1. A young woman, twenty-two years of age, had pleurisy with effusion about two years ago ; some three quarts of serum were removed by tapping. The lung appears never to have wholly expanded, and she has suffered from cough and expectoration ever since. Of late she has had fever, loss of flesh and strength, loss of appetite, and has failed considerably. For the past month has had a diarrhoea which has resisted all remedies used to check it, and it was for this that she sought advice. The

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... ts were described as frequent, involuntary, dark, watery, having a bad odor, and accompanied by considerable slime. It was learned that she had been using a morphia suppository twice a day for a long time. Physical examination of the chest showed an advanced phthisis, and the sputa contained bacilli. The abdomen was full and rather prominent on the left ; it was somewhat tender on palpation in the same locality, and a number of small lumps could be felt inside, the size of a hen's egg or larger ; at the same time there was a general fullness of the pelvis. The lumps were arranged in a row in the region of the descending colon, and were considered to be perhaps faecal masses, and it was thought that the sigmoid flexure was probably packed. Rectal examination confirmed this view. She was treated by enemata, and after several days of patient washing she was relieved of a large number of hardened lumps and soft faeces, and the bowels became natural. The symptoms for which she had summoned aid were ended4; subsequent care, has kept her free from trouble thus far. 2. Not very long since a man about thirty-five presented himself, saying he suffered considerable pain in the right inguinal region, which kept him from walking erect, and prevented sleep. He had suffered several days, and had been somewhat constipated for quite a while. An examination of the abdomen revealed a somewrhat prominent belly, with percussion resonance everywhere except in the right inguinal region, in an oval space three inches in diameter. Tenderness was a marked feature, and was so great that the percussion had to be very gentle. Palpation showed the tumor to be somewhat larger than was believed on percussion ; its boundaries were sharply-defined and regular, and it was thought to be confined to the region of the caecum. The temperature was 101^°Fabr., pulse 90. It was believed that he was suffering from typhlitis, and he was therefore sent to bed, and a few large oily enemata were cautiously given, which soon brought awray a considerable mass of faeces, and caused the tumor to diminish very much in size, and abolished the pain. A few days later he felt so much better that he got up and w-ent out, but within a month returned to me in the same condition as at first. A repetition of the treatment, and subsequent care in following out directions as to the treatment of the bowels, brought him to his natural condition of health. I have since seen him twice walking on the street, when he has assured me that he has remained perfectly well. A very similar case I saw last winter in the outpatient department of the Massachusetts General Hospital. 3. Mrs. S., about forty years old, had been under treatment for some uterine difficulty, and having been relieved of that, she was referred to me as possibly having typhoid fever. She complained of a sensation of great heat, pain in the head, sweating, anorexia, chills, extreme feebleness, and feeling of faintness on attempting to sit up. The pulse was rapid and feeble, temperature 101£°. The face was flushed, the eyes were dull, appearance despondent. Under simple treatment she was nearly well in a few days, when some paroxysms of pain in the left hypochondriac region led me to examine the abdomen very carefully. I then found some hard round masses on the left side, apparently inside the intestine. To bring these away an enema of soapsuds, castor oil, and vinegar was ordered. This was given by a midwife. The patient was much exhausted by the process, and only a little hardened faeces w-as brought aivay. Paroxysmal pain of great intensity followed, and after several times repeating the enema, evacuation of all the faecal masses followed, with complete relief. The masses were half the size of the fist, and as " hard as rocks," as the patient described them. Seen by me they certainly were very hard, and seemed to consist of masses of dried faeces. In looking over a considerable number of reported cases, I find that the affection is met with far more frequently in women than in men. The causes of the faecal accumulation in these cases were constipation (in a very large proportion), pregnancy, dilatation and pouching of the rectum or colon, vaginal rectocele, presence of an ulcer or fissure causing pain, haemorrhoids, congenital smallness of the anus (Matthews Duncan reports the case of a valvelike obstruction about one inch within the external orifice of the anus), cicatricial contraction following too thorough operation for piles, rectal scybalum, tumors inside and outside the bowel, bands outside, cicatricial contraction outside, malignant, lupus, syphilitic, catarrhal contractions, hernia, pessary in the vagina, foreign bodies of all sorts in the colon or rectum.