270
Aneurism.
Number of Cases Examined during the year, 1904 :-
No. Sex.
Age.
Vessel.
Variety.
1
M.
56
Aorta asc. arch.
Saccular.
N
M.
50
Do.
Do.
Transrense
Arcli.
3
M.
40
Do.
Do.
Junction of
asc. and
transvarch.
4 M.
40
Dr. asc. arch.
Do.
Remarks.
Marked arterio-sclerotic condition of vessels throughout the body, Rupture into pericardium, Mitral Stenosis.
Well marked signs of Syphilis.
Rupture into pericardium.
Do.
Do.
As a predisposing factor, in these cases, there may be mentioned "violent muscular exertion.' The cases were amongst Chinese of the coolie class who in- variably have large hypertrophied hearts. As I mentioned in my Report for 1902, arterio-selensis is very prevalent amongst the Chinese. Its exact etiology is not clear. Probably Syphilis has something to do with it.
In connection with this subject, it may be mentioned that course cirrhosis of the liver and interstitial Nephritis are frequently met with in the Public Mor- tuary.
Liver Abscess.
This has been the cause of death in 3 cases. Five cases of the condition were found during the past year. In 2, however, the immediate cause of death was Acute Peritonitis following rupture of the abscess into the peritoneal cavity.
The details of the cases are as follows:-
Case No. 1.-An unknown Chinese male, aged about 36. The liver was much enlarged and soft It was of a reddish brown colour, but over the right lobe the surface was marked by the presence of large greyish or yellowish spots.
The organ on incision presented the following appearance --The right lobe was practically converted into one large solitary abscess containing chocolate col- oured and viscid pus. The amount of pus collected from this cavity was about 5 litres. The walls of this abscess were formed of hepatic tissue, but the latter, owing to the occurrence of changes, could scarcely be recogised as liver. The living walls of the abscess were rugged, consisting of necrotic hepatic tissue.
In the immediate surrounding, several small abcesses were found, each containing about 20 C., of pus. These had no apparent connection with the large abscess cavity. Each of these small abscesses was separated from the large cavity by a zone of liver tissue. The pus in the small abscesses was of a similar nature to that found in the large cavity.
The pus was examined bacteriologically but no micro-organisms were found. All the other organs in the body were healthy, excepting the presence of interstitial Nephritis. No gall stones were found. There was no trace of Dysentery.
Case No. 2.-An unknown Chinese male, aged about 35. The right lobe of the liver contained a large solitary abscess, which almost wholly occupied the lobe. It had burst intra-peritoneally. About 4 litres of pus were obtained from the abscess cavity itself. The fluid was yellowish-green in colour and contained numerons solid and semi-solid pieces of necrosed liver tissue. The walls of the abcess had a honeycombed appearance. The remaining liver parenchyma was in condition of intercellular cirrhosis. The liver was firmly adherent to the lower diaphragmatic surface and over the side of the abscess the diaphragm was thickened to the extent of about ₫ of an inch.