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the size of a hen’s egg. The skin covering it was red, andfelt doughy, as though something were making its way tothe surface. Fluctuation could be felt over the tumour.’There appeared to be a portion of liver below the swelling,’but this could not be accurately determined owing to tender--ness at this point; elsewhere the abdomen was not tender.,’Splenic dulness not increased. No ascites ; no œdema of thelower extremities; tongue slightly furred; appetite good;,no nausea or vomiting. Bowels acted about three times aday; motions loose, but free from blood and mucus. All he.suffered from was a burning, gnawing pain in the region of-the swelling in the right hypochondrium, and he kept hishand over the part to protect it from the pressure of the bed-.clothes.On Jan. 16th the skin was more red over the swelling.

The largest needle of Dieulafoy’s aspirator was introduced,,and many ounces of reddish-brown or chocolate-colouredfluid drawn off; the microscope showed this to consist of

I us-corpuscles, compound granular corpuscles, and coloured’blood-corpuscles. The aspiration caused no pain, and it- afterwards afforded relief.

For several days after this there was no material changein the patient’s condition, except an evening rise of tem-perature. He had pain in the region of the right hypo-chondrium. The abscess continued to discharge itselfthrough the small opening made by the aspirator. Several,ounces of dark-coloured matter escaped, which Dr. Fenwickfound in part to consist of broken-down liver-cells. Theskin around the opening was very thin and red on the 5thof February.On Feb. 14th the aperture was enlarging, and the skin

.around sloughing.On the 24th the sinus almost admitted the little finger;

the skin was sloughing for some distance around, and ex-ternal to this it was red and cedematous. The patient hadnot suffered much pain at any time, only a gnawing feelingin the region of the liver. He had not vomited or shivered,but all along he had wasted and weakened, and been hectic.He was extremely feeble, his pulse soft and very compres-sible. Bowels acted regularly ; there was no diarrhoea, and- the- appetite had been hitherto fair. The abscess dischargedLarge quantities of broken-down liver-substance ; it had beenwashed out daily with lukewarm water.

Sloughing of skin went on uninterruptedly, and on Feb.29th the necrosed skin was as large as the palms of twohands. What came from the abscess was now a dirty fetid-looking fluid. He wasted visibly, and was very weak. No-vomiting’, shivering, or purging. Patient -gradually sank,and died March 2nd.

Necroposy.—Body extremely wasted. There was a largegaping wound in the right hypochondrium opening intoperitoneal cavity. The heart was wasted, valves andorifices healthy; left ventricle firmly contracted. Lobularpneumonia and cedema of both lungs ; base and posteriorpart of right lung covered with recent lymph. Spleennormal. Liver: Upper surface of right lobe excavated by a:large, ragged, irregular cavity, with sloughing walls. Leftlobe had three masses of soft curdy matter not yet broken-down into pus. Numerous smaller masses were scattered-throughout substance of liver. The hepatic flexure of the- colon was adherent to liver. A large sac, extending from,the lower part of thorax to the crest of ilium, outside peri-toneum, but communicating with the general peritoneal,cavity. The intercostal nerves lay in the sac dissected out,:as by a scalpel. Stomach and small intestines healthythroughout. Large intestine, from ileo-cæcal valve to

’rectum, studded with ulcers, some circular, some transverse,;some with solitary follicles, enlarged and surrounded by.commencing ulceration. Coats of intestine much thickened.No pigmentation of mucous membrane. Kidneys normal.Remarks by Dr. STEPHEN MACKENZIE. —The case was

one of much interest. It is usually stated that abscess ofthe liver (so-called " tropical abscess") does not follow upondysentery acquired in this and other temperate countries.’Though rare, I have, however, seen more than one instanceof this. The connexion between dysentery and abscess of.the liver has given rise to much discussion. It is argued bysome—Dr. Budd, for example-that it is due to purulent- absorption from the intestine and deposition in the liver. Yetit is not, at least always, due to this occurrence. Moreheadhas collected twenty-one fatal cases of hepatic abscess with- out ulceration of intestine. Waring found that in 204 casesof hepatic abscess, fifty-one cases, or one quarter of thewhole number, were free from ulceration of intestine. At

Netley, also, of forty-eight fatal cases of tropical abscess, inthirty-four there was no intestinal lesion. Moreover, whenthey coexist, the abscess may precede the dysentery. It hasbeen stated that something more than dysentery is requiredto produce the abscess; for when dysentery does occur intemperate climates abscess of the liver does not result.This statement the present case refutes. Dr. Baly statedthat out of hundreds of cases of dysentery at Millbankprison, not one had abscess of the liver. The explanation ofthis is, that his cases of dysentery were of scorbutic origin.Abscess of the liver does follow dysentery of malariousorigin in this country, as in the above case and others whichI have seen. Sir Ranald Martin, Morehead, and Murchisonare inclined to attribute the abscess to hepatitis, arisingfrom exposure to cold. But in India, hepatitis and abscessof liver especially occur in hot low-lying localities wheremalaria is endemic, and the range of malarious dysenteryand hepatic abscess is almost identical. The evidence there.fore seems to point to the malarious origin of the abscess ofthe liver. It may be that some particular form of malaria,or some other coexisting circumstance, determines the occur.rence of abscess ; for while it is common in India and China,it is rare in the West Indies. In the present case aspirationwas not attended with benefit ; in others it is much moresuccessful.

NOTTINGHAM AND MIDLAND EYEINFIRMARY.

CASES OF MINERS’ NYSTAGMUS.

(Under the care of Dr. BELL TAYLOR.)IT is important to remember that in the following cases

Dr. Taylor states that there was no ametropia, and that thesight was good when the eyes were at rest.CASE I.—Benjamin W-, aged forty-four, a miner reo

siding at Clay Cross, applied at the Eye Infirmary onDec. 26th, 1877. He stated that he had worked in a pit forthirty years, that his sight began to fail six months ago, andgradually got worse, so that he became unable to work.The eyeballs oscillated whenever he looked earnestly at anyobject. The oscillations were synchronous, horizontal, andequal in extent and number-namely, seventy-six in aminute. He said he had not been accustomed during workto look upwards, but downwards, and that the dimness ofvision was much aggravated by stooping. General healthgood; moderately temperate ; does not smoke much. Orderedto give up working by artificial light, and to take smalldoses of steel and nux vomica thrice daily.CASE 2. -J. H-, aged twenty-nine, applied at the

infirmary on Jan. lst, 1878. Had worked at the Annesleypits twelve years. Three weeks ago he noticed that hisDavy’s lamp began to "dance" whenever he attemptedwork; said that it was often necessary for him to lookupwards while at work, that he required to strain in orderto see in the dim light of the pit, and that the defect wasaggravated by stooping. In this case it was somewhatdifficult to excite the oscillations, and they were not manifestuntil he had been shut up in the dimly-lighted ophthal-moscopic room and induced to stoop for ten minutes. Itwas then seen that the oscillations were both vertical andhorizontal, causing a rotatory movement of the globes.They did not number more than fifty in a minute, andsoon subsided. He attributed these favourable symptomsto his having had a " drop of drink," which he said hadenabled him to master the disease. Is sometimes in-temperate, and smokes moderately. Ordered to discontinueworking in the pit, and to take bromide of potassium andtincture of nux vomica.CASE 3. -James A-, aged fifty-four, applied on Dec. 3rd,

1877. Had worked seventeen years at the Seymour pit,Stavely, and had had several blows on his head. In this casehorizontal nystagmus was readily excited by directing thepatient to look inwards. The oscillations numbered 100 inthe minute. He said the disease had existed for a year, andwas brought on by using a Clennie lamp, which flickers, and

! is consequently much worse for miners than the Davy lamp.He had not to look upwards while at work, and the diseasewas aggravated by stooping and exertion ; fairly temperate,

! but smokes half an ounce daily. Ordered arsenic with steeland nux vomica thrice daily ; to cease working underground

and give up smoking.

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CASE 4.—Samuel C-, aged twenty, applied on Feb. 1st,1S7S. Had worked ten years in the Annesley pits. Hori-zontal oscillations 50 in the minute ; had been suffering sixmonths; had not to look upwards when at work ; was muchworse when stooping, and attributed the disease to Clennie’slamp ; is temperate, and no great smoker.CASE 5.-Frederick E-, aged fifty, residing at North

Wingfield, applied at the infirmary in November, 1877. His

eyes were quiet when he was in repose, but if he becameexcited they would begin to oscillate horizontally as muchas 90 times in a minute. The disease was aggravated bystooping or looking upwards, which he said sets them"a-gate." Had been bad seven months, and the eyes hadgot worse even while resting. Is temperate, but a greatsmoker. Ordered to leave off smoking and working under-ground, and to take phosphide of zinc, with steel and nuxvomica.Remarks by Dr. BELL TAYLOR.—This curious affection,

which has only attracted notice of late years, is evidentlymore common than most writers on the subject suppose. Thefive preceding cases have come under my notice within asmany months, and there are always one or two cases undertreatment in the out-patient department of our hospital.The disease is clearly the result of strain, and appears to beanalogous to writers’ cramp, pianists’ and telegraphists’cramp, or the similar affection of the gastrocnemii occasion-ally observed in ballet-dancers ; and may be developed inany or all of the muscles supplied by the third nerve, andis clearly caused by the overtaxing of these organs. Thepatient makes a great and sustained effort to see in a dimlight; the muscles engaged in the accommodative strain areoverburdened, in course of time give way, and at last, when-ever called upon, just as in the analogous cases cited above,become, as it were, agitated, fluttered, escape from the con-trol of the will and perform irregular motions. If the internalrecti are most affected, horizontal oscillations occur; if thesuperior rectus and inferior oblique have been overtaxed,owing to the patient having been compelled to raise theeyes above the horizontal plane, the oscillations are eithervertical or rotatory-in either case they usually vary from60 to 120 in the minute. If one eye turns inwards duringthe oscillatory motion more than the other, the effect of asquint is induced, and the patient sees double. The remarkof one of the patients as to a drop of drink enabling him tomaster the disease is significant evidence as to the influenceof a want of tone in favouring the advent of this affection.In all the above cases the sight was good when the eyeswere at rest. The fundus was healthy, and there was noametropia. The disease may last from a few months to afew years, but, as a rule, the patients get well if they leaveoff working in the pit, abandon bad habits, and attend tothe general health.

LIVERPOOL ROYAL INFIRMARY.MALIGNANT DISEASE OF BLADDER AND RECTUM;

COLOTOMY.

(Under the care of Mr. REGINALD HARRISON.)IN the following case colotomy was performed, with con-

siderable temporary success, for the relief of recto-vesicalfistula.James R-, aged fifty-three, was admitted on October

9th, 1877, suffering from a recto-vesical fistula of a malig-nant nature. The disease appeared to have commenced inthe rectum ten months previously. On admission the patient

’, was in a very miserable and reduced condition. Within therectum was a scirrhous ulceration, which communicated withthe bladder by means of an opening, through which a large-sized bougie could be passed. On introducing a catheterinto the bladder there was first an escape of most fetidflatus, followed by urine containing fæces in considerablequantity. The patient was suffering very severe pain, muchof which was due to the collection of flatus within theladder. Frequent washing out of the bladder and rectum,in addition to various anodyne applications, failed to giveany permanent relief. After a consultation with his col-leagues, Mr. Harrison opened the left colon, and made anartificial anus. The operation was effected without anydifficulty, the gut being readily found.The relief that followed was most marked, all the more

distressing symptoms at once disappearing, and for some

time the patient improved. The disease was, however, evi-dently very extensive, and death took place from exhaustion.seven weeks after the operation.At the post-mortem examination the posterior wall of the

bladder was found completely involved in a scirrhous massundergoing ulceration. The communication between therectum and bladder would admit the passage of two fingers.No other cancerous deposits were discovered.The operation quite fulfilled all that was expected of it-

that is to say, it was the means of prolonging life and miti-gating pain. The chief distress of the patient on his ad-mission was referable to the distension of the bladder with-flatus and feculent matter. Mr. Harrison remarked that, asall means of relieving this by medicine had proved ineffec-tual, there were only two courses open-viz., either toparalyse the sphincter ani by such an incision as would befollowed by incontinence of faeces and flatus, or by openingthe colon to divert the faeces from the fistulous comnnmica-tion. The latter course was decided upon as affording thebest means for giving relief. Mr. Harrison’s previous.experience of the operation was very favourable to it, andhe had no hesitation in recommending it in cases such asthese.

QUEEN’S HOSPITAL, BIRMINGHAM.EXTREME GENU VALGUM IN BOTH LOWER LIMBS; SUE-

CUTANEOUS DIVISION OF THE INTERNAL CONDYLE

OF BOTH FEMORA; COMPLETE REMOVALOF THE DEFORMITY.

(Under the care of Mr. FURNEAUX JORDAN.)THE efficacy and apparent safety of this operation, together

with the ease with which it may be performed, promise tgive it permanent value.Thomas D-, aged twenty, was admitted with severe

double in-knee. He could walk with crutches only, andthen not without pain. The deformity was increasing, andgave him a dwarf-like appearance ; one knee overlapped theother when his feet were put to the ground. Mr. Jordan

performed (March 31st, 1877) the operation devised by Dr.Ogston, of Aberdeen, with the instruments used by Mr.Adams in section of the neck of the femur. A tenotome was-introduced about three inches above the centre of the internalcondyle of the left femur, and carried into and through thejoint to the front of the notch between the condyles; Adams’s.saw was passed along the incision, and, the teeth being;.

directed backward, the internal condyle was sawn through.The tibia was then with moderate force readily put into aproper position, driving upwards the detached condyle, readyfor union in its new position. All antiseptic precautions.were taken. The limb was kept in position by a long splint.No shock, or bleeding into the joint, or synovial effusion,orfever followed. Six weeks later the right knee was operatedon in a similar way. The limbs retained an excellent posi-tion, and after a few weeks passive movements were made,the first time under chloroform. The man soon walked with.straight limbs and knee action, but it was found that sometalipes equinus retarded easy progress. It was proposed to