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Much more research would appear to be required before one could sefely include, and recommend in the above list, protective inoculation and the employment of the various plague sera advocated.
6. A Case of Chorion Epithelioma.-(Jointly with Dr. BELL, Superintendent of the Government Civil Hospital, Hongkong) published in the Lancet.-October, 1905.
A piece of the growth was removed and examined microscopically. The following is my Report: Microscopically the piece of tissue submitted for examination was not unlike placental tissue. It was soft and spongy and full of blood. Histologically the tissue was found to be made up of areas of free hæmorrhage, blood sinuses, and a peculiar parenchyma. No definite stroma was found. The greater portion of the mass was composed of extravasated blood, and 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 endothelial tunics, and were packed full of the formed elements of the blood. The parenchyma pos- sessed a characterisic histogenesis and led me to the diagnosis. At first sight certain parts resembled a small round celled and rapidly growing sarcoma, but this, on more careful examination proved to be largely composed of 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 epithelioid cells some resembling giant cells were scattered throughout the parenchyma, arranged sometimes singly, sometime in small groups. They contained nuclei, varying in number, and endow- ment with chromatin. The diffuse plasmodial masses were few in number, but contained many nuclei.
The most typical forms arranged themselves into a network containing the polyhedral cells and leucocytic accumulations already referred to In certain sections of the tissue, evidence of a hyaline metamorphosis was noted. From the histological appearance, I am of opinion that the tissue is a rapidly growing chorion-epithelioma. The various contained tissue elements, especially the parencliyma, 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 sub-division of the syncytial masses into immense epithelioid cells with large nuclei. Such a metamorphosis is not infrequent in certain forms of chorion-epithelioma.
7. A Case of Suppurative Cholangitis.- (Jointly with Dr. HARSTON, Hongkong,) published in the British Medical Journal.-November, 1905.
The clinical course of this case was carefully described by Dr. HARSTON. After death, a post-mortem examination was held and the liver forwarded to me for a special report. This was done as thoroughly as possible owing to the rarity of the disease, and the interest attached to the pathological changes found in the liver, and the features which distinguish these appearances from multiple abscesses of the liver. The following is my Report:-The post-mortem examination of this case was conducted by Dr. HARSTON. I bave no know- ledge of the condition of the other organs and tissues of the body. On receipt of the liver, I found that the gall bladder had been opened and washed, the organ sectioned, and not com- pletely intact. It was, therefore, impossible to obtain accurately the weight of the organ.
The
The liver was generally enlarged. It was increased in specific gravity. Its consistence was tough and leathery. It was jaundiced. It did not appear to be much congested. The general contour of the organ was maintained. On section of the liver, a
On section of the liver, a remarkable appear- ance was found. Studded throughout the entire right lobe, were rounded areas of a yellow colour. These varied in size, from a millet seed to a pea. Many had a deeply pigmented centre. Surrounding these areas, there was a narrow zone of a deep brownish colour. remaining cut surface of the organ was that of a jaundiced liver with commencing inter- lobular cirrhosis. An examination of the yellow areas, more in detail, showed that they were not equally distributed throughout the right lobe. They were most abundant in the neighbourhood of the main portal, hepatic, and biliary channels. In the intervening hepatic parenchyma, they were few and scattered. These areas were further examined as to their relation to the parenchyma of the liver, to their consistency, and their microscopic appearance and bacterial composition.
They bore no direct relation to the actual hepatic parenchyma. They could be picked out en masse, leaving a hollow or space with roughened but hard and fibrous walls. The- consistence of that masses varied. Some were pultaceous; others were hard and gritty. To touch, the harder masses were like small peas, and could be thrown about without much