VERATRUM VIRIDE IN PERICARDITIS. The August number of the Practitioner contains a condensed paper of mine on the important therapeutic effect which I have obtained from the administration of veratrum viride in pericarditis. I believe it to be preferable to opium, which hitherto has been our sheet-anchor in this disease, when combined with calomel, because of its magical influence in evercoming that irritable condition of heart, so pathognomonic of the malady; by its certain power, if carefully watched in its administration, of reducing the frequency of the pulse, thereby affording relief to the violent palpitation and tumultuous action of the heart, giving steadiness to the hitherto irregular pulse, quieting the respiration, alleviating the darting pains so characteristic of the complaint, and enabling the patient to swallow with less difficulty, and change his position in bed as it becomes painful, while it increases to a marked degree the renal and hepatic secretions, of no little moment in such a disease as pericarditis. Sir Thomas Watson, in his elaborate work on the "Practice of Medicine," states that he believes icterus neonatorum is not icterus at all, and has no relation to the biliary organs, but that the child at the time of its birth being in a hyperamic or congested condition, presenting an universally bruised appearance, which gradually fading I invariably employ the extract-considering it the gives, as the redness disappears, shades of yellow, which in safest and surest preparation-made by inspissating the a day or two pass, or are converted into the genuine flesh juice of the root, and prescribe it in two grain doses, with colour. This is all very nice in theory, but in practice, one grain of calomel in the form of pill, every two hours when one meets with an infant jaundiced over the surface until its effects are readily discernible. The distressing of the body universally, the conjunctiva tinged, abdominal symptoms are then kept at bay until the calomel does its disturbance indicated by constant symptoms of pain, induty, and the disease mastered. Advocates for local or, cessant crying, pressing the legs spasmodically against the perhaps, general depletion, have only to observe its thera-abdomen, general muscular twitchings, vomiting, and dispeutic influence once, to feel convinced that we do possess coloured and foetid evacuations, one does not feel inclined a remedy which will afford all the benefits to be obtained to wait for the yellow tinge to pass into the normal flesh from either bleeding, leeching, or cupping, without im- colour. poverizing the blood and increasing the tendency to serous Having paid considerable attention myself to the subeffusion, constituting hydrops pericardii, which has been ject, I have found that infantile icterus is of very frequent unfortunately not an unfrequent consequence of this dis-occurrence, and in many cases requires prompt remedying. ease, particularly in hospital practice. In several instances which lately came under my notice the symptoms were very severe, painful to witness, and disturbing to the entire household. The history of the three following cases will impart all that I would fain convey on the subject : that little, if any, bile passes through the ductus communis choledochus, and have reason to think that the mischief lies either in the duodenum or common bile-duct, that a spasmodic condition of these parts, from the irritation or passage of the bile through the delicate structures, is the cause of the mischief. The duct becomes spasmodically closed, the bile, instead of being eliminated as it is secreted, is blocked up in the liver, and we have re-absorption of it taking place into the blood. Case A.-R. R., aged 27 years, the subject of rheumatic I am of opinion that the bile in these cases is not supfever, for which he has been under treatment six days; on pressed in its secretion, but that it is retained, that the the seventh day of his illness he presented all the well-liver and gall bladder become surcharged and distended, marked symptoms of pericarditis. On going into the room I noticed that peculiar distressed, broken-hearted appearance of face so indicative of cardiac mischief; there was visible pulsation of carotids, hurried respiration, tumultuous action of heart, and decubitus on right side. He complained of severe lancinating pain extending up between the shoulderblades to the left side of neck, thence extending down the arm of same side; pulse 130; respirations 40; skin dry; tongue parched; secretion arrested; high fever. On practising auscultation, a well-marked to-andfro sound is audible, all the unequivocal symptoms of acute pericarditis being present. I immediately put him on two grains of the extract of veratrum viride, and one grain of calomel, to be given in pill every two hours, with a potass mixture, and a mustard blister to be applied over the cardiac region. Evening Visit.-Pulse 60; respiration 20; bowels have been operated on twice, bilious, feculent stools; passed a large quantity of acid urine; more free from pain, and expresses himself easier. Owing to vomiting, which set in later in the night, I discontinued the veratrum, and prescribed an effervescing mixture containing dilute hydrocyanic acid. The following day there was an aggravation of the symptoms-the veratrum was renewed, and steadily employed, discontinuing it when the symptoms required me, until a complete and satisfactory cure was effected. The patient recovered without a bad symptom, and is now attending to his usual avocation. Case B.-This was also a well-marked case of rheumatic pericarditis, presenting all the symptoms of the complication to a marked degree. The veratrum brought down the pulse from 120 to 70 in the course of twenty-four hours, increased the secretions, and produced a most de sirable termination. Case C.-Pericarditis with severe dyspnoea and violent nter-scapular pain; irregular pulsation and congestive A few months ago I had the opportunity of making a post-mortem examination of a child aged seven days, who died from an injury to the head produced by falling from the nurse's arms. It had been previously out of health, and from the generally tinged condition of the skin, I was induced to examine the liver. I found it preternaturally enlarged, distended with bile, and in carefully examining the duodenum and common bile-duct, I found the duct narrowed, and the characteristic tinge made by fresh bile entirely absent. I came then and there to the conclusion, that the duct had been spasmodically closed during life, and thus the egress of the bile prevented. That I have been correct in my opinion is best exemplified by the immediate relief afforded in the treatment of similar cases by tincture of belladonna in two-drop doses. After its administration, there is an end to the incessant crying, the child falls asleep, passes bile freely by the bowels, and rapidly recovers its natural state and condition. The administration of calomel I consider unnecessary and cruel. The act of secretion has gone on naturally enough. The elimination of the bile is what is required, and for this purpose tincture of belladonna will be found expeditious and curative, by overcoming the spasmodic condition of that portion of biliary apparatus so frequently affected in children a few days after birth. AMPUTATION OF THE PENIS FOR CANCER: a dose of castor oil, followed by senna and salts, without effect. MR. RECOVERY. BY HENRY GRAY CROLY, F.R.C.S.I., SURGEON TO THE CITY OF DUBLIN HOSPITAL, ETC. aged 65 years, was brought to me by his medical attendant to have the penis amputated for cancer. History.-Had congenital phymosis. Six months before consulting me he felt a hard and tender spot on the inside of the prepuce at the left side: he thought it was produced by the saddle, as he was in the habit of riding long distances on horseback. He never suffered from venereal disease in any form. The hardness in the prepuce extended to the glans penis, which soon became entirely involved in the disease. The patient suffered intense pain of a burning, lancinating character, and was obliged to take large opiates to produce temporary relief. His prepuce was slit up by his medical attendant a few days before I saw him. Appearance of patient and diseased part before operation. -General health excellent. Arcus senilis well-marked. Heart's sounds strong and natural. Penis enlarged. Fætid discharge of sanious fluid from beneath the prepuce. On examining the glans it feels as hard as a stone. The hardness extends to within one inch and a half of the pubes. No glands enlarged in the groin or on the dorsum of the penis. The patient was most anxious for immediate operation, which I accordingly performed at his residence, assisted by his surgeon. Chloroform having been administered, I grasped the penis and drew it gently forwards. With one sweep of the catlin the organ was severed behind the diseased part. The dorsal arteries and those of the corpora cavernosa were ligatured, and a small branch close to the urethra. When all hæmorrhage was controlled I passed a scissors into the urethra, and divided it fully half-an-inch. The angles of the divided mucous membrane were then stitched to the integument at each side. A No. 8 gumelastic catheter was introduced into the bladder, and retained. The ligatures came away within a week, the wound healed, and the patient made an excellent recovery. Microscopic examination showed the disease to have been epithelial cancer. I devised a silver funnel to fit over the pubes, which enables the gentleman to pass water without wetting his clothes, thereby contributing much to his personal comfort. The appliance was manufactured by Weiss, of London, by direction of Fannin and Co., Grafton-street, Dublin. Remarks.-Diagnosis of cancer of the penis must be carefully made, especially if the disease occurs at or before the middle period of life, when syphilis is more likely to exist than in advanced life. Congenital phymosis is a cause of cancer (according to Hey), the preputial discharge being retained producing irritation. In operating, the penis should not be drawn too much forwards, as retraction of the skin is liable to occur, thereby leaving the stump exposed. All bleeding vessels must be secured by ligature or acupressure; torsion is not suitable for vessels of the corpora cavernosa--secondary hæmorrhage is to be apprehended, and pyæmia has followed the operation. Removal of the penis by the ecraseur, if effected slowly, to prevent hæmorrhage, prolongs the operation unnecessarily. Free division of the urethra is of much importance, to avoid stricture at the orifice; and retaining a catheter in the bladder, for the first forty-eight hours, prevents irritation from the urine on the freshly-cut surface. Present Symptoms.-Spasmodic pain, starting from a hard moveable mass to the right of the umbilical region ; pressure here caused increased pain; belly tympanitic; lineæ transversæ deeply marked; face pale, anxious; eyes sunken, dull; skin cool, clammy; feet and hands cold; tongue coated; vomiting (not stercoraceous) set in same morning; constant loud gurgling in bowels; pulse 94, fair volume. Treatment.-A sinapism, followed by turpentine stupes, an emollient enema (3 pints) was given by a long tube, and retained one hour; came away unchanged; turpentine enema twice administered without carrying away any fæcal matter. Subsequently a 3 pint enema of warm oil (Dr. Head, Carlisle) brought away a trace of fæces. No purgatives by the mouth; belladonna and opium in full doses with relief to pain, spasms, and vomiting. 15th.-Passed a tolerable night; had some sleep; pain less; abdomen becoming tender; pulse 104; vomiting very troublesome since 4 A.M. Finding that the measures adopted for his relief did not produce any good effect, I determined to use electricity, applied as follows: Patient being placed on the left side, a "Radford's Uterine Director" was introduced into the rectum, and the negative wire of the electric machine attached to it. The sponge attached to the positive pole was rapidly passed over the whole abdomen from coecum to left iliac region. This caused intolerable agony, as all the abdominal muscles were thrown into violent action. The electricity was applied (at intervals) with gradually increased power for half-an-hour, when such exhaustion was produced that it was discontinued. As he complained much of pain in the back, a vulcanite hot-water bag was applied to it with relief. In two hours after the use of the electricity, he had several copious, dark-coloured, offensive stools. During the rest of the day and night following, his bowels were moved twelve times. The pain disappeared, the hard mass was so much reduced as to be made out with difficulty. He made a rapid convalescence. The failure of the ordinary measures in this case induced me to try the effect of electricity, and the successful issue furnishes additional evidence of the great therapeutical value of electricity in the treatment of ileus. In the ninety-sixth number of the Dublin Quarterly Journal of Medical Science, will be found a case reported by Dr. Finney, in which electricity was used on Dr. Stokes' recommendation. It was the recollection of that case, and the favourable result, that gave me confidence in the trial of a similar remedy, and happily with similar good fortune. The battery used was a Davis and Kidder's electro-magnetic machine. Hospital Reports. RICHMOND SURGICAL HOSPITAL. CASES UNDER THE CARE OF MR. WILLIAM STOKES. (Reported by Mr. J. A. Ross, L.R.C.S.I.) URETHRAL STRICTURE. THE results of the treatment by internal urothrotomy of the following cases of urethral stricture, tend considerably to confirm Mr. Stokes in the high opinion he has formed of the operation for the cure of this affection. A CASE OF ILEUS SUCCESSFULLY TREATED Case 1.-STRICTURE OF THE URETHRA OF THIRTEEN YEARS BY ELECTRICITY. UNDER THE CARE OF T. A. VESEY, A.B., M.B. T.C.D. ON July 14, 1868, I was called to see John Hughes, aged 59, a pensioner. Always healthy. Three months since was treated for enteralgia; subject to constipation. On the 12th, his bowels not being moved for two days, he took 66 IMME DURATION, PREVIOUSLY TREATED TWICE BY THE DIATE DILATATION" METHOD: INTERNAL UROTHROTOMY. Michael B., æt. 43, was admitted into the Richmond Hospital, under Mr. Stokes' care, on the 22nd of last May, suffering from a very tight stricture of the urethra, situated in the region of the bulb, and which, with great difficulty, would admit No. 1 catheter. The patient stated that in 1865 he had been treated by the "immediate method," and that the stricture having returned, the operation was performed a second time, by another surgeon, in July, 1867. The stricture had a second time recurred, and the difficulty in passing water was considerably greater than it had ever been. On May the 23rd the operation of internal urothrotomy was performed by Mr. Stokes, and immediately after a No. 10 gum-elastic catheter was introduced. No rigor or other evidence of any constitutional disturbance occurred during the patient's convalescence. On the 27th the patient left hospital. On September 3rd No. 9 catheter was introduced without the slightest difficulty. The patient has been perfectly well ever since the ope ration. Case 2-STRICTURE OF THE URETHRA OF TEN YEARS' DURATION: INTERNAL UROTHROTOMY: RECOVERY. Cornelius M., æt. 32, was admitted into the Richmond Hospital on the 10th of last March. The case presented all the symptoms of urethral stricture, which the patient attributed to gonorrhoea, and which the patient stated he contracted about eleven years previously. The stricture, situated in the membranous portion of the urethra, was so close a one, that it was not until after repeated trials that a No. 2 catheter could be passed. When this was done, Mr. Stokes then passed in the filiform bougie of the urethrotome, and completed the operation then, in the ordinary manner. A large gum-elastic instrument was immediately in troduced after the operation. Nothing untoward occurred during the convalescence of the patient, and more than four months after the operation No. 9 catheter could be introduced with the greatest facility. Case 3.-STRICTURE OF THE URETHRA OF TWO YEARS' DURATION: INTERNAL UROTHROTOMY: RECOVERY. Peter S., æt. 22, was admitted into the Richmond Hospital under Mr. Stokes' care, on the 20th of last March, suffering from stricture of the urethra, which he had, he stated, for the last two years. He attributed it to an attack of gonorrhoea, which had been treated by injections, and which he did not believe had ever been quite cured. Mr. Stokes treated the case for some days by partially dilating the stricture by wax bougies, as the ordinary small sized gum-elastic catheter could not be introduced. As soon as the filiform bougie of the urethrotome could be passed, the remaining steps of the operation were completed in the ordinary manner. After the operation No. 10 gum-elastic catheter was introduced. Four hours after the operation the patient had a rigor, but no other evidence of any constitutional disturbance supervened during the convalescence of the patient. A week after the operation, he left hospital able to pass water in a full and uninterrupted stream. Case 4.-STRICTURE OF THE URETHRA OF FOUR YEARS' DURATION: INTERNAL UROTHROTOMY RECOVERY. Peter G., t. 45, was admitted into the Richmond Hospital under Mr. Stokes' care on the 6th of last April. The stricture, situated in the membranous portion of the urethra was of four years' standing. The patient stated he never had any gonorrhoea, nor had he ever received any injury to the perineum. There was some obscurity therefore as to the cause of the stricture. The gradual dilatation method had been tried only, however, for the stricture to return afterwards in a still more contracted state. The stricture was situated in the membranous portion of the urethra. At the time of the operation No. 2 gum-elastic catheter could alone be introduced, and that with much difficulty, and requiring very delicate manipulation. The operation was performed in a similar manner as in the preceding cases, and immediately after No. 9 gum-elastic catheter was introduced. There were no rigors after the operation. Twenty-four hours after the operation, the instrument was withdrawn, and no instru The following points are of some practical importance:1. The operation should not be performed unless the grooved metallic director can be introduced with facility. Any forcing of this portion of the instrument into the bladder will, in the great majority of cases, be followed by rigors and other symptoms of constitutional disturbance. 2. The patient's bowels should be cleared by an enema on the morning of the operation. 3. Immediately after the operation a full opiate with quinine should be given. 4. The catheter introduced after the operation should not be allowed to remain longer than twenty-four hours. If it is, it will probably give rise to irritation, and the formation of an abscess where the stricture is divided. 5. No instrument should be re-introduced for at least three days. 6. The patient should be kept on milk diet for forty, eight hours after the operation, and no stimulants given, DR. STEEVENS' HOSPITAL. CLINICAL REPORTS BY EDWARD HAMILTON, F.R.C.S.I. FRACTURE OF THE CLAVICLE CAUSED BY MUSCULAR THIS bone, so frequently fractured by indirect violence, is rarely broken by muscular action, and yet cases now and then present themselves, which place the possibility of the occurrence beyond doubt. Various muscular acts have been recorded as resulting in fracture of the clavicle-e.g., securing a carriage trace, mounting a horse, whipping a dog, shaking a wet coat. The following case illustrates this accident : J. H., a cabinet-maker, aged 48, a healthy man, fairly developed, presented himself at the hospital with all the symptoms and evidences of a fracture of the clavicle of the right side, a little external to the centre. He stated that a week previously he was pulling the lath from the hem of a linen blind, which, after considerable resistance, suddenly gave way; he felt something crack in his shoulder, with great pain and loss of motion in the limb; he did not mind it subsequently, but finding that the limb was still weak, he applied for relief. The fracture appeared to be quite transverse, and there was no difficulty in procuring perfect union. There was no history of syphilis, or other constitutional disease, to cause structural change in the osseous tissues. POLYPUS OF THE RECTUM. E. D., 12 years of age, presented himself as an outpatient; he had suffered for the last four or five years from tenesmus and constant hæmorrhage from the rectum; his aspect was pale and delicate, which his mother attributed to loss of blood: these symptoms at this early age suggested the idea of polypus he was accordingly placed on his hands and knees, and directed to force down, when a polypus was protruded about the size of a filbert, very red and vascular; a wine ecraseur was applied to the neck of the tumour, and while it was being tightened the growth was drawn down, exhibiting a neck of fully an inch in length, attached to the posterior wall of the gut; steady traction was made on it, while a silk ligature was slipped round the pedicle, below which it was divided with a scis sors. The age of the patient and the long narrow penduncle at once served to distinguish it from a pile, although the colour, the appearance of the surface, and the bleeding, might easily lead the superficial observer to an erroneous idea of its pathology. TRAUMATIC ENCHONDROMA OF THE FINGER. A. B., aged sixty, ten years ago received a severe blow on the index-finger of the left hand by the falling of a plank. The pain at the time was not very severe, but the finger remained sore and swollen, and gradually increased in size until about three years since, when it began to increase more rapidly, and was also more painful. On examination, the finger was considerably enlarged-about the size of a hen's egg,-had a peculiar elastic feel, amounting in parts to a sense of fluctuation; it felt hot and throbbing, and was very painful, but the pain was removed by gradual and steady pressure. The disease was limited to the finger; the metacarpo-phalangeal joint was perfect; there was no trace of glandular contamination; no evidence of cachexia. In every respect the case was favourable for operation, which was suggested to the patient twelve months before, but he was afraid to encounter it. The amputation was performed in the ordinary way. The end of the metacarpal bone was removed, as his occupation did not require the breadth of surface in the palm of the hand. Two vessels spouted during the operation, but ceased to bleed almost immediately, so that they did not require hæmostatic treatment. The wound was closed by means of sticking-plaster, one stitch only being inserted into the lower part of the wound. Silk steeped in carbolic oil was used for the purpose. The parts were covered with the antiseptic putty and tinfoil, and the bandages well soaked in the oil. The dressings were not disturbed until the fifth day, but were each day saturated with the oil, a little matter appeared under the edge of the bandages, but the entire suppuration did not amount to half an ounce. On making a section of the tumour it presented all the characters of enchondroma, which were corroborated by the microscope. It had grown from the second phalanx, which was completely merged in the tumour, and from thence extended up on each side of, but did not implicate, the first phalanx. The digital nerves on each side were much enlarged and flattened, which may explain the increase of pain. Altogether, the disease was a fine specimen of traumatic enchondroma : ANEURISM OF AORTA. rapidly enlarged, attended with the most agonising pain and loss of sleep, which was with difficulty procured by the strongest anodynes. The tumour became somewhat dark on its posterior surface, and after a few days the extremities became cold, and he gradually became weaker and weaker. The post-mortem examination revealed an enormous mass of blood occupying the right side of the abdomen, behind the peritonæum, extending up behind the liver to the diaphragm, and down in the substance of the psoas muscle, which encapsuled it to Poupart's ligament. Immediately behind the mouth of the cœleac axis and superior mesenteric artery a large aneurism existed, eroding the vertebra. It became diffused behind the liver and kidney, both of which organs were projected forward. Admitted March KING'S COLLEGE HOSPITAL. CASES UNDER THE CARE OF DR. BEALE, F.R.S. (From brief notes by Dr. TONGE.) DYSPEPSIA.-G. A., æt. 36, gardener. 8; discharged March 26. In hospital 18 days. Recovery. Five weeks ago while straining at work sudden pain in loins, epigastrium, and right hypochondrium, continuing up to present time. Loss of flesh and strength, disturbed sleep, sour risings, occasional retching, pain aggravated by food. Mist. rhei. co. iodide of potassium, bicarbonate of potass. and chloric ether; castor oil and opium; linseed and laudanum poultice. Admitted DYSPEPSIA. Mary A. C., æt. 19, servant. December 18; discharged February 13. In hospital 57 days. Recovery. Slight hæmoptysis six months ago; loss of flesh six months; epigastric and dorsal pain after food; sour risings. Mist. rhei. co.; bismuth, magnesia, soda, calumba, and hydrocyanic acid; pepsine and hydrochloric acid; quinine, sulphate of iron, and sulphate of magnesia. Admitted December 1; discharged December 20. In hosDYSPEPSIA. Cornelius K., æt. 38, street fruit seller. pital 19 days. Relieved. Abdominal pain and vomiting 14 days; bowels confined for one week before; much tenderness at a spot two inches above umbilicus; tongue furred. Hydrocyanic acid and carbonate of soda; pepsine and hydrochloric acid; grey powder, rhubarb and henbane. DYSPEPSIA.-Mary A. P., æt. 40, married. Admitted February 2; discharged February 20. In hospital 18 days. Relieved. Catamenia ceased two years ago; pain in right side 18 months, constant last three months; tremor of right leg and arm 18 months; hæmatemesis 10 weeks ago; loss of flesh and colour of late. On admission pain in right side; small deep-seated moveable tumour in epigastrium; occasional vomiting; appetite bad; tongue furred; bowels confined; right leg dragged slightly in walking. Pepsine and hydrochloric acid; effervescing mixture; quinine and sulphuric acid; purgatives; hydrochloric acid lotion. HYDATID (?) TUMOUR OF LIVER.-Mary A. M., æet. 22, W. M., a plasterer, æt. 29, was brought under my notice widow. Admitted July 1; discharged August 3. In through the kindness of Dr. Shortt. He presented a well- hospital 33 days. Relieved. Occupation sedentary; had marked tumour of right lumbar region, projecting between acute rheumatism six years ago; since then a tumour to the last rib and the crest of the ilium. Also, somewhat in right of epigastrium only occasionally painful up to one front, it exhibited distinct diastolic impulse, and bruit de month ago, since then constantly so; never jaundiced; no soufflet audible in front, but not behind. His general ap-loss of flesh. On admission tumour 3 inches transversely, pearance was anæmic and unhealthy, and he suffered severe pains of a neuralgic character in the back, groin, and knee; he stated that he was in perfect health, and worked hard at his trade until six months ago, when he became affected with pains, which he attributed to rheumatism. He did not observe any enlargement of the side until three weeks before. He was admitted to hospital, and underwent a careful physical examination, from which was deduced the diagnosis of an aneurism of the aorta behind the cœleac axis, becoming diffused toward the right side. The tumour nodulated (?), extending two inches below costal margin to belladonna plaster. Re-admitted October 1; discharged November 9. In hospital 39 days. Unrelieved. Since discharge the tumour has become larger and more tender, but there has been no loss of flesh. The tumour got slightly larger and more painful while she was in hospital. Quinine and dilute sulphuric acid. COLIC.-W. P., æt. 23, a blacksmith. Admitted May 26; discharged May 30. In hospital 4 days. Recovery. Slight epigastric pain and purging 6 days; much vomiting and intense abdominal pain on day before admission; scybala brought away by injection. Then slight jaundice. Castor oil and warm water enema. Aromatic spts. of ammonia and sulphate of magnesia. ether. COLIC.-R. B., æt. 50, smith. Admitted July 14; discharged July 16. In hospital 2 days. Recovery. On morning of admission ate some tainted meat, and, a few minutes afterwards, was seized with severe abdominal pain, vomiting, and purging, followed by faintness. Warm bath. Aromatic spts. of ammonia and chloric ABSCESS OF LIVER.-W. R., t. 22, sailor. Admitted December 2, 1863; discharged March 23, 1864. In hospital 112 days. Unrelieved. Left West Indies two years ago; soon afterwards jaundice 7 weeks, followed by loss of strength; pain and enlargement of liver 6 months; diarrhoea for 1 month, 4 months ago. On admission, skin dark, slightly jaundiced; pain and tenderness on pressure in right hypochondrium and epigastrium; pain sometimes in right shoulder; liver from sixth rib to below umbilicus; slight dulness and faint tubular bruit over base of right lung; motions dark; frequent paroxysms of severe pain in liver; diarrhoea after 30th day from admission. Forty days later, expectoration of pus streaked with blood; dulness and crepitation at left apex. Slight hæmatemesis 35 days later. Chloric ether and iron (first sesquichloride, then citrate). Nightly opiates. Hydrochloric acid lotion over liver. Re-admitted April 5. Died on May 20. In hospital 45 days. Pain in liver has increased since discharge; right side now extremely tender. Eighteen days later began to expectorate viscid, brownish-red sputum ; two days later, pain worse; much dulness and crepitation at right base; some dulness at left base; nineteen days later, purged five or six times daily; expectoration abundant, fætid, yellowish-brown; orthopnoea; exhaustion; death. Post-mortem.-Liver fatty and much enlarged, extending to one inch above umbilicus; the upper two-thirds of right lobe occupied by an abscess, lined by a cyst one-fourth of an inch thick, containing stinking pea-soup coloured pus, its anterior surface adherent to the abdominal wall; base of lower lobe of right lung yellow and disintegrated, and communicating with abscess by an aperture in diaphragm, which was adherent around it to liver and lung. Old dysenteric ulcers in large intestine. Cod liver oil; quinine; cod liver oil and syrup of iodide of iron; logwood and opium, and opiate enemata for diarrhoea. Locally, opiate poultices, lin. belladonna, and I. P. JAUNDICE.-E. G., æt. 37, milliner. Admitted January 21; discharged February 13. In hospital 23 days. Recovery. Acute rheumatism 15 years ago; jaundice 3 years ago, and twice subsequently; each attack prolonged. Previously ill one week; shivering; itching of skin headache; sleeplessness; low of spirits; ocular spectra. On 2nd day after admission, became slightly jaundiced. Gallbladder distended and painful on pressure. Aromatic spts. of ammonia; chloric ether and bicarbonate of soda; quinine and dilute muriatic acid; grey powder and rhubarb. Hydrochloric acid lotion over liver. JAUNDICE.-Julia N., æt. 68, married. Admitted November 16. Died November 17. In hospital one day. Was in King's College Hospital last summer under Dr. Beale, for dyspepsia. Since discharge much pain in epigastrium and frequent vomiting; 12 days ago was seized suddenly with violent pain in hepatic region, recurring 2 and 4 days later. On admission very emaciated; slightly jaundiced; great pain and tenderness in upper part of abdomen; tongue dry; double bruit over base of heart; pulse 100, collapsing. On day after admission was seized with severe pain and vomiting, followed by exhaustion and death. Post-mortem.-Heart nine and a quarter ounces; left ventricle slightly hypertrophied; mitral and aortic valves somewhat thickened; a bony nodule at base of one aortic valve, and bony plates in aorta; liver clay-coloured and small, its ducts full of bile; gall-bladder distended to size of a large pear; two gall-stones in it; mucous memt. ulcerated; recent lymph on its peritoneal surface; a small gall-stone impacted in lower end of common duct. Stimulants. Enemata. Ad CIRRHOSIS OF LIVER.-R. S., æt. 45, law-writer. mitted July 19. Died on July 22. In hospital 3 days. Has drunk gin freely. Ascites 3 months; legs oedematous 3 weeks. On admission considerable ascites and oedema of legs; superficial abdominal veins much enlarged; skin dry, slightly sallow; urine scanty and bilious, not albuminous; dulness and large crepitation at bases of lungs; liver dulness as high as fourth rib in front. Pulse 108; appetite bad; tongue furred. On second day after admission 517 ounces of fluid were drawn off by tapping. Sunk, and died next day. Aromatic spts. of ammonia, chloric ether, sp. junip. co. and liq. ammon. acetatis. Pepsine and hydrochloric acid. Purified ox bile. Paracentesis abdominis. CIRRHOSIS.-T. K., æt. 48, miner. Admitted September 30. Died on October 24. In hospital 24 days. Has drunk spirits freely. Ten weeks ago, vomiting, diarrhoea, loss of appetite, and debility; dropsy 1 month, commencing in legs; motions loose and frequent, sometimes bloody; slight jaundice; legs oedematous; much ascites (girth at umbilicus, 38 inches); skin of genitals, abdomen, left chest, left axilla, and inside of left arm, deep purple (began in left axilla 7 days ago); large crepitation and sibilus over chest ; tongue brown in centre; red at tip and edges; pulse 96 ; urine bilious; no albumen. The jaundice ascites and dyspnoea increased, and he died on the 24th. Post-mortem.-Much turbid serum, the colour of yolk of egg, in peritoneum; liver contracted, fissured and nodulated, bright yellow on section; weight seventy-three and a half ounces; lungs much congested; some patches of pulmonary apoplexy in lower lobes; heart healthy; stomach rather inflamed. Chloric ether and carbonate of ammonia (19 days). Then hydrocyanic acid and bicarbonate of soda. Turpentine stupes. CIRRHOSIS.-GRANULAR KIDNEYS.-G. G., æt. 65, compositor. Admitted May 25. Died June 25. In hospital 31 days. Intemperate. Jaundice 25 years ago; cough and shortness of breath 3 months; cedema of legs and great dyspnoea, 10 days. On admission slight ascites, legs cedematous; dulness and crepitation under right clavicle and over right supra superior fossa; wheezing elsewhere; expectoration frothy, viscid and puriform ; pulse 110; respiration 36; urine albuminous; became weaker; passed much clotted blood by rectum on 28th day after admission. Died 3 days later. Post-mortem.-Much fluid in pleure and peritoneum ; lungs oedematous and emphysematous; old chalky bodies and cicatrices in their upper lobes; liver 43 ounces; slightly granular; contracted and tough; deep oblique fissure on upper surface of right lobe; kidneys granular and contracted; cysts in cortex. Chloric ether, carbonate of ammonia and senega. Logwood, sulphate of copper, and opium. ST. GEORGE'S HOSPITAL. DR. OGLE'S CASES OF ABDOMINAL TUMOURS. NOTHING in the whole art of medicine is involved in greater uncertainty than certain tumours in the abdominal regions. Some of the most obscure cases have been very patiently investigated by Dr. J. W. Ogle, who published his conclusions and full details of the cases in the last volume of the St. George's Hospital reports, upon which |