168 pus; these were rather purulent infiltrations than abscesses, many of them softening down in the centre into much the same clear serous fluid as escaped from the side before the last opening was made : they varied in size from that of a nut to that of an egg. The larger one, which had been opened, presented a ragged interior, with walls of a dark-brown colour, and was traversed by several vessels of considerable size; but no opening could be found into the intestine. The colon, at the

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... on of its ascending and transverse portions, was firmly adherent to the under side of the right lobe. On laying open the large intestine, it was found to be in a state of dysenteric ulceration all over from the caecum downwards; many of the ulcers having evidently been old ones, which had healed and left cicatrices. There were many points of deposit of pigment in the mucous membrane-apparently preparatory to further ulceration. No disease of any of the branches of the vena porta, or of the veins forming it, could be found. The left external iliac vein was laid open, and contained a soft grumous clot, quite separate from the internal lining membrane of the vein, which did not show any sign of inflammation. On laying open the inferior vena cava and two common iliac veins, a firm clot was found extending some way along the left common iliac vein, and quite blocking it up; and a clot extending down the right common iliac vein, but not so far as on the left side, and three inches up the inferior vena cava; but there, and in the left vein, it allowed the blood to pass. ST. GEORGE'S HOSPITAL. ABSCESS OF THE LIVER AND LOIN, PUNCTURE OF THE FORMER; SECONDARY HEPATIC AND PULMONARY ABSCESSES. (Under the care of Dr. PAGE.) Ouit next illustration of hepatic abscess arose from quite a different cause to that in the preceding case, and would seem to have occurred by the extension of suppurative action from the right loin, arising, it is quite fair to assume, independently of the liver itself. What gives strength to this supposition is, that there was much bilious vomiting for some days before the appearance of the tumour beneath the right breast, and when the latter appeared it was very painful, and resembled an acute recent abscess, although these details are not mentioned in the notes of the case. Its termination was, however, similar to that in the previous case-namely, by secondary abscesses in other parts of the liver and also in the lungs, the effects of pyæmia readily engendered by the large amount of suppura. ting surface in the loin and liver together. We have availed ourselves of the notes of Dr. Dickinson, the medical registrar, -and the account of the autopsy made by Mr. T. Holmes, curator of the museum at the hospital. Mary C--, aged thirty-four, admitted June 8th, 1859. 'She stated that she had had good health until five months ago, when an abscess appeared in the neighbourhood of the loins ; this opened, discharged a quantity of matter, and then healed. Eleven weeks ago a small round tumour showed itself just below the right breast. For some days before there had been much bilious vomiting. The swelling increased, and she became weak and emaciated. When admitted, there was a soft, fluctuating swelling occupying the lower part of the right side of the chest in front ; this was about as large as a child's head. There was considerable pain about it. There was also a small opening in the loins, which did not discharge much ; but when pressure was made above it, a little, not unhealthy, pus appeared. The tongue was dry; pulse weak, 90; bowels open. June 9th.-The patient slept badly, and during the night vomited a quantity of bile. The pain was somewhat relieved by the application of a liniment of opium ; good diet was given, with some wine. In the evening a well-markbd rigor occurred. 10th. -The tumour was now opened by Mr. Cesar Hawkins, and thirty-eight ounces of very fœtid matter allowed to escape. Mr. Hawkins was inclined to consider the abscess as in the parietes, and not connected with any of the viscera. The wine was increased to eight ounces. Next day the tongue was drier, the pulse weaker, and the skin was cold and clammy. During the night another rigor had occurred. 13th.--There was still some enlargement about the right hypochondrium, with tenderness. The tongue was glazed, and there was no appetite ; nothing was taken but wine and beeftea. A cinchona draught, with aromatic spirit of ammonia, was now given three times a day. 15th.—The throat was said to be sore, but nothing could be seen, and the patient's state generally was much the same. On the night of the 17th, there was a severe attack of shiver. ing, and in the morning the countenance was anxious, and the pulse more feeble; the tongue was glazed. The abscess con. tinued to discharge freely. On the 20th, there was more shivering ; some matter, apparently purulent, was expectorated, and the woman appeared to be sinking. Next day (21st), after another fit of shivering, she died. Autopsy, twenty-five hours after death. -The body was some. what emaciated. A sinus existed in the back, at the lower part of the right loin, which led amongst the muscles towards the crista ilii, but did not expose any bone. There was an opening made, during life, below the cartilages of the ribs on the right side, into a large abscess situated between these cartilages and the skin. On laying open this cavity, several apertures were found in its posterior wall, leading, some of them between, others below, the cartilages of the ribs, into a circumscribed cavity situated between the liver and diaphragm; and from the bottom of this cavity, again, the probe passed down directly into the substance of the liver. This cavity in the liver was filled with pus, and there were numerous other abscesses, evidently of pyæmic origin, in the liver, which were filled with fœtid pus, and some of them presented a well. marked pyogenic membrane. The kidneys were smooth, and their capsules adherent. The spleen was of large size, but healthy. -Thorax: The heart was healthy. There were several secondary deposits, in their first stage, in both lungs, a few of which had softened and formed small abscesses. There was recent adhesion in the right pleural cavity near the apex, cor. responding to one of these deposits, and there was some gelatinous lymph in its cavity. ST. THOMAS'S HOSPITAL. ABSCESS OF THE LIVER FROM DYSENTERY IN A HOT CLIMATE; PUNCTURE EXTERNALLY; RECOVERY. (Under the care of Dr. BARKER.) IN the patient who was the subject of the following case, the history was clear, of dysentery in a hot climate, suddenly followed by pain in the side, then jaundice, and absence of bile in the motions. He was admitted with a tumour over the liver, the nature of which was readily made out. It was punctured, and some bilious pus evacuated. A recovery ensued in forty-four days. For the abstract of the present and succeeding cases we are indebted to Dr. Stone, medical registrar to the hospital :--A seaman, aged thirty-five, in Sierra Leone some years pre. viously; had dysentery for eleven months, with great hæmorrhage from the bowels. During the continuance of this he was suddenly seized with a " stitch" in the right side, so severe that he rolled on the ground with pain. From that time he had slight jaundice and pipe-clay motions. On admission, he had an elastic, globular tumour projecting from under the right costal cartilages to about two inches above and outside the umbilicus. Its diameter was about four inches either way. It could be felt to fluctuate, and was made tense by the act of respiration. It was readily made out as an hepatic abscess. It is probable that acute hepatitis, in the first instance, gave rise to the formation of abscess in the following case, for the mere passage of blood by the rectum does not necessarily constitute dysentery. It is well known that in inflammation of the liver all the symptoms-are not invariably present. There were here severe epigastric pain, vomiting, jaundice, and blood by stool. This last may have depended upon impediment to the free transmission of the blood through the portal venous system, in consequence of the inflamed state of the liver.