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This is followed by an hypertrophy of the epithelium of these ducts, and, in addition, by a great increase in the amount of the peri-connective tissue. New capillaries are formed in the hypertrophic connective tissue leaving to a narrowing of the lumina of the biliary channels, and also to degeneration of the surrounding liver parenchyma. Disturbances in

the normal functions of the liver, interference with the portal circulation, ascites, etc., are gradually set up, and by degrees become so aggravated as to lead to actual disease and disorganisation of function quite incompatible with life. The extent and the intensity of the pathological changes found depend upon the number of parasites present. They may be present in hundreds or in thousands. It is only in instances of the latter condition that the disease would appear to endanger life. To those who practise extensively amongst the Chinese, I repeat what I have advocated in previous Reports, that in all cases of obscure hepatic disease, the examination of the fœces for the characteristic eggs of the parasite, should never be neglected.

5. Aneurism of the Pulmonary Artery-One case was found during the year. It is one of the rarest pathological conditions of the human body. In many books on the subject of aneurism, the condition is not even mentioned. This aneurism occurred in an adult Chinese male, aged about 50. There was marked evidence of syphilis and generalised atheromatous changes in the vessels. These were most marked in the aorta, the wall of which was greatly thickened and puckered. The intima was studded with masses of calcareous atheroma, The pulmonary artery was also markedly atheromatous. aneurism on the vessel was situated just inside the pericardial sac. It was saccular and communicated with the vessel by means of a small opening. Fibrin had been abundantly deposited in the sac. The rupture took place at the point of junction of the sac with the vessel wall, bæmorrhage into the pericardial sac resulting.

The

6. Extra-Uterine Pregnancy.-Four cases were examined during the year. All were in Chinese females under 30 years of age. In 3 of the cases ampullar pregnancy had occurred. The other was an instance of isthmial pregnancy. In each case rupture of the sac took place, resulting in bæmoperitoneum.

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7. A Case of Suppurative Cholangitis, Cholecystitis and Intra-hepatic and Chole- lithiasis. This case is somewhat similar in many respects to that published by Dr. HARSTON and the Government Bacteriologist in the British Medical Journal, of November, 1905. The case was that of a Chinese adult female, aged about 35. No previous history was obtainable, the condition being discovered post-mortem. The liver was greatly enlarged. Its weight was about 4 lbs. The surface was rough and showed the presuce of cirrhosis. The capsule was greatly thickened. On section, suppurative cholangitis was found present. The biliary channels were enormously dilated and their walls in some places were at least to inch in thickness. On gentle pressure, thick, tenacious pus, deeply bile stained, welled out from the bile ducts. In many places saccular dilatations of the biliary canals were found, and many of these contained one or more cholesterin bile pigment calculi. Many of these stones were as big as a walnut. Over a hundred calculi were found in the biliary canals throughout the liver substance. The pus contained B. coli commune. Cholecystitis was also present and over a hundred gall stones of varying size and shape were extracted. These were mostly of the nature of bile pigment and calcium salts.

The presence of numerous calculi scattered throughout the substance of the liver is an exceedingly rare pathological condition.

Tumours.

During the past year, a number of new growths have been examined. Most of these have been sent to me for diagnosis by medical men in Hongkong, and along the coast of China. The following is a list of the tumours which have been examined:

I.-Malignant New Growths.

1. Primary Cancer of the Liver, (3 cases.)

2. Diffuse Colloid Cancer of Stomach.

3. Scirrhus Cancer of the Pylorus, (2 cases.)

4. Cancer of the Lungs, (2 cases.)

5. Cancer of Prepuce, (3 cases.)

6. Glandular Cancer of Coecum.

7. Epithelioma of Penis, (2 cases.)

8. Cancerous Metastasis in Cervical Glands.

9. Spindle-celled Sarcoma of arm.

10. Chorion-epithelioma of Uterus.