaths certifiedby the medical attendants and registered as due to influenza,would be utterly incorrect and misleading. For while these

figures would represent only the small number of instancesin which the disease proved fatal, either from asthenia inuncomplicated cases or from complications and sequelsesupervening in the course of the disease itself, they wouldexclude the vastly greater number in which these secondarylesions followed at a later period, medical advice not havingbeen sought in the primary attack, as well as the evenlarger number in which influenza was the means of causingor of accelerating a fatal termination of other and mostdiverse diseases of a more or less chronic character whichwould not have occurred otherwise, at any rate for months.or perhaps for years. Thus, while the deaths in Paris.certified as due to influenza were but 213 in all, the generalmortality of the city during the months of December andJanuary exceeded the average by no less than 5500, anexcess which could not be accounted for by any climaticconditions, an unusual prevalence of other epidemics, or, infact, by anything except the influence, direct or indirect,of this disease. The total mortality from all causes duringthe period in question was just double the average ofprevious years. There was no greater prevalence of in-fectious diseases, as small-pox, enteric fever, scarlatina"diphtheria, measles, and whooping-cougb, but a largerproportion than usual of those persons suffering from thesediseases succumbed to pulmonary complications. Theenormous increase of the mortality from bronchitis, pneu-monia, and pleurisy was clearly owing to the frequent.occurrence of these conditions as sequelse of previous attacksof influenza; but still more remarkable was the increasedmortality from chronic diseases, as phthisis, organic lesionsof the heart, diabetes, alcoholism, chronic diseases of thebrain, kidneys, &c., in which the supervention of influenza,even of a mild or obscure type, hastened a fatal termina-tion, and not infrequently suddenly. It was not dangerous.to children unless already suffering from pulmonaryaffections, or diseases, as measles and wbooping-cough, liable.to pulmonary complications, and with these exceptionsit was rarely fatal to persons under twenty years of age, butfor every period beyond this the general mortality was.doubled. It was only half as fatal to women as to men,probably from their being less exposed to cold and wet,during and after an attack. No class of society, however9was exempt, the excessive mortality being equally markedin the wealthier and the poorer quarters of the city ; but.the most surprising fact, which Dr. Bertillon did notattempt to explain, was that the number of suicides was.increased by about 40 per cent. ! Besides the figures on theblackboard referring to Paris, Dr. Bertillon exhibited someingenious charts of several countries of Europe, showing, bymeans of lines and circles, the populations of the principaltowns, the total excess of mortality in each during themonths of December and January, and the weeks in whichthe deaths were less or more than 50 and 100 per cent. above.the average.

Dr. GEORGE RICE read a report of an Outbreak of Influ-enza in the Union Schools on Banstead Downs, in whichfrom 30 to 50 per cent. of the children in the several blocks.or departments, as well as from one- to three-fourths of theadults, were attacked, the latter (with the exception of theinitial and imported case) subsequently to the larger pro-portion of the children. The history of this outbreak andits progress through the establishments conclusively provedits contagious nature.