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stitial pneumonia. Carrington6 recorded an example of largeblood cysts of the suprarenals, with a more recent haemor-rhage in the left side; on each side the cyst was as large as anorange. The man, who was fifty-four years of age, hadmarked bronzing of the skin. Records of suprarenalapoplexy are few in number. Canton7 found the rightcapsule full of blood at the necropsy on a patient agedseventy-eight, who had had a severe fall and sustainedfracture of the ribs. For the account of this case we areindebted to Mr. J. J. G. Pritchard, assistant medical officer.

C. S-, a demented old woman aged seventy-six, wastransferred from another asylum to this one in April, 1889.She was feeble and complaining, and was described as beingsubject to chronic bronchitis, with irregular heart. Duringher residence here she frequently complained of aches andpains; but nothing definite was discovered except constipa-tion, and she remained up all day. On Feb. 1st, 1890, shewas suddenly seized with severe pain in the abdomen. Shevomited several times and appeared to be in a condition ofcollapse. Her extremities were cold, and her face wore ananxious expression. Her bowels were confined; there wasno hernia discovered. She did not pass any urine for twenty-four hours, and then only a moderate quantity, which wasclear, and nothing abnormal was discovered in it. Thesickness continued, and she rejected everything. She com-plained of great pain in her abdomen, now in one hypo-chondriac region, and now in the other, and sometimes inthe back, in the lumbar region. She was ordered a poulticeto her stomach, and was given opiates. The sickness stoppedon the third day, but the bowels were not open, and she con-tinued to look very ill; a glycerine injection had no effect.Her temperature hitherto had been subnormal On Feb. 5thshe developed pneumonia, and died on the morningof the 6th.Post-mortem examination showed a large fatty heart,

with dilated right auricle and ventricle. The valves werenatural. Both lungs were congested and cedematous, andconsolidation was present in the left lower lobe. On turningover the intestines there was an extravasation of blood overthe right kidney, showing through the peritoneum. Oncloser examination there was seen to be a large mass ofextravasated blood enveloping the kidney, the mass beingabout the size of two kidneys; this was easily removed,and the source of the haemorrhage was seen to be connectedwith the suprarenal capsule, which was dark-coloured andswollen to about two-thirds the size of the kidney. Thecapsule had burst on the outer side, and blood had beenextravasated around the kidney-which organ, however,could be easily separated from it-and was found fairlyhealthy, with the exception of one or two small cysts. The

I

lupmorrhage had taken place into the centre of the capsule,as there were traces of the substance of the gland spreadout over the blood-clot. It was then seen that the samecondition of things existed on the left side, the suprarenalcapsule being swollen to the same extent. The aorta wasvery atheromatous, and contained large bony plates in itswalls. The suprarenal artery and vein were not found.Remarks by Mr. PRITCHARD.-One of the specimens was

sent to an eminent pathologist at one of the large univer-sities, who said it was hemorrhage into the substance of thecapsule, the cortical portions being spread over it. He saidthis condition was stated to be not uncommon, though hehad never seen a similar case. It was generally caused bygreat venous congestion, and sometimes from no apparentcause. I myself cannot find any similar cases recorded inback numbers of THE LANCET, though Dr. Greenhow refersto the condition in his lectures on Addison’s disease, 1865,and Dr. Addison himself records a case which was on oneside only. Reference to apoplexy of the suprarenal cap-sules is made in Dr. Neale’s Medical Digest in two places,the Medical Tinzes and Gazette, and the British and ForeignMedical and Chirurgical Transactions.

LIVERPOOL NORTHERN HOSPITAL.A CASE OF HÆMORRHAGE INTO THE PONS VAROLII ;

NECROPSY.

(Under the care of Dr. BARR.)THIS case is a good example of haemorrhage into the

pons, proving quickly fatal, with coma, contracted pupils, arapid pulse, and high temperature. In apoplexy of the ponsor the me(lulla, it is not uncommon to find this rise of tem-

6 Trans. Path. Soc., vol. xxxvi., p. 454.7 Medical Times and Gazette, vol. ii. 1856, p. 429.

perature. " It may rise above the normal within an hourof the onset, and during the next hour may attain a heightof 104° or 106°, and the rise may go on until death."1 Oftwelve cases of haemorrhage into the pons primarily, in fivethe blood had escaped into the fourth ventricle, and in twoit had reached the base of the brain. For the followingnotes we are indebted to Dr. Quintin M. Wallace, housephysician.D. J-, a tailor, aged fifty-six years, was admitted to

hospital, under the care of Dr. Barr, on Feb. 1st, 1890, in astate of coma. It was learned from an acquaintance thatfor some weeks previously he had complained of giddinesswhenever he was the least excited, that his memory hadbecome very treacherous, and that he sometimes had con-fusion of ideas. On Feb. 1st, while sitting on a stool at hiswork, he suddenly fell to the ground. He did not at oncelose his senses, but unconsciousness soon set in, and he be-came gradually comatose. When seen, half an hour afterthe attack, he was quite unconscious, his pupils wereminutely contracted and insensible to light. There wasslight response to irritation of the left cornea, but no

reflex on the right side. The temperature was 974°.The respiration was stertorous, and the patient nearlyasphyxiated. On drawing forward the tongue thebreathing improved and the face regained its natural hue.The face was expressionless and the mouth deviated alittle towards the right side, but that may have beendue to the fact that he was lying on his right side. Theleft corneal reflex gradually disappeared. The breathingagain became laboured and stertorous (25 per minute),and the face congested. The pulse was 150 per minute,full, and of high tension. Three hours and a half aftrer theattack the temperature was 106°, and three-quarters of anhour later 109°. Towards the end there was slight twitchingof the right upper eyelid. The patient died four hours anda half after the seizure. The diagnosis of a pontine hasmor-rhage was made.

jVge’o..—The membranes of the brain were venouslcongested. The convolutions were somewhat atrophied,with excess of fluid in the sulci and thickening of thearachnoid mater over the vertex. The arteries at the baseof the brain were thickened and atheromatous. The ponswas much enlarged, and gave a sense of fluctuation on

palpation. On slicing it, the interior was found to be tornup and thinned out, enclosing a large clot, principally onthe right side. The blood had burst its way into theiter a tertio ad quartum ventriculum, and had filled thefourth ventricle, the iter, and partially the lateral ven-tricles, which were distended with a large quantity ofsanguinolent blood serum.

Medical Societies.CLINICAL SOCIETY OF LONDON.

Hereditary Enlargement of Spleen.-Do2eble Ovariotomy andNephrectomy followed 6-r/ Abscess of Litng.-Laparotoiny0’ Saeppurating Yeriatifornz Airopendix.AN ordinary meeting of this Society was held on March

28th, the President, Mr. Christopher Heath, in the chair.Mr. MORGAN exhibited the case of a Welsh miner aged

twenty-eight who was affected with Molluscum Fibrosum.It was noticed at birth, when it was not larger than awalnut, and was probably of naevoid character; since thenit had gradually increased in size, especially during the lastfew years. It now formed a huge pendulous fold, whichhung down from the left supra-mammary region, extendingfrom the sternum to behind the posterior axillary border.The nipple was drawn down with it, and was much enlarged,and there were numerous enlarged sebaceous glands to befelt in the skin. A bunch of axillary glands could be feltin the upper part of the fold; they had by traction beendrawn considerably out of their normal position. It causedmuch inconvenience from the accumulation and decompo-sition of sweat beneath it. Mr. Morgan proposed to removeit with the knife.

Dr. CLAUDE WiLSoy read a paper describing some casesof Hereditary Enlargement of the Spleen, accompanied by

1 Fagge : System of Medicine, vol. i., p. 481.