aged forty-three, had been a village school master for the last seventeen years and led a sedentary life. He had lived well for his position, indulged in a moderate amount of stimulants, and eaten freely. Up to Feb. 22nd, 1891, he had had no illness of any importance. On that date Dr. Murphy of West Malvern was called in for an acute attack of pain in the epigastric region, which subsided in twenty-four hours. The pain does not appear to have had the character of biliary colic. There was no

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... dice or vomiting, and for some time previously the patient had been taking huge quantities of cod-liver oU, under the impression that his chest was weak. On Dec. 20th, 1891, Dr. Murphy was called in again for a supposed bilious attack. The patient had been vomiting more or less continually for three days, and the first thing that struck Dr. Murphy was the reduction in the size of the patient that had taken place during the six months that had elapsed since he had seen him; previously he had been a man of 14 stone weight, now he was under 12 stone. His face was pale and pinched, with an anxious expression. The vomiting had come on suddenly three days before, and was copious and bile-stained. There was no pain, and for two days the bowels had been confined, notwithstanding he had been taking purgatives. He complained of great thirst, there was entire loss of appetite, and the temperature was normal. There was nothing abnormal to be detected in the abdomen by Dr. Murphy except a distinct feeling of resistance to the right of the umbilicus. He prescribed for him five grains of calomel, to be followed by an enema, and a bismuth mixture. On the 22nd there had been a slight action of the bowels, the vomiting was less frequent, and the patient expressed himself as feeling better. Dr. Murphy administered a copious enema, which was followed by three large stools. The first showed traces of the action of the calomel, and the following were black from the bismuth. There was a great deal of flatus. On the 23rd the patient partook of some chicken, and the vomiting became much more frequent, was very copious, and contained large quantities of bile. He continued in much the same condition until early on Dec. 25th, when the vomit became very offensive and was more or less continuous. I was called in to see him in the evening, and found the abdomen much distended. He was extremely restless ; his pulee was 120 and the tougue dry and brown. He did not complain of pain, which symptom, indeed, he said bad been entirely absent during the whole of his illness. It was decided to perform abdominal section early the nexb morning. On Dec. 26th Dr. Pike administered chloroform to the patient, whose condition was unaltered from the previous night. When under the anmsthetic a hard mass, freely movable, was detected in the right iliac region. I opened the abdomen in the middle line below the umbilicus and found the lump to be a hard mass, which completely blocked the lumen of the small intestine. The intestine above was much distended and around the mass was so tightly stretched that it was completely immovable. The coil of intestine was then brought outside the wound, and, Dr. Murphy holding it firmly above and below the obstruction, I incised it in its long axis opposite the attachment of the mesentery. The obstruction proved to be a large gallstone, and was easily extracted. The intestine near was 1 hen thoroughly washed out and the wound united with Lernbert's sutures. Two-vessels in the mucous coat, which bifd rather freely, were previously tied. On account of the critical condition of the patient a further examination of the abdomen was out of the question, so the abdominal wound was closed as quickly as possible, and a drainage-tube inserted into the peritoneal cavity. He was ordered nutrient enemata and a grain of opium every six hours. On Dec. 27th the patient had recovered completely from the shock of the operation, and expressed himself as feeling quite well-indeed, he had to be very closely watched to prevent him getting out of bed. His temperature was normal, he had no pain or tenderness, and his pulse was 96. There had been no return of vomiting. The next day he still expressed himself as feeling better. There were no abdominal symptoms, and the wound when dressed was quite healthy. On Dec. 29th, as he fcliveiy weak, a small quantity of milk was ordered to be given every hour in addition to the nutrient enemata. There were still no abdominal symptoms; the drainage-tube was removed. On the following day he was much weaker, so essence of beef and milk were administered in small quantities every quarter of an hour, but he gradually became more exhausted, and died on the afternoon of the 31st, the sixth day after the operation. Only a partial examination was allowed by the friends, The abdominal wound was healed, except at the part where the drainage-tube bad been inserted. There was slight peritonitis of some of the superficial coils of intestine on the right side in the neighbourhood of the intestinal wound. This was firmly united, and was situated high up in the jejunum. On tracing the small intestine upward it was found to be firmly matted together by old adhesions, and the gall-bladder was firmly incorporated with the mass, and could not be separated. The liver was apparently healthy The gall-stone, an unusually large one, was pear shaped, and measured 2 in. in length,