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as a result of this copious masses of blood pigment were found in certain areas of the tissue, particularly in the areas of free hemorrhage but also in the parenchyma. The blood sinuses were abundant. They varied in size, possessed delicate endo- thelial tunics, and were packed full of the formed elements of the blood. The parenchyma possessed a characteristic histogenesis and led me at once to the diag- nosis. At first sight certain parts resembled a small round-celled and rapidly growing sarcoma, but this, on more careful examination, proved to be leucocytic accumulations in which were found phagocytes, polyhedral cells, large epithelioid cells, and diffuse plasmodium-like structures. The polyhedral cells arranged themselves into alveoli. The large epythelioid cells-some resembling giant cells —were scattered throughout the parenchyma arranged sometimes singly, some- times in small groups. They contained nuclei varying in number and endowment with chromatin. The diffuse plasmodial masses were few in number but contained many nuclei. The most typical forms arranged themselves into a network con- taining the polyhedral cells and leucocytic accumulations already referred to. certain sections evidence of hyaline metamorphosis was noted. From the histolo- gical appearance I am of opinion that the tissue is a rapidly growing chorion epithelioma. The various contained tissue elements, especially the parenchyma, and their arrangement are characteristic. The plasmodial masses are of the type of a well-defined syncytium. These were few in number but this is probably due to the subdivision of the syncytial masses into imminense epithelioid cells with large nuclei. Such a metamorphosis is not infrequent in certain forms of chorion epithelioma.
In
Remarks.-The case seems worth recording as this form of malignant disease is not very common and certainly not common immediately following a normal labour. The diagnosis of malignant disease was easy enough for us but it is not easy to say when it became so, as presumably the fever and metrorrhagia were possibly put down to endometritis following the labour, though, on the other hand, the case may have been overlooked owing to the fall of the celebrated fortress and to the incoming medical men having their hands full of war casualties.
Case of Liver Abscess,—Death.
A Chinese male, aged 40, was admitted on August 26th. Patient looked very wasted and ill and stated that he had been ill for over a month with fever on and off but no very definite account of his illness could be obtained. All the internal
organs scenied healthy save thar the liver dulness was slightly increased down- wards. There were a number of purpuric spots on his body of various sizes. Tongue very furred and dry; urine normal. A blood count taken by Lieut. RANKIN, R.A.M.C., was normal. The patient continued in much the same condition for a few days but getting weaker all the time and on the 4th day his temperature rose from subnormal to 104°. The purpuric spots increased in number and size and slight diarrhoea supervened, the stools being acholic but no amabæ or tubercle bacilli were found microscopically. The tongue continued to become more furred and drier. On August 31st (6th day) he had a rigor with a rise of temperature to 104°. The liver was found to be increased in size downwards but not tender. A distinct swelling extended on the right side from the middle line to the mid- axillary line. This swelling had a peculiar emphysematous feel, heard as loud friction sounds by the stethoscope. The swelling was aspirated over the dull and resonant areas giving exit to air and a little blood. Blood count gave 14,000 white cells. Temperature was normal on the 1st September all day but rose on the 2nd to 102° in the evening. Jaundice now came on and the liver dulness was aspirated but without any pus being found. Jaundice rapidly increased and the patient died on the 5th September.
Post-mortem.-All the organs, except the liver, were healthy. This organ was increased in size, extending two fingers' breadth below the ribs. In the right lobe was a large well defined mass about the size of a large orange extending to within inch of surface, the mass being composed of thick cheesy material. Below and behind this mass and continuous with it was a small abscess cavity about the size of a coffee cup. The lining membrane of the abscess and the cut surface of the pass teemed with living amoeba. The large intestine was quite normal and showed no signs of old or recent dysentery. No signs were found to account for the emphysematous condition.
Remarks. This was a most puzzling case. The absence of amabæ in the stool or of any history of dysentery negatived a liver abscess, more especially as the liver dulness was not much increased and there was no tenderness present at