PERFORATION INTO PLEURAL CAVITY OF A PERITYPHLITIC ABSCESS: PURULENT PLEURITIC EXUDATE, MIXED WITH FÆCES.

E. Grawitz (Berl. klin. Wochenschr., 1889, No. 32) reports the case of a female, aged thirty-seven, in which the autopsy revealed fæcal impaction of the appendix vermiformis, with inflammation and ulceration of the same, followed by perforation and a perityphlitic abscess. The pus from this location mixed with fæces had burrowed extensively upward through the retroperitoneal tissues, behind the right. kidney, and formed an intra-diaphragmatic abscess, which finally broke into the right pleural cavity. Previous to perforation of the pleural side of the diaphragm, there appeared, on one side of the diaphragm, a fibrinous perihepatitis, on the other serous pleurisy, which was diagnosticated, ante-mortem, by hypodermic puncture.

ETIOLOGY OF CANCER.

F. Bracella (Bulletin delle sc. Med., 1889) examined, with every precaution and using various culture-media, six neoplasms for germs, as follows: three carcinoma of breast, one primary carcinoma of liver (?), and one carcinoma, and one sarcoma testis. Results in every case negative.

Exceptionally he got bacteria and micrococci traceable to contamination, e. g., pus-organisms in an ulcerating breast. He concludes that Scheurlen's bacillus is not specific, and that, if cancer and sarcoma are infectious diseases, the infection is of a nature hitherto unknown.

CONTAGIOUS NATURE AND MODE OF PROPAGATION OF CANCER.

Armandit (Union Med., 1889, No. 52) under this title makes the following statements: The population of Saint-Sylvestre-de-Corneille (Normandy) is about 398 souls. From 1880 to 1887 there were 74 deaths, II of which, or 14.88 per cent., were of cancer. Comparing percentage with that of deaths of carcinoma in Paris, he finds death of this disease to be three times as frequent in the former place as in the latter. Of the eleven deaths in Saint-Sylvestre, ten were in males and one female. Ages of patients ranged from sixty-one to eighty-four years In eight cases the stomach, and in one each the face, throat (sarcoma), and mesentery, were the seat of the lesion. Five cases occurred in various parts of the village and six adjacent in a bordering revier.

During twenty-two months three patients died in the village (one sarcoma, two gastric cancer). Previously, in the course of three years, there were two deaths of gastric cancer. The houses of these patients were close together. No heredity proved in any of these patients.

Two were brother and sister.

No alcoholic habit. The locus in quo

of the disease then changed from high ground to low, in the direction. of the water-course. The author believes the water to have been infected above with "cancer virus," coming from dung-hills on which were thrown vomited material and fæcal matter from the first series of patients; that the virus was active for an indefinite time; and that the thus-infected water, being consumed by the second series of patients on low ground, gave to them the disease.

A CASE OF GASTRITIS CATARRHALIS CHRONICA CYSTICA PROLIFERANS.

Langerhans (Virchow's Archiv) describes a rare case of extensive lesion of gastric mucous membrane, in which the mucosa is seen, both macroscopically and microscopically, to be much thickened and covered with a tenacious mucus. The gastric tubules are greatly lengthened, run a spiral course, and some of them evidently dilated, others blending with each other and forming large cysts. There is .mucous degeneration of the glandular epithelium, with hyperplasia and atrophy of the glandular epithelium, and hyperplasia and atrophy of the intra-glandular tissue; also widespread catarrh, affecting the entire mucosa, excepting a small portion covering the lesser curvature. The author regards the cause of the cystic degeneration to be, not the plugging of the ducts of the tubules with mucus, but partly disease of the glands themselves, through improper emptying of them of their tenacious secretion, thus promoting dilatation and spiral lengthening; and partly atrophy of intra-glandular tissues.

A SERIES OF CASES OF CANCER HAVING PECULIAR PATHOLOGICAL INTEREST.

Hansemann (Berlin, Virchow's Archiv, Bd. 17, pp. 1-51, 209-227) reviews in brief an interesting series of cases of cancer, with particular reference to their primary location and metastasis:

1. Cancer-Metastasis, through Capillary Embolism.-Three cases, in which numberless capillary emboli were observed throughout the body, including the bones.

2. Cases of Rare Tumor-Metastases -Two cases of secondary gastric cancer, one of secondary ovarian cancer, and one of metastasis in the tonsils. Primary tumors found in first, third, and fourth cases, in the mammary glands; in second case in the oesophagus.

3. Etiology of Epithelial Cancer.-Three cases of epithelial carcinoma, with previous and lasting irritation:

(a) Case of epithelial carcinoma of the heel, after mal-perforans. (6) Case of primary liver-cancer, in the site of pressure of an ancient fracture of the ribs.

(c) Case of primary cancer of liver in the site of a chronic contracting perihepatitis.

4. Histogenesis of Carcinomata-

(a) Beginning flat-cell epithelial cancer of the posterior lip of cervix uteri.

(b) Commencing cylindrical epithelial cancer of pylorus.

Both cases furnished remarkable autopsy findings, with ample proof of the origin of the cancer-cells from the epithelial cells of the mu cous membrane, namely, of the glands.

5. Two cases of perforation of the aorta by œsophageal cancer. Sudden death from hemorrhage.

OPHTHALMOLOGY.

BY RICHMOND LENNOX, M.D.

PTERYGIUM.

Alt (Am. Jour. of Ophthal., March-April, 1889,) ascribes the formation of pterygium to the development of microbes in a corneal ulcer which becomes covered with an adherent fold of conjunctiva. These microbes have a tendency to grow into the corneal tissue, and cause a gradually extending ulceration in this direction. The adherent fold of conjunctiva is "dragged on the cornea by the continued progress of microscopical death and attempted repair in the corneal tissue." He ascribes but a secondary influence to Theobald's theory of increased conjunctival congestion over the insertion of the recti muscles, and to Young's view of a protective contraction of the orbicularis, by which the eye is shielded from irritants except "over the centre of the cornea and a small strip to the nasal side."

To avoid the mechanical irritants which might start an ulcerative process that could lead on to pterygium, protective spectacles might be worn, but Alt does not favor their use. Antiseptic washes used night and morning are, however, of service. For pterygia already developed, Alt favors the following method of operation. After careful disinfection of the conjunctival sac, lids, lashes, etc., with corrosive sublimate solution (1-2500), he dissects under cocaine the pterygium from the cornea, and with scissors excises it together with an angular piece of the conjuctiva. The conjunctiva is then freed somewhat and the edges of the conjunctival wound brought together as neatly as possible with one or two sutures. He then cauterizes the "uncovered

portion of sclero-corneal tissue cornea" with pure carbolic acid. in the instillation of gradually weaker bichloride solutions (1 30005000) every few hours for several days, the stitches being removed on the fourth or fifth day. He has found the results of this method "all that could be wished for."

and the loss of substance on the This after-treatment consists simply

INFLUENCE OF LIGHT ON THE EYE AND SKIN.

Various papers have appeared from time to time on the ophthalmia produced by the electric light (effects similar to those seen in the so-called snow blindness), but the reponsibility has not been placed either upon the chemical, heat or luminous rays. Widmark, in papers published in the Transactions of the Biological Society of Stockholm and abstracted in the Ophthalmic Review (June, 1889), reports conclusive results obtained from original experiments, and ascribes the irritation to the direct action of the light, and chiefly of the chemical rays, upon the anterior portion of the eye, or upon the skin. It is not due in a reflex way to the effect of the light upon the retina.

EXCEPTIONAL FORMS OF CHOROIDITIS.

At the January meeting of the Ophthal. Soc. of the United Kingdom, Mr. Jonathan Hutchinson read a paper on this subject, which has been reported in the Ophthalmic Review for March, 1889. He offered the following clinical grouping of the different forms of choroiditis, and then spoke at more length of certain of the less common varieties, these latter remarks being here incorporated in the original list.

Ist. Choroiditis of myopia, usually central at yellow spot or around the optic disc, but occasionally in scattered patches. The chief factor in diagnosis is the presence of myopia of high degree.

2d. Choroditis senilis centralis ("Tay's" choroiditis) always central and never causing denudation of large areas. Occurs only in those past middle age, but is sometimes simulated in syphilis.

3d. Choroiditis as a family disease may occur in childhood or middle life, and in various forms. Changes are usually aggressive. In some of the cases used to illustrate this form, there were also mental and nervous disturbances, as failure of intellect or paraplegia. He compares these cases with Kaposi's disease, retinitis pigmentosa and other maladies, which go to prove that under some law of inheritance the children of certain couples may possess by structural idiosyncrasy a weakness of certain tissues and organs which renders them liable to disease at a certain age.

4th. Choroiditis in early periods of syphilis, analogous to the exanthematous eruptions of secondary syphilis, always in scattered patches and usually symmetrical, may be completely cured by treat

ment.

5. Choroiditis in late periods of syphilis, analogous to the tertiary skin eruptions, often not symmetrical, and always serpiginous and aggressive, may be benefited by treatment, but not often cured.

6th. Choroiditis of inherited syphilis, often affects only the periphery of fundus, and may occur in either of the two preceding forms.

7. Choroido-retinitis, simulating pigmentosa. This group includes cases resulting from blows, and many of those due to inherited syphilis. It is almost always aggressive and attended by changes in the disc.

FEBI

8th. Choroiditis without obvious cause, usually but not always occurring in young adepth, ME Dyk after an interval symmetrical. Changes often serpiginous in tertiary syphilis ("lupus of choroid "but emetimes mate. minate. Only distinguishable from syphilitic cases by the absence of any specific history or symptoms. He would adduce evidence of the existence of this class of cases, yet must admAylo Sofeel quite so certain that there are cases which resemble syphilis and yet are not syphilitic. Specific contamination is often effected without the patient's knowledge, and as regards inheritance it is not always possible to find its proof These exceptional cases should be carefully recorded and the facts sifted, both to decide the syphilitic question and perhaps to discover other antecedents which may be the cause of the disease.

9th. Hæmorrhagic choroiditis, very rare, seen in growing adolescents and in sexual disturbances. Analogous to the cases of recurring vitreous hæmorrhages, and sometimes associated with such hæmorrhages.

10th. Choroiditis with iritis and cyclitis, characterized by extending with definite recurrences through the whole life, and causing progressive failure of sight. Of a similar nature to the relapsing cyclitis so often associated with chillblains, and sometimes seen with inherited gout.

11. Choroiditis following blows in the eye, to be distinguished by the scars caused by lacerations. A progressive form of choroido-retinal disorganization, and always limited to one eye.

12th. Tubercular choroiditis, not proved to be aggressive. Perhaps the "lupus of choroid" referred to under the eighth group may be associated with tubercle.

In conclusion Mr. Hutchinson said that his endeavors to find guiding symptoms to distinguish specific from non-specific choroiditis