He was now quite coherent in his speech and could recognise faces. He was put on simple diapho-diuretic mixture of sweet spirits of nitre and ammonium acetate solution. The morning temperature was 1000 and that of the evening 102-60, which continued so for a week. A blood examination was again made. Pigment granules were found inside the polymorphonuclear leucocyte, and there was an abnormal increase of mononuclear leucocytes (large), 53 per cent. The patient was put on huge doses of quinine

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... the fever yielded to it readily. Subsequent examinations of the urine on several occasions showed it to be clear and orange-brown in colour ; specific gravity 1025-1020. The blood pressure registered from 120 to 130 mm. The patient has since made an uninterrupted recovery and is now quite hale and hearty. THE following case of an inguinal hernia, which was remarkable both for its size and for the nature of its contents, may prove interesting to readers of THE LANCET. The patient was a male, aged 86 years, who died in the West Ham Union on Feb. 4th. He had an enormous leftsided inguinal hernia measuring 18 inches from the external ring to the apex, the circumference at the widest part being 36 inches. At the post-mortem examination the following condition of .affairs was found. The circumference of the neck of the sac was 11 inches. Through it had passed the greater part of the intestinal tract. The stomach measured 16 inches from fundus to antrum pylori. Its lower half was herniated, a very marked constriction being produced by the external ring. The upper intra-abdominal portion was enormously distended and occupied the whole of the left half of the abdominal cavity. The first part of the duodenum, together with that portion of the second part proximal to the opening of the common bile-duct, was elongated, measuring 8 inches in length. The lower or proximal half of this part of the gut was in the sac ; the upper or distal part extended intra-abdominally and vertically as far as the projection of the umbilicus on the posterior abdominal wall. At this level it was acutely flexed upon the lower half of the second part of the duodenum, the convexity of the flexure receiving the common bile-duct. From this flexure the gut returned to the sac. The remainder of the small intestine and the whole of the large, with the exception of a small portion of the sigmoid colon and the rectum, occupied the hernial sac. The csecum was placed inferiorly and laterally, whilst the descending colon and splenic flexure were closely adherent to the medial wall and apex of the sac. There was a compensatory descent of the diaphragm and consequently of the liver, the lower border of the right lobe of this organ being slightly below the intercristal plane. The bladder occupied the right iliac fossa, its usual mesial position being usurped by the intra-abdominal portion of the sigmoid colon. A great increase of fat in the omenta and mesenteries and the binding together of the contents of the abdomen and sac by dense fibrous adhesions complicated the examination considerably. The testicle, very small, flattened, and atrophied, with an enlongated cord, was situate medially at a point midway between the pubis and the apex of the sac. According to his wife's statement, the patient had had a hernia for over 50 years, the size having remained in, statu quo for 12 years or more. For five years previously to his death the patient was bedridden. Prior to this he had been able to get about, although with some difficulty. The capacity of the sac is unusual. It equalled, if not exceeded, that of the abdomen proper. Worthy of notice are, first, the extent to which the normal arrangement of the abdominal organs had been altered; and secondly, the maintenance of practically normal physiological functions under such circumstances. Apart from occasional attacks of vomiting and the necessity of fairly frequent use of laxatives, a very fair state of health obtained until the last.