Middle-ear disease causes death, either by producing an abscess of the brain, or by causing thrombosis of some of the large veins within the skull. The dangers involved in a discharge from the ear are now well recognised. Insurance companies refuse to take risks on the lives of persons affected by chronic otitis media, as it is called scientifically. Such persons may run along in perfect good health for years without accident, but a sudden stoppage of the flow may be the signal for the formation of the brain abscess, with almost inevitable death. {160} Certain severe forms of the infectious fevers are very often fatal. These forms are popularly known as black fevers, that is, black measles, black scarlet fever, etc. These fulminant forms occur especially in camps, barracks, orphan asylums, jails, and the like, where the hygienic conditions of the patients have been very poor, and where the resistive vitality has, as a consequence, become greatly lowered. The black spots that occur on such patients are really due to small hemorrhages into the skin. The hemorrhages are caused by a lack of resistance in the blood-vessels and by a change in the constitution of the blood that allows it to escape easily from the vessels. Where such cases occur, patients should be fully prepared for the worst As a rule, the mortality is from 40 to 70 per centum. Acute pancreatitis is a uniformly fatal disease, though fortunately it is rare. It occurs much more frequently, however, than used to be thought. It occurs in persons over thirty who have been for some years addicted to the use of alcohol. The symptoms of the disease are severe pain in the upper left zone of the abdomen, that is, above and to the left of the umbilicus. This is accompanied by nausea and vomiting. Collapse ensues and death takes place on the second to the fourth day of the affection. This disease may have important medico-legal bearings. Some slight injury in the abdomen, as from a blow or a kick, may precipitate an attack in predisposed individuals. Accusation of murder may result. The mental attitude of the physician and the clergyman with regard to such cases must be very conservative. No opinion as to possible culpability should be ventured. Cholelithiasis, that is, stone in the bile duct, may not only cause severe pain, but may lead to rupture of the duct and a rapidly fatal termination. Owing to the practice of wearing corsets, gall-stones occur much more commonly in women than in men. Twenty-five per centum of all women over 60 years of age are found to have gall-stones. While these cases suffer from intense pain they are very seldom fatal. But it must not be forgotten that a fatal issue can take place either from collapse and stoppage of the heart, because of the intensity of the pain, or from perforative peritonitis. {161}