of superficial sloughing on the outer sides of both hips, and on the inner sides of both knees and ankles. They vary from 4 to 6.5 cm. in diameter. The skullcap, brain case, sinuses, and vessels are normal. There is a chronic meningitis present, especially well marked along the median sulcus. The brain is normal. The pericardium is normal. The heart is dilated; weight, 370 grams. The walls of the ventricular cavity are thinned and the cavity is dilated. The pleuræ and lungs are normal. The omentum is normal. The spleen is normal. The kidneys present on section the condition of a chronic diffuse nephritis. They weigh 165 grams each. The genito-urinary tract is otherwise normal. The digestive tract is normal. The spinal cord presents no gross lesions.

S. W.

H. S. M. J. M. G.

INFLAMMATION BRAIN MEMBRANES DIFFUSE, ACUTE SEPTIC.

C. J.; aged 32 years; nativity, Norway; was admitted to the United States Marine Hospital, port of San Francisco, Cal., November 27, 1897, and died December 2, 1897, at 2.45 p. m.

History.-On entrance the patient, who was slightly delirious, gave an indefinite history of headache, weakness, and fever for the preceding week. Physical examination: No evidence of any lesions of the viscera were discovered. His face was flushed, tongue coated, and his breath foul. The abdomen was distended with gas, and there was some rigidity on pressure. The pulse was full and ran 80 per minute. The temperature taken in the axilla was 39 c. There was no facial or local paralysis. During his first night in the hospital he became violently delirious, at times requiring restraint, and at other times he lay in a stupor. A second physical examination made on the third day after his entrance revealed a slight facial paralysis of the right side, some inequality of the pupils, and a thickness of speech. There was also some rigidity of the muscles of the neck and a rise in the surface temperature at the base of the skull. In spite of treatment his temperature remained high, and he steadily grew worse until his death.

Necropsy (twenty-one hours after death).—The body is that of a well developed, well nourished adult white male. Rigor mortis is well marked. The subcutaneous fat is abundant. The skullcap and brain case are normal, presenting no evidence of injury. The sinuses and vessels are normal. The pia mater over the convexity of the brain is injected, and along the larger blood vessels is thickened. The pia at the base of the brain and over the medulla and pons is thickened, injected, and covered with thick creamy pus. The tentorium cerebelli is also bathed in pus. The basal ganglia of the brain are normal with the exception of the pituitary body, which is the seat of an acute suppurative inflammation. The ventricles of the brain are distended with clear fluid. The brain is otherwise normal. The parietal and visceral layers of the pleura on both sides of the chest are everywhere adherent. The lungs present the condition of hypostatic congestion; the right lung weighs 720 grams and the left 750 grams. The pericardium and heart are normal; the heart weighs 350 grams. The omental fat is abnormally developed. The spleen is congested, but is otherwise normal; it weighs 150 grams. The kidneys are normal; the right weighs 170 and the left 190 grams. The genito-urinary tract is normal. The liver is normal; it weighs 1,970 grams. The digestive tract is normal. The spinal cord was not examined.

S. W.
J. M. G.

10918- -9

DEGENERATION CYST OF CEREBELLUM.

D. S.; aged 45 years; nativity, Massachusetts; admitted to United States Marine-Hospital, Cleveland, Ohio, October 6, 1897; died January 14, 1898. History.-Mother dead from heart disease; one brother and one sister dead from tubercle of the lungs. Patient had syphilis eight years ago and pneumonia five years ago. Present trouble dates from March. 1897, when he began to suffer from severe pains in the head, occipital region. The pains are most severe in the morning and during exertion. He has alternating constipation and diarrhea, his gait is cerebellar (walks with the feet wide apart) and balances himself with difficulty. The cervical, epitrochlear, inguinal, and femoral lymph glands are enlarged; there is a small umbilical hernia, and circulatory and respiratory systems show nothing abnormal. Owing to the history, the case was considered one of cerebellar tumor, probably syphilitic in its nature and the usual specific treatment was adopted with anodynes for the relief of pain. Slight improvement was noted, but he complained much of his head and at times he became so noisy that he was restrained with difficulty. On November 15 he was much better, and the improvement continued until December 14, when he relapsed. His gait is now markedly cerebellar, stands with his feet wide apart, and if he attempts to walk with his eyes closed he pitches forward. The attacks of severe pain are frequently preceded by a kind of epileptic fit, and if he is about the ward he has to be carried to his bed. He has had a number of epileptiform convulsions recently in which he becomes very rigid, and these are followed by profuse perspiration and total unconsciousness of what has occurred during the seizure.

January 10, 1898.—Condition worse for the past few days, great pain in the head, and attacks more frequent. He attempted to throw himself out of the window last night, but remembers nothing of it this morning. Operative measures were considered in this case but abandoned, as it was considered impracticable to reach the seat of the trouble.

January 14, 1898.—During the morning ward visit at 9 a. m. he seemed quite rational, free from pain, and stated that he felt much better. At 10 a. m. while the medical officers were engaged in the surgical dressing room a sudden call came from his ward and on hastening there he was found dead in bed. He died without a struggle.

Necropsy (three hours after death).-Body fairly nourished; rigor mortis absent; post-mortem lividity on dependent portions of body. Head: Scalp and aponeurosis normal. Calvarium of moderate thickness; parietal eminence on left side very prominent. Slight adhesions over dura on right superior region, superior longitudinal sinus. Pia mater shows venous engorgement over cerebral hemispheres. Brain of average size and lateral ventricles contain considerable serum, choroid plexus on right side enlarged. Cerebral hemispheres and nuclei on cross and lateral section show no deposits of any kind and no softening. Fourth ventricle distended and marked by irregularities in the floor. Calamus scriptorius enlarged and bands stand out in bold relief. Other points of the floor marked by nodules and there is slight softening. The superior surface of the cerebellum was occupied by a cystic tumor which had produced by pressure absorption of the greater part of the superior vermiform process and upper surfaces of both lateral lobes. This tumor pressed directly on the pons and medulla, and was as large as a goose egg. The contents were gelatinous. Spinal cord not examined. Chest: Pleural adhesions on both sides; no effusions; leucomatous patches on visceral layer of pericardium; normal amount of pericardial fluid present. Heart in systole, valves normal, except slight thickening on margins of tricuspid. Slight atheroma in wall of ascending aorta. Lungs crepitant, carbon deposits present, and a puckered cicatrix in each apex. A

cretaceous particle the size of a small pea was found in the outer margin of the upper lobe of the right lung. Liver, large; pancreas, normal; spleen enlarged and somewhat softened. Small cyst on outer surface of right kidney, and both have considerable fat in the pelves. Stomach and intestine normal. Bladder distended with urine; walls thin. Microscopic examination of sections of the different tissues shows only slight catarrhal nephritis.

CEREBRAL HEMORRHAGE.

D. A. C.

P. R.; aged 42 years; nativity, Louisiana; admitted to United States Marine Hospital, Louisville, Ky., July 19, 1897, case being transferred from Chattanooga, Tenn.

History.-Six weeks prior to admission to hospital patient suffered a stroke of paralysis affecting left side. The center of speech was also affected to such an extent as to produce ataxic aphasia later in his sickness. Amnesic aphasia partially developed. The case developed no special points of interest, the cerebral hemorrhage being followed by softening, and as this progressed the physical and mental condition became worse; still the man retained considerable intelligence and a reasonable amount of physical ability, up to time of death, notwithstanding the large area of cerebral softening present as shown at necropsy.

Necropsy (fourteen hours after death).-Body of greatly emaciated colored male about 45 years old. Rigor mortis slight, neck quite movable, mouth wide open, eyelids partially closed, front teeth missing. No discharge from nose or mouth. Thorax flat, abdomen retracted. No cicatrices. Scalp divided by incision across from one ear to the other. There are no extravasations of blood or other signs of injury to head present. Skull cap very thick and difficult to remove, bones of skull about 8 mm. thick. The dura mater is everywhere thick and opaque. The vessels of the pia mater, choroid plexus, and the large vessels of the walls of the ventricles were calcified and atheromatous, and although empty they retained their shape, not collapsing at all. The corpus striatum and optic thalamus pale and soft. The white substance of the hemispheres is pale and moist; the ventricles empty. Considerable area of softened, broken-down tissue was found in both the pons and medulla oblongata. Thorax: Left lung adherent, pleural cavity contained about 400 c. c. fluid. Right lung free and very little fluid in cavity. Both lungs were oedematous with some small areas of hypostatic pneumonia in posterior inferior parts. Heart very considerably hypertrophied, about 30 c. c. blood in right auricle, somewhat smaller amount in left. Small ante-mortem clot extending into right ventricle. Aorta narrow, its inner coat hardened and atheromatous. Aortic and mitral valves incompetent: other valves competent. The spleen firm and somewhat wrinkled, at inferior border a cicatrix such as is at times left by a large hemorrhagic infarct was found. Liver of chocolate brown color, tissue on section of bronze color, substance firm. Both kidneys were hard and granular; the left contained an abscess about the size of a hazelnut. The omentum and intestines were normal in appearance, except post-mortem discoloration. Urinary bladder contained about 50 c. c. urine. Weight of organs: Heart, 540 grams; brain, 1,450 grams; liver, 1,170 grams; left lung, 440 grams; right lung, 770 grams; left kidney, 100 grams; right kidney, 110 grams; spleen, 75 grams. The radial and other arteries examined were not atheromatous except as noted. The amount of softening and breaking down of brain tissue about the centers of life were out of all proportion to the clinical phenomena, and in fact would seem to have been incompatible with continued existence.

W. P. McI.

EPILEPSY MAJOR.

A. I.; aged 24 years; nativity, Norway; admitted to the United States Marine Hospital, Stapleton, N. Y., December 27, 1897; died December 29, 1897. History.-A strong, well-developed white man, with light brown hair and mustache, gray eyes, and yellowish skin. Height, 165 cm.; weight. 73 kilos. Patient was brought to the hospital in the ambulance, and was irrational, able to walk with an unsteady gait, and to comprehend a command sharply given, but no information could be elicited from him. Fellow-seamen stated that he had had a similar attack of fits" twelve days before, lasting two days, after which he was perfectly rational. He lost consciousness at the onset. He was suddenly taken with a "fit" the night before admission, frothed at the mouth, was unconscious, and fell, and continued to have these attacks at intervals of twenty minutes to two hours, and has not been rational since. A few minutes after admission the patient's eyes had a wild, fixed look, the pupils contracted, the eyes moved as in lateral nystagmus, the left corner of the mouth twitched, and a condition of grand mal supervened. The patient vomited frequently and passed urine and feces involuntarily. The small amount of urine obtained showed a small relative quantity of albumen, but no casts of any character. Morphia and nitro-glycerin hypodermatically and chloral per rectum were given. Nutrient enemata were used, and efforts made to give food and medicine by the mouth or nose, but the convulsions continued at varying but frequent intervals until the patient's death, December 29, 1897. For some hours before death liquid râles could be heard over the lungs.

Necropsy (twenty hours after death).—Body that of a large, well-developed white man, with blue eyes, light-brown hair, and mustache. Height, 165 cm. Weight, 73 kilos. Rigidity marked. Lividity moderate. Pupils contracted. No marks of violence or traumatism found, either recent or old. Calvarium removed, the bones being uniformly thin and compact. Sinuses contained some very dark blood. Brain weighed 1,325 grams and seemed normal, save a softened area about the temporo-parietal lobe of cerebrum (probably post-mortem). Puncta well marked. Vessels of cortex large and injected; no adhesions; ventricles well filled with fluid. Pons varolii and cerebellum normal, as was the medulla. Thorax opened and nothing abnormal noticed in the anterior mediastinum. The pericardium contained about 15 c. c. of straw-colored fluid; the heart weighed 340 grams, and both valves and walls were intact. Lungs: From both, upon section, exuded a sanious frothy fluid; the tissue was red in color and felt somewhat gelatinous. Sections of each lung and the lungs as a whole did not sink in water. Pleural surfaces normal. Abdomen contained some little loose fluid. The stomach was nearly empty and nothing abnormal was detected. The intestines were inflated with gas. The liver weighed 1,500 grams and the gall bladder contained 10 or 15 c. c. of brown fluid. The right kidney weighed 340, the left one 150 grams, and both were congested. The left kidney was about 15 cm. long and curiously shaped. The spleen weighed 180 grams. The bladder was nearly empty. A careful necropsy revealed no pathological condition which would account for the death and symptoms preceding it.

H. S. C.

G. W. S.

TRAUMATIC ABSCESS OF LIVER-RUPTURE INTO PERICARDIUM.

P. B. (colored); aged 26 years; nativity, Virginia; admitted to United States Marine Hospital, Louisville, Ky., March 14, 1898; died June 30, 1898.

History.-Patient states that he has been sick for six weeks. Complains of some pain in bowels and diarrhea, stools being slightly tinged with blood. On March 8, 1898, one week before admission to the hospital, while handling a

sack of potatoes weighing about 200 pounds it fell a distance of four feet, striking him on the chest and over the stomach. He complains of some pain in chest, especially aggravated by pressure on ensiform cartilage of sternum, although there is no evidence of fracture. The stools passed by patient since admission do

not contain blood. pulse 100 and weak.

There was very decided shock; temperature subnormal;

It is worthy of note that during subsequent illness and for whole time the man lived, his pulse was never less than 90 per minute and ranged most of the time from 120 to 130. This tachycardia persisted notwithstanding the use of heart sedatives and stimulants and in spite of the fact that for a considerable part of the time the patient's temperature was nearly normal, his appetite good, and no heart murmur could be detected. The condition was correctly attributed to strong pericardial adhesions. The apex beat was 3 inches out of normal line, being displaced upward and backward toward axilla. The liver dullness was extreme, indicating severe congestion of this organ. There was some dullness over left kidney; urine contained albumen but no casts. About two months after admission (June 12) the patient, who had never been entirely free from fever for any length of time, began to have high fever at night, also slight rigors, indicating pus formation; liver abscess suspected, but the other symptoms led to diagnosis of suppurative pericarditis. Shortly after this a marked dullness, with elimination of intercostal spaces, was found to exist on the right side of chest. Aspirations followed by resection of two ribs, sixth and seventh, and the evacuation of large quantities-5,000 c. c.-of pus was the next step. This pus contained shreds of liver tissue and was grayish brown in color. Numerous bacteria, of which the staphylococcus pyogenes aureus was one, were found.

Necropsy (fourteen hours after death)-Body of colored male, much emaciated. Post-mortem lividity slight. Rigor mortis present. No cicatrices. Froth on lips and nostrils. Wound in anterior chest wall, right side, near axillary line, about the size of a hen's egg. This wound connected with left pleural cavity. The skullcap is thin and moderately arched. Dura mater strongly adherent. The pia mater is greatly congested, the vessels full and tumid, exudate of lymph on apex of brain. Lateral ventricles contained slight quantity of fluid. No injury to brain. Weight of brain 1,260 grams. Thorax: Upon removal of sternum the left lung comes prominently into view, the right lung being compressed to about one-fourth its normal size. On the left side the adhesions are very firm between the heart, pericardium, diaphragm, and liver; the pericardium also is adherent to sternum and is cut through in removing that bone. On the right side the pleural cavity is lined with thick grayish-white pyogenic membrane and converted into a pus cavity. A fistulous track as large as a man's finger is found to pass from anterior part of right pleural cavity along the upper and anterior surface of diaphragm into pericardium, and thence through diaphragm into an abscess cavity in left lobe of liver. The pericardium was strongly adherent to heart in an attempt to cut off and limit pus cavity. A distinct abscess cavity the size of a goose egg is in pericardium. The liver abscess is about the size of a large navel orange. The adhesions are so strong between heart, diaphragm, and liver that it is found impossible to remove one without the other. The valves of the heart are found to be pale and flabby; the mitral and pulmonary contain recent vegetations. The heart muscle is somewhat atrophied and is so strongly bound down by adhesions that it is surprising that it could pulsate at all. The color of liver is grayish brown. The gall bladder is empty. The liver and heart together weighed 1,440 grams. The left lung apparently healthy, weight 310 grams. Right lung contracted and congested, weight 360 grams. Both kidneys were pale and mottled, like mottled castile soap. The organs were both contracted and hard; line of demarcation between cortical and medullary substance was very ill defined. The capsule was torn in peeling, being strongly adherent to kidney. Weights: Left, 100 grams; right 90 grams. There is nothing remarkable about the spleen