is by no means established. The individual hæmorrhages generally become absorbed in the course of a few weeks, during which period, however, new ones are generally formed. The association of optic neuritis with pernicious anæmia is rare, but, as Gowers remarks, a certain amount of œdema of the optic nerve and retina is frequently seen. The following case is more correctly classed with the latter than with the former group:

R. C., æt. 54 years, a carter, was first seen in Rochdale, in March, 1901, by Dr. W. C. Burns. The symptoms at that date were weakness and dyspnoea, and dated only one month back. The man was markedly pale, and had oedema of the left leg without evidences of thrombosis. The radial arteries gave evidence of atheromatous degeneration. There was a diastolic and also a systolic cardiac murmur, the latter best heard at the base.

In June, 1901, the condition was rather worse in spite of all that could be done. The anæmia was more marked, and the skin was now tinged yellow. There were hæmorrhages into the buccal mucous membrane, and the patient was becoming emaciated. Examination of the blood at this stage showed diminution of red cells, the presence of pear-shaped and nucleated red cells, but no change as regards white cells. The pulse-rate rose from 80 to 100 per minute, and the evening temperature fell from an average of 99.5° to 97° one hour before death. The urine, of normal specific gravity, contained neither sugar nor albumen.

On 20th July the patient became comatose, and died on 3rd August.

Ophthalmoscopic examination was made by Dr. Burns twenty-five days before death. The following are his notes:"The optic discs are somewhat swollen and red, the edges being indistinct. There is some cedema of the retina, but the details of the fundus are clearly seen. The veins are congested, but the arteries normal. There are several spots of white exudation and many small rounded hæmorrhages in each retina. Most of the hæmorrhages are below the discs, but not all. None of the hæmorrhages are flame-shaped, and there are no spots of either exudation or hæmorrhage in the macula region of either eye."

Post-mortem.-The heart was found to be enlarged and fatty. The lungs were normal, but there were several small hæmorrhages under the pleura. The liver was enlarged, and sections appropriately stained showed the existence in it of free iron.

The left eye was removed, placed in 5 per cent formalin solution, and sent for examination.

Examination of the eye.-The only noteworthy changes found in the eye on macroscopic examination were the presence of hæmorrhages into the retina and blurring of the outline of the optic nerve entrance, which latter was probably due to cedema.

Microscopic examination: The optic nerve.-There is a

SECTION OF RETINA FROM CASE OF PERNICIOUS ANEMIA (x 200).

To show-(1) Elevation of the internal limiting membrane by hæmorrhage, (2) hæmorrhage into the nerve fibre and ganglion cell layers, and (3) exudation between the retina and the chorioid. The blood-vessels in the chorioid are seen to be empty.

slight degree of round-celled exudation of the nerve behind the eye, gradually becoming less marked in passing back wards. There has evidently been a hæmorrhage into the sheath of the central retinal artery at a point 5 or 6 mm. behind the lamina cribrosa, but most of the red cells have been absorbed, only fibrinous clot with a few leucocytes in it now remaining. There is a noteworthy degree of lateral bulging of the optic

nerve in the optic pore, but beyond this there is little evidence of oedema of the optic nerve.

Retina. In the retina the changes found are of three types, and almost all parts of the structure are involved. The changes are (1) Exudations under the internal limiting membrane, probably hæmorrhagic in origin; (2) small capillary hæmorrhages into the layers of the retina; (3) exudations outside the external limiting membrane.

1. The exudations under the internal limiting membrane give rise to the formation of bulla-like elevations of this structure. They vary greatly in size, some being 02 and others 2 mm. in height, whilst in diameter they vary from 25 to 2 mm., the larger ones being quite visible to the unaided eye. The majority of the bullæ are intact, but several have been torn open (possibly during histological preparation). They contain fibrin clot with remains of red-blood cells in various stages of degeneration, the more perfect cells being found usually near the margin. The ends of fibres of Müller are in several instances seen projecting free in the cavities. appearances seem to justify the conclusion that these elevations of the internal limiting membrane are the result of hæmorrhages.

The

2. The hæmorrhages into the various layers of the retina are usually of small size, are probably of capillary origin, and are not so numerous as might be expected. They are found in practically all the layers of the retina, in the fibrous and ganglion cell layers commonly, in the internal reticular and nuclear layers more frequently, and in the external reticular and nuclear layers less often. Owing to their small size they cause but little disturbance of the retinal structure.

3. Exudation outside the external limiting membrane exists to a greater or less extent over most of the fundus, and gives rise to elevation of the retina of wavy appearance. The layer of exudate varies much in thickness, being at most 0:30 mm. The composition of the layer varies in different parts, but the main constituent is fibrinous coagulum in which granular débris is entangled. Large numbers of pigment granules are found in it, and are evidently derived from the hexagon pigment layer. Small round protoplasmic globules, which are probably the result of degeneration of the elements of the bacillary layer, form an important part of the exudate also. The rods and cones are in a moderately advanced state of degeneration, and as vacuolisation usually begins at the base, the terminal positions are in many instances cut off and set free in a form still quite recognisable.

The protoplasmic globules above mentioned are frequently seen adherent to the ends of the broken cones, and as such formations have been seen before in other degeneration of the retina, it is very probable that their origin is as stated.

The size of the globules is very small, about half the diameter of a red-blood cell, and they stain but poorly with an acid, and not at all with a basic stain. A few red-blood cells are found in the exudate, but they are by no means plentiful. It is thus probable that the exudate is, to a large extent, the result of degeneration, and not of hæmorrhage.

Blood-vessels. The blood-vessels of the retina exhibit only slight signs of atheromatous degeneration, and in general it may be said that, apart from the appearances indicated, the retina as a whole is but little altered.

Chorioid. No change of any importance is found in the chorioid. The extensive congestion remarked upon by some writers is absent, the blood-vessels being empty as a rule. There is no sign of interstitial hæmorrhage.

Iris and ciliary body.-It is of interest to note that although the vessels in the retina show little evidence of the existence of atheromatous degeneration, the vessels in the iris and ciliary body are markedly affected. In the ciliary body especially, many of the vessels have calcareous inasses developed in their walls. There is no evidence of hæmorrhage into the tissues at any point.

Conclusion. As the number of instances in which the tissues of the eye have been examined in cases of pernicious anæmia is limited, it is of interest to note that the remarks made regarding the state of the blood-vessels of the retina is in accordance with the finding of most preceding writers on the subject.

So far as can be found, the elevation of the internal limiting membrane by hæmorrhagic effusion has not been specially remarked upon before, although in this case it was very well marked. Exudation of blood in large quantity between the retina and chorioid has been observed in a few cases, but the formation of such a layer as was present in this case between these structures has not been noted before. The rapid fixation of the tissues by formalin may account for the preservation of these pathological appearances, as the exudate may have been fluid, or semifluid, before death. It is suggested that the exudation of blood into the most anterior layer of the retina, and its subsequent absorption, may account for the appearances of white spots in the retina noted on ophthalmoscopic examination.

In concluding, I have to acknowledge my indebtedness to Dr. W. Cochrane Burns, of Bury, Lancashire, for his kindness in sending me the specimen, and supplying me with a résumé of the clinical history.

V. SPECIMENS.

BY DR. HUGH M'LAREN.

Dr. M'Laren showed

1. A specimen of cancer of the oesophagus, with secondary growth in the stomach.

2. A specimen of obstruction of the intestine by Meckel's diverticulum.

3. A specimen of obstruction of the intestine by fibrous bands.

GLASGOW EASTERN MEDICAL SOCIETY.

SESSION 1903-1904.

MEETING I-7TH OCTOBER, 1903.

The President, DR. CHARLES R. M'LEAN, in the Chair.

PRESIDENTIAL ADDRESS

ARE WE DECADENT ?"

BY DR. CHARLES R. M'LEAN.

Dr. M'Lean began his address by remarking that all the masterful nations in the world's history had paid much attention to the physical condition of their people. This might be cultivated by the ordinary labours of everyday life, or by exercises specially designed to develop manly vigour, and these again might be of such a nature as to promote mental culture in addition. Among the nations, Britain might, without vanity, claim to be the greatest, and as she had been the means of conferring untold benefits on mankind, it was of the utmost importance that she should not suffer from racial deterioration. The question had been raised whether all was right with our nation, and this question was in itself a hopeful sign. There was no doubt as to the marked falling off in the physical quality of candidates for military service, and there was too good reason to fear that in this respect they were