calcium oxylate crystals. A portion of a thin cyst wall was spread out upon a glass slide, and seen to be covered, more or less, with epithelium undergoing degeneration. After hardening a portion of the main cyst wall, sections of the same were made and studied in the usual manner. The microscope reveals at several points near the main cyst wall somewhat regularly formed acini lined by epithelium, showing varying degrees of degeneration and be

Fig. 6.-High amplification showing (a) glandlike acini lined by epithelial cells in (b) connective tissue stroma.

ginning cyst formation. While this adenomatous tissue is not typical of pancreatic tissue, it might pass for such. My first impression in the examination of this tumor was that it was an echinococcus cyst. I searched in vain for the hooklets. The further microscopic study, as detailed above and illustrated by the accompanying drawings, convinces me that the tumor is an adenocystoma of the pancreas."

Several interesting questions grow out of this case. What must

be the explanation of the seeming disappearance of the tumor? This question is considered worthy of note because the statement of the patient that the tumor "seemed to go away" when she suffered pain influenced me somewhat in making my diagnosis. I found, however, that by placing the patient upon her back with the head low I could cause all visible signs of the tumor to dis

Fig. 7.-Portion of a very thin cyst wall spread out flat and showing (a) large polygonal epithelial cells and (b) connective tissue wall from which the epithelium is denuded.

appear, and found it difficult, even with deep palpation, to trace its outline. I have recently had a similar experience in a case of movable liver. In this latter case, when the patient sat up, a tumor in the epigastric region could be grasped between the hands. Dulness on percussion extended from the xyloid cartilage to the umbilicus. When the patient lay upon her back with her head low, the mass disappeared and the areas of dulness and tym

pany were not markedly abnormal. Upon exploratory incision a markedly movable liver was found, which could be easily pushed down into the position occupied by the mass when the patient was in an erect position.

What relation did this tumor bear to the pancreas? It is called a pancreatic cyst, because it occupied the position usually occupied by such a cyst and was attached to the pancreas. The fluid was not tested to determine if it possessed any lyolitic properties. The pathologist, in his report, says: "While this adenomatous tissue is not typical of pancreatic tissue, it might pass for such." We have failed to demonstrate the presence of the two most positive signs of the pancreatic origin. It has, however, been the custom to clasify cysts occupying a similar position and attached to the pancreas as pancreatic cysts. Our case bears a close resemblance to those of Bozemaus, Ranshoff, Vankreef, Martin, and the one pictured in Robson and Moynihan's book on "Diseases of the Pancreas," page 223. Robson and Moynihan state (page 202) that "unless a careful post-mortem examination is made, the origin of the tumor of the pancreas cannot be proved, for if the growth begins in the suprarenal capsule in adhesion to the pancreas, it is probably formed very early on the left side, and at the operation a portion of the pancreas may have to be removed." In my case the suprarenal capsule origin of the tumor may be excluded, I think, because when at rest it was two or three inches removed from the site of the suprarenal gland and kidney. Neither could the case described have been a cyst of the omentum, for it lay entirely behind the omentum. If it be true that there are sometimes remnants of the Wolffian body in the posterior layer of the mesocolon, there may be here an explanation of the origin of some of the tumors in this region. This growth had the gross appearances of many cases of ovarian cystoma I have extirpated.

There is a lesson in the mistake made in puncturing the tumor for diagnostic purposes. All late writers caution aganst this procedure, but it is surprising how frequently the error is committed. Disaster might have come to my patient had this proved to be a case of hydatids or a proliferating cyst of the pancreas. Certainly, an exploratory incision is less dangerous, and should be preferred.

In my patient, pain was the prominent symptom. It came usually after supper and was intense, requiring for its relief the administration of large doses of morphine. Freidrich has given

the name of celiac neuralgia to such attacks of pain attending pancreatic cysts. Vomiting, which is so common a symptom, was not present in my case. The urine was examined upon the day of the operation, and showed an absence of sugar. The stools were not examined. There was no jaundice, and the patient's general health was not greatly impaired, which fact may be accounted for in the absence of the involvment of much pancreatic tissue.

This case well illustrates the advisability of enucleating cysts of the pancreas when it is possible so to do. It is not at all probable that puncture and drainage would have resulted in a cure, for the reason that there were numerous cysts, and further cystic proliferation was in active process, as is shown in the accompanying drawings.

224 NORTH MERIDIAN STREET.

CORRESPONDENCE.

DOUBLE MONSTERS.

To the Editor of THE AMERICAN JOURNAL OF OBSTETRICS. DEAR SIR: As I have recently become interested in a line of investigation which requires the careful examination of all forms of double monsters, I would be extremely grateful for the gift or loan of fetal or new-born specimens exhibiting any grade of this phenomenon. As such cases are rare, there is a natural tendency to store them up as museum specimens, in which state the benefit derived from them is inconsiderable, while a thorough anatomical investigation would yield far more important results. As I am working upon a definite problem at present, I do not care for other forms of monsters, such as those of the microcephalous, acephalous or amorphous types, but would include all those which exhibit a doubling of any axial part, ranging from single individuals with doubled median parts to two complete individuals united at a single point. Similar cases occurring among the lower mammals, or, in fact, any vertebrate will be of nearly equal in

terest.

For fresh material, the best preservative for my purpose is 5 per cent. formaline, i.e., the commercial article mixed with water in the proportion of 1 to 20 or thereabouts, although material preserved by any other method will be of value. In specimens larger than four-month embryos the thoracic and abdominal cavities should be freely opened to insure complete preservation.

For a more detailed description of the types of monster I especially desire, I may refer the reader to the enumeration of the various forms grouped under Diplo pagi in my article in the American Journal of Anatomy, Vol. III, No. 4, Sept., 1904.

HARRIS HAWTHORNE WILDER. Smith College, Northampton, Mass.

Dec. 15, 1904.