Pollock had used the tendon of the kangaroo's tail; and Dr. Wyeth, of New York, had used the whole thickness of the aorta. He scarcely understood how the mucous membrane of the sheep's intestine could be removed without some putrefaction. In the preparation of catgut, chromic acid was used in very various proportions. One surgeon used forty times as much as Mr. Lister; and yet both got reliable ligatures. A year ago Mr. Bellamy tied the femoral artery for popliteal aneurism with ox-aorta ligature; the wound healed. The other femoral artery was afterwards tied with catgut prepared according to Mr. Lister's method; the wound was nearly healed, when it reopened, and a large crack was found, leading down to the place of ligature, which no doubt would come away. Certain modes of preparation might not suit all forms of catgut; and hence catgut could not be reliable. Experiments with blood-serum did not help much. The only reliable experiments were those made on the living tissues; but it must be remembered that they were also made on the lives of men. MEDICAL NEWS. APOTHECARIES' HALL, LONDON.-The following gentleman passed his examination in the Science and Practice of Medicine, and received a certificate to practise, on Thursday, March 10:Pigott, Peter, Dulwich. The following passed on the 17th inst. :— Atkinson, Thomas Ruell, 32, Fleet-street, E. C. The following gentlemen also on the same day passed their Primary Professional Examination :— Neale, George, London Hospital. Roberts, Henry, St. Bartholomew's Hospital, Taylor, Thomas, Middlesex Hospital. BIRTHS. ANDREWS.-On March 19, at Eastrop Villa, Basingstoke, the wife of Samuel Andrews, L.R.C.P., of a daughter. CARNE-ROSS.- On March 18, at 5, Chalmers-street, Edinburgh, the wife of J. Carne-Ross, M.B., C.M., prematurely, of a son. ELLIS.-On February 17, at Sitapur, Oudh, the wife of J. Ellis, M.D., Bengal Medical Service, of a daughter. EMBLETON.-On March 15, at Funchal, Madeira, the wife of Dennis Cawood Embleton, M.R.C.S., lately of Hurworth-upon-Tees, at Funchal, Madeira, of a son. LAND.-On March 18, at Bordyke House, Tonbridge, Kent, the wife of William J. Land, M.R.C.S., of a daughter. LAW.-On March 22, at 20, Warrior-gardens, St. Leonards-on-Sea, the wife of W. T. Law, M.D., of a son. WINCKWORTH.-On March 11, at Shefford. Beds, the wife of Charles Edward Winckworth, L.R.C.P., of a daughter. MARRIAGES. HOWARD-HOLDSWORTH.-On February 7, at Gorakhpur, India, William James Howard, Esq., of Gaza, barrister-at-law, to Constance Catherine, youngest daughter of J. H. Holdsworth, M.D. MOORE-ARMSTRONG.-On March 15, at Dublin, John W. Moore, F.R.C.P., Physician to Meath Hospital and Cork-street Fever Hospital, to Louisa, youngest daughter of the late Edmund J.Armstrong, Esq.,J.P. and D. L., of County Clare and Lower Leeson-street, Dublin. PURVES-ADIE.-On March 19, at Woodlands, William Laidlaw Purves, M.D., of Stratford-place, Oxford-street, W., to Elizabeth, second daughter of Patrick Adie, Esq., of Worton Hall, Isleworth. TURBETT-TUFNELL.-On March 17, at Dublin, Thomas Turbett, Esq., of Owenstown, co. Dublin, to Florence, youngest daughter of Jolliffe Tufnell, F.R.C.8., of 58, Lower Mount-street, Dublin. YEO-SICH.-On March 16, at Chiswick, Robert F. Yeo, L.K.Q.C.P., Surgeon R.N., to Alice, eldest daughter of William Thrale Sich, Esq., of Chiswick. DEATHS. ADAMS, LOUISA STOTT, wife of H. Adams, M.R.C.P., at Stoke Newington, on March 19. ASHFORD, JOHN BUTLER, M.D., at 7, Windsor-villas, Plymouth, on March 18, in his 59th year. CHILDS, ARCHIBALD PRENTICE, F.R.C.S., at Tower House, Uxbridge, on March 14. DAVIES, ALBERT, M.D., late of Maidstone, Kent, at Nice, on March 13. ELLIS, JAMES, M.D., at 18, Tower-street, Hackney, on March 19, aged 77. FORBES, GEORGE FEDDES, Surgeon-Major H.M. Indian Army, at 33, Queenstreet, Edinburgh, on March 20. JENKS, G. S., M.D., at 18, Circus, Bath, on March 20. SPROTT, ROBERT PORTER, M.D., at Kingstown, St. Vincent, West Indies, on February 16, aged 59. WELCH, SUSANNAH AMELIA, wife of J. Welch, M.D., at 18, Girdler's-road, West Kensington-park, W., on March 17. VACANCIES. GENERAL DISPENsary, BournemoUTH.-Resident Medical Officer. Applications to be sent to the Treasurer, C. T. Nixon, Addiscombe, Cranborneroad, Bournemouth, of whom all particulars can be obtained. Testimonials to be sent in on or before April 2. BRITISH LYING-IN HOSPITAL, ENDELL-STREET, W.C.-Physician. Candidates must be Fellows or Members of the Royal College of Physicians, or have a degree in medicine of one of the Universities of the United Kingdom. Applications, with testimonials, etc., to be sent to the Chairman of the Board of Management on or before April 9. POPLAR HOSPITAL FOR ACCIDENTS.-House-Surgeon. Candidates must possess diplomas in surgery and medicine. Applications, with testimonials, to be sent to the Secretary, W. H. Beaumont, Rosherville, Kent (of whom all particulars can be obtained), on or before April 13. ST. MARY'S HOSPITAL, PADDINGTON, W.-Ophthalmic Surgeon. Candidates must be Fellows or Members of one of the Colleges of Surgeons in the United Kingdom. Applications to be sent to Jos. G. Wilkinson, Secretary, on or before March 31. TOTTENHAM TRAINING HOSPITAL.-House-Surgeon. Candidates must be members of the Royal College of Surgeons, registered, and unmarried. Applications, with testimonials as to moral character and professional ability, to be sent to Dr. Laseron, Tottenham, on or before April 30. WESTMINSTER HOSPITAL, BROAD SANCTUARY, S.W.-House-Surgeon. Candidates must have completed their medical education at the Westminster Hospital and be registered under the Medical Act, 1858. The appointment will be for six months. Applications to be sent to Sidney M. Quennell, Secretary, not later than March 18. WEST SUSSEX, EAST HANTS, AND CHICHESTER GENERAL INFIRMARY AND DISPENSARY.-House-Surgeon and Secretary. Candidates must possess both a medical and surgical qualification, and be duly registered. Applications, stating qualifications, and accompanied by testimonials, to be sent to William Thos. Atkey, House-Surgeon and Secretary, the Infirmary, Chichester, on or before April 9. Operations at the Metropolitan Free, 2 p.m.; St. Mark's Hospital for Diseases of the Rectum, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m. SOCIETY OF ARTS, 8 p.m. Prof. W. G. Adams, F.R.S., "On the Scien tific Principles involved in Electric Lighting." (Cantor Lecture-Third Course.) MEDICAL SOCIETY OF LONDON, S} p.m. The President will exhibit a Case of Paralysis in an Adult, simulating Hypertrophic Paralysis; and a Case of Double Facial Paralysis. Dr. J. Milner Fothergill will make a few Remarks upon the Digestion of Fats, and exhibit some Specimens of Oils. Dr. Stephen Mackenzie, "Notes of a Case of Syphilitic Disease of the Spinal Cord." Dr. Day, “On Tubercular Meningitis and the Mode of Treatment." 29. Tuesday. Operations at Guy's, 14 p.m.; Westminster, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m.; West London, 3 p.m. ROYAL INSTITUTION, 3 p.m. Professor Schäfer, "On the Blood." 30. Wednesday. Operations at University College, 2 p.m.; St. Mary's, 1 p.m.; Middlesex, 1 p.m.; London, 2 p.m.; St. Bartholomew's, 14 p.m.; Great Northern, 2 p.m.; Samaritan, 24 p.m.; King's College (by Mr. Lister), 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m.; St. Thomas's, 1 p.m.; St. Peter's Hospital for Stone, 2 p.m.; National Orthopedic, Great Portland-street. 10 a.m. ROYAL INSTITUTION, 3 p.m. Mr. H. H. Statham, "On Ornament." 31. Thursday. Operations at St. George's, 1 p.m.; Central London Ophthalmic, 1 p.m.; Royal Orthopedic, 2 p.m.; University College, 2 p.m.; Royal London Ophthalmic, 11a.m.; Royal Westminster Ophthalmic, 14 p.m.; Hospital for Diseases of the Throat, 2 p.m.; Hospital for Women. 2 p.m.; Charing-cross, 2 p.m.; London, 2 p.m.; North-West London, 24 p.m. OPHTHALMOLOGICAL SOCIETY, 8 p.m. Adjourned discussion "On the Relation of Optic Neuritis to Intracranial Disease." Living specimen at 8 p.m. Mr. Sebastian Wilkinson, "On a Case of Retinal Hæmorrhage." April 1. Friday. Operations at Central London Ophthalmic, 2 p.m.; Royal London Ophthalmic, 11 a.m.; South London Ophthalmic, 2 p.m.; Royal Westminster Ophthalmic, 14 p.m.; St. George's (ophthalmic operations), 1 p.m.; Guy's, 14 p.m.; St. Thomas's (ophthalmic operations), 2 p.m. ROYAL COLLEGE OF PHYSICIANS, 5 p.m. Dr. Southey, "On Bright's Disease." (First Lumleian Lecture.) ROYAL INSTITUTION (Council Meeting. 8 p.m.), 9 p.m. Sir H. S. Maine "The King in his Relation to Early Civil Justice." The figures for these towns (except for Nottingham, Salford, and Oldham) are the numbers enumerated in April, 1871, raised to the middle of 1881 by the addition of ten years and a quarter's increase, calculated at the rate that prevailed between 1861 and 1871. Revised estimates have been adopted for Nottingham, Salford, and Oldham, based upon special returns of inhabited houses existing within those boroughs. At the Royal Observatory, Greenwich, the mean reading of the barometer last week was 30.06 in. The lowest reading was 29.70 in. on Monday morning, and the highest 30-36 in. on Thursday evening. NOTES, QUERIES, AND REPLIES. Se that questioneth much shall learn much.-Bacon. CORRIGENDUM. TO THE EDITOR OF THE MEDICAL TIMES AND GAZETTE. HENRY COLLEY MARCH. SIR,-I have just received an inquiry from Dr. Henry Savage about a formula of mine in your last issue, page 319, for making a mixture of citrate of lime. Acid. citric. živ. should be acid, citric. 3iv. Would it not be well if this were corrected in your next issue?-I am, &c., Rochdale, March 22. An Abstainer.-Yes; it is said that the three first wranglers at Cambridge this year are all of them practical abstainers from alcohol and tobacco. Opium Traffic.-The new United States Consul at Siam has refused to grant consular protection and the use of the United States flag to dealers in opium and native liquors within his consular jurisdiction. Scotus.-The managers of the Royal Infirmary at Edinburgh have considered the offer of the Lord Provost and Public Health Committee to purchase a portion of the old Infirmary buildings for the purpose of converting them into a hospital for the treatment of infectious diseases. The managers, we believe, agreed to accept the offer of £16,000 for the central block, but in the interests of the Infirmary they declined to allow the western block to pass into the hands of the Town Council at so low a price as £7000. Michael B.-According to an analysis of the census taken in the United States, the number of whites is given at 43,404,876, while there are only 6,577,151 coloured people. Sophistication.-1. 1877. 2. There is a possibility that adulterating tradesmen have learnt how to deceive the inspector by selling him better goods than they sell to the public. The local authorities should encourage the public to buy samples for themselves, instead of buying them through the inspector. The former system would be much more likely to lead to detection than the latter. 3. The standard of strength for spirits having been lowered by a recent Act of Parliament, many samples that would formerly have been classed as adulterated now pass the analyst unscathed. D., Mildmay, N.-The collections on Sunday week at Brompton Church on behalf of the Brompton Consumption Hospital amounted to £148 8s. 9d. Rations, Bayswater.-The calculation as to the cost of carrying out the suggestion of giving men in the Royal Navy the option of having their usual allowance of grog, or twopence a day in lieu of it, is something like a hundred thousand pounds. Another plan, it is reported, which it is believed would be equally effectual for promoting sobriety in the Navy, is under the consideration of the Admiralty, and with a probability of its being carried out. Pro Bono Publico.-No fresh schemes were presented to the Inclosure Commission during last year, and the work of the Commissioners was confined to maturing a scheme for securing, as open spaces for the public, Brook Green, Eel Brook Common, and Parson's Green, as to which final arrangements have been made. A. H. C., Westminster.-Yes; the Asylum for the Deaf and Dumb, Old Kent-road, and Margate, now receive children into the Asylum at the age of seven, instead of eight and a half years, as formerly. COMMUNICATIONS have been received from Dr. RENNER, London; Dr. J. W. LANGMORE, London; Mr. WARD COUSINS, Portsmouth; Mr. J. A. GRANT, Ottawa, Canada; Mr. LAWSON TAIT, Birmingham; Mr. CLIFFORD SMITH, London; Mr. SHIRLEY MURPHY, London; EDITOR OF "HOUSE AND HOME," London; Mr. S. DREW, London; Mr. G. C. HARDING, London; THE SECRETARY OF APOTHECARIES' HALL, London; Dr. OCTAVIUS STURGES, London; Dr. HERMAN, London; THE SECRETARY OF THE ROYAL INSTITUTION, London; Mr. J. CHATTO, London; THE HONORARY SECRETARY OF THE MEDICAL SOCIETY OF LONDON; Dr. S. COUPLAND, London; Mr. H. W. BELLEW, Punjaub; Dr. ACLAND, Oxford; Dr. Moxon, London; THE SECRETARY OF THE CENSUS DEPARTMENT, 1881; Dr. H. COLLEY MARCH, Rochdale; THE REGISTRAR-GENERAL, Scotland; Surgeon G. BARNES, Washington; Dr. WM. KELLY, Taunton; Dr. F. CHURCHILL, London; Dr. GUISAN, Vevey; Mr. W. SPENCER WATSON, London; THE SECRETARY OF THE OPHTHALMOLOGICAL SOCIETY, London; Mr. E. L. HUSSEY, Oxford; THE SECRETARY OF THE INTERNATIONAL MEDICAL AND SANITARY EXHIBITION, London. PERIODICALS AND NEWSPAPERS RECEIVEDLancet-British Medical Journal-Medical Press and Circular-Ber liner Klinische Wochenschrift-Centralblatt für Chirurgie-Gazette des Hopitaux-Gazette Médicale-Le Progrès Médical-Bulletin de l'Académie de Médecine-Pharmaceutical Journal-Wiener Medizinische Wochenschrift-Centralblatt für die Medizinischen WissenschaftenRevue Médicale-Gazette Hebdomadaire-National Board of Health Bulletin, Washington -Nature-Occasional Notes-Deutsche MedicinalZeitung-Le Concours Médical-Louisville Medical News-The American -L'Impartialité Médicale-Portsmouth Times and Naval Gazette, March 16-Transactions of the American Ophthalmological SocietyHouse and Home-Centralblatt für Gynäkologie-Revue d'HygièneStudents' Journal-Cincinnati Lancet and Clinic-Leisure HourBoston Medical and Surgical Journal. LETTSOMIAN LECTURES ON TROPICAL DYSENTERY AND DIARRHEA. By Surgeon-General SIR JOSEPH FAYRER, K.C.S.I., M.D., LL.D., F.R.S., Q.H.P. LECTURE III.-PART II. TREATMENT. I SHALL confine what I have to say on the subject of treatment to that of chronic diarrhoea; for it is needless that I should occupy your time by describing that of the ordinary forms. I would merely again refer to the importance of checking all forms of diarrhoea during cholera seasons, or when that disease is imminent. The commencement of chronic diarrhoea is often insidious, and the disease gains ground before radical measures are resorted to for its removal. In the cases that come under notice at home, the most essential step towards recovery has been taken by returning to Europe; but there remains much to be done to further the improvement, which may probably have advanced considerably during the sea-voyage. The successful treatment of chronic diarrhoea depends very much on the patient's resolution and perseverance in carrying out the instructions he receives. Diet is the most important element in it, and this must be strictly regulated; all irritating or indigestible and solid food must be at first entirely prohibited, and only that which is most easily assimilated allowed. Milk, alone or (better) diluted with about onefourth or one-third part of lime-water, given in small quantities and at frequent intervals, say a wineglassful or small tumblerful every second or third hour, in some cases more frequently, will generally be found to answer, and may be continued for a long time, to the exclusion of all other food, with great advantage. Milk undiluted will not always agree, as may be seen by its causing irritation, frequency of action, and the passage of undigested caseine; but it is quite sufficient for all purposes of nutrition, and by the time the patient finds that he is taking three to four quarts a day, he will have realised that he obtains from it all that is needed to support health and strength. At first he may lose weight, but soon regains and increases it. Beef-tea, raw beef-juice, or other plain animal broth, free from extraneous matters; a raw egg beaten up with milk, to which a teaspoonful of brandy may be added, will sometimes be tolerated; arrowroot, tapioca, or other plain farinaceous food will sometimes, but not always, answer-certainly not at first. Tea and coffee, as a general rule, disagree, and should be avoided. Stimulants, especially for those who have long been habituated to their use, may be needed; the best are a little whisky or brandy diluted with Vals or Vichy or potash water; but these should be laid aside if they increase the action of the bowels. A little good port wine may be tried; but, as a general rule, I find all wines unsuitable. Regularity in the times of administration and in the quantity of nourishment given is most essential. The greatest care should be taken not to give too much of anything at a time, and at once to discontinue whatever appears to disagree. It is necessary that the patient should be kept warm, and at an equable temperature day and night. The body should be covered with flannel or woollen next the skin, and a flannel bandage should surround the abdomen. Chills and damp are especially to be avoided, for exposure to them may seriously aggravate the mischief. During cold weather the patient should not leave the house. As the condition improves, this discipline may be relaxed, and gradually the patient may be allowed to go out and take moderate exercise; but until considerable improvement has taken place he should be extremely careful in this respect. It is desirable to keep much in the recumbent posture, as mechanical rest for the bowels is a most important element in the treatment. It might be well, if possible, for the patient to reside during the cold months of the year in some of the milder and more sheltered parts of the country, and perhaps near the seaside of the south coast. The care, attention, comforts, nursing, and good food of a home, however, are more important than any benefit to be gained from such changes as may be VOL. I. 1881. No. 1605. derived from removal to different localities in the United Kingdom, where home advantages might be wanting. As the diarrhoea diminishes, the condition of the excreta improves, and strength is regained, the diet may be more varied and out-of-door exercise more freely taken. But long after recovery is apparently complete, the greatest care must be taken to avoid errors in diet, over-fatigue, or exposure to extremes of temperature, or a relapse may take place. It is desirable that the stay in Europe should be prolonged, especially after recovery from severe attacks, beyond one Indian hot season at least, and it may be necessary to defer return to India for another year. Drugs will do little good if strict dietetic and hygienic rules are not most carefully and continuously observed. Under the impression--derived chiefly from the appearance of the evacuations-that the liver is mainly at fault, it is sometimes deemed expedient to administer cholagogues or alteratives. This, I think, is unnecessary, as there is not sufficient ground for supposing that the liver is specially at fault. The chief indication is to restore the healthy functions of the bowel by giving it rest, to promote absorption, and delay the expulsion of its contents. This we may hope to effect by introducing only bland, unirritating, and nutrient fluids, by allaying irritation and checking excited action, and by administering such remedies as may tend to improve the general health. To allay the irritable state of the bowels, the compound ipecacuanha powder, in combination with bismuth, quinine, and alkalies, may prove useful; where the motions are fluid, copious, and frequent, tannin or gallic acid may be given in combination with Dover's powder. Sulphate of copper with opium has been recommended. Dilute nitric and muriatic acids in combination with opium have been found beneficial where other remedies have failed. Nitrate of silver is sometimes given, but I have not found it to produce very satisfactory results. Counter-irritation over the abdomen by sinapisms or turpentine stupes is useful. Opiate and small demulcent injections are often efficacious in allaying the irritability of the bowel and giving rest; hypodermic injection of morphia may be tried if opiates do not agree, but I have not found it necessary to resort to them. Opiates are sometimes objected to on aecount of their interference with the secretions; but this is, I believe, a groundless objection. The colour of the evacuations need not prevent their use, and the rest and quiet that they give may be of importance. Mucilaginous decoctions or infusions, such as those prepared from the fresh bael fruit, or from the isophgool (Plantago Isophgoola), the seeds of which are often given with good effect by the natives of India for the sake of the mucilaginous envelope. Solution of gum, water arrowroot, etc., may be beneficial for their soothing and nutrient properties. The preparations of iron are often useful in controlling the diarrhoea and in improving the condition of the blood. The iron alum in doses of four or five grains, the citrate or the potas. tart. of iron, in three- to five-grain doses, in some aromatic water, two or three times a day, are good forms in which it may be given; and it may, viewing the malarious origin of so many of the cases, be well to combine quinine with the iron. Two or three grains of quinine with three or four of Dover's powder, and three or four of bismuth, may be given. In the earlier stages of the disease, where there is hepatic and portal congestion, ipecacuanha in large dosesten to twenty grains-may cut short the state which would have passed into diarrhoea. This, however, is quite inapplicable to the disease in its more developed stages. I have found some cases which were aggravated by a state of portal congestion improve rapidly after a few doses of a saline aperient. As recovery progresses, preparations of quinine, iron, and other tonics are beneficial. A visit to some of the Continental health-resorts may be of advantage in expediting recovery, not only for the sake of the waters, chalybeate or others, but for that important element in recovery from nearly all chronic diseases, change," and for the regulated and physiologically correct life, and the mental tone imparted by the determination to get well. The use of drugs will be modified by the peculiar circumstances of each case, but I think that, generally, the plan I have suggested will prove successful in cases that have not advanced too far. Where emaciation has made great progress, where the tongue is always red, smooth, and glazed, the mouth dry or aphthous, the diarrhoea constant, and the exhaustion great, one cannot but feel great anxiety and uncertainty as to the result, though it is seldom necessary to declare a case hopeless. The diarrhoea may disappear in this condition, giving a delusive appearance of improvement, which is not unfrequently the precursor of death. Happily, a number of chronic diarrhoea cases of the character I have been describing have a favourable termination, and they are so in proportion to the care in which the patient adheres to the plan of treatment laid down for him; and I would emphatically repeat that strict adherence to simple milk for a long period-it may be for months-will often prove of more value than medication of any kind. I would only add, in conclusion, that in these cases the fresh bael, taken early in the morning in the form of mixture, or sherbet, as it is given in India, will often have good effect. A remedy that has often produced good results in India could hardly fail to do so here; but of course it, like all other mere drugs, is altogether of secondary importance to the dietetic and hygienic measures I have tried to describe. I will now relate the details of some cases illustrative of the diseases I have just been considering. Case 1.-Chronic Dysentery. (London.) C. H., aged thirty; December 7, 1880. Has been at Manilla since 1872, though away at times. Had dysentery and fever after six years of health. Returned to England in 1879. Went out again in 1880, but had to leave in three weeks, with return of dysentery and diarrhoea. He is pallid, anæmic, and emaciated. Passes blood and mucus, and loose fæculence. Tongue clean, not smooth. Bowel thickened. Functions otherwise healthy. Argent. nit. injection gr. ij. ad 3j. Ipecac. gr. j., pulv. rhei gr. ij., pulv. hyd. gr. j., in pil. every fourth night. Warm clothing. To take only milk, or milk diluted with soda- or lime-water. Mist. belæ, mane. December 14. - Has followed the instructions as to diet closely. The only solids eaten in the first three or four days have been a little fish and a few small pieces of biscuit; found that taking about a dessert-spoonful of whisky in a claretglass of water two or three times a day almost put a stop to a slight feeling of nausea and faintness which at first was troublesome. For the first two days he had loose stools twice a day, accompanied by a little blood and mucus, but since then only one, the quantity of blood and mucus both decreasing; yesterday and to-day the former were entirely absent and the mucus only in very small quantity. The stools for four days have been nearly quite formed, and the fæces much larger than any passed for more than two years. Since the second day has suffered from a constant pain in the pit of the stomach, like indigestion, or as if the stomach were filled with wind which refused to be expelled. The stomach is painful on pressure. This he had often felt before, but found relief in taking food. The injection argent. nit. was used once, and it caused little pain, but the inconvenience of using it was so great that he discontinued it. He has had less irritation about the anus, and any pain he felt in the lower bowels has been evidently caused by flatulence. In weight he fell from 10 st. 5 lbs. to 10 st. 2 lbs. in twenty-four hours, and has remained stationary at that since; still feels rather exhausted about five in the afternoon, but thinks not more so than when on ordinary diet. Has been walking two or three miles daily, but has not ridden. December 31.-Is much better; all symptoms of diarrhoea and dysentery have ceased. He is taking two to three quarts of milk daily, and no other food. January 6, 1881.-Is feeling very well Had no more dysenteric motions. There is still some thickening about sigmoid flexure of colon. Stools are formed. To continue the bael every morning. May add a little solid food to the milk on which he has lived almost entirely lately. To take gr. iij. of potass. tart. of iron twice a day. A few days later he wrote to ask permission to go to South America, apparently feeling quite well. Permission granted, with caution as to diet. Case 2.-Chronic Dysentery, with Enlarged Spleen. (Calcutta.) (Dr. McConnell.) R., Mahomedan, aged twenty-five, admitted into Medical College Hospital on April 23, 1879; died June 30. Had been suffering from enlargement of spleen and intermittent fever for three months, with occasional attacks of dysentery. Emaciated; skin dry and harsh; conjunctivæ anæmic; tongue moist, coated with white fur; pulse quick and feeble. No enlargement of liver, but the spleen descends nearly to umbili cus. For five days after admission the fever was distinctly quotidian, and there was no bowel trouble. After the fifth day the temperature fell to normal, and the patient began to improve in condition. On the sixteenth day after admission, dysentery set in with a recurrence of the old symptoms, and he now began to pass eight to ten stools in the twenty-four hours, the evacuations consisting of rosy mucus and blood May 15.-Eight stools in last twenty-four hours; loose, bilious, and containing gelatinous mucus and blood. 30th.-Better; only one stool during the last twenty-four hours, and purely fæculent. Continued well and slowly gaining strength until June 23, when another relapse of the dysentery occurred. From this time to death the disease was unabated and unchecked by treatment. Fourteen or more stools in the twenty-four hours, with rosy or shreddy mucus and blood. He died, quite exhausted and worn out, on June 30. Treatment.-While the fever lasted, cinchona alkaloids in seven- to ten-grain doses, with bismuth and soda, were prescribed. When the dysenteric symptoms set in, twenty-grains of pulv. ipecac. were given at bedtime; Dover's powder, soda and bismuth, each gr. v. t. d. Latterly, catechu and opium or koorchi mixture, anodyne enemata, lead and opium pill. Post-mortem Examination (July 1, 1879; fifteen hours and a half after death). -Body greatly emaciated. Brain and membranes anæmic. Peritoneum healthy. Liver a little shrunken; surface slightly rough; substance mottled on section; the interlobular tissue thickened; the lobules prominent, and the hepatic cells composing them fatty in parts, in others darkly pigmented and ecchymosed. No reaction with iodine. Weight of liver 2 lbs. 4 ozs. Gall-bladder half full; bile thin, of a turmeric-yellow colour, and measures about half an ounce. Spleen enlarged; capsule thick and opaque; substance very dark and soft; proper structure almost undistinguishable; weight 1 lb. 2 ozs. Kidneys a little atrophied. Stomach small mucous membrance slightly corrugated, pale, and anæmic. The mucous membrane of the small intestine has a slate-grey colour in the duodenum and jejunum. The ileum shows patches of recent vascularity. No affection of the glandular structures. The mucous membrane of the large intestine from the cæcum to the anus exhibits dark, gunpowder-like pigmentation in smaller and larger patches -the sites evidently of old ulceration. Here and there the gut is puckered by firm cicatrices or ulcers partially healed. The ulcers are found chiefly on the descending colon, sigmoid flexure, and rectum. They are all small, superficial, with sharp-cut, punched-out edges, their margins surrounded by a ring of pigmentation, their bases of rosy-pink colour and ecchymosed. They all possess a more or less indolent, weak, unhealthy character. The rectum shows serpiginous ulceration of the same type. The muscular coat of the bowel is thickened here, but throughout the rest of the intestine all the coats are thinned and atrophic. The mesenteric glands are all a little enlarged and hyperemic. The stomach contains about six ounces of milky fluid, yellow-coloured from admixture with bile. In the small intestine about the same quantity of offensive, clay-coloured fluid was found; and in the large gut also some offensive serous-looking fluid. Case 3.-Chronic Dysentery. Mrs. H., aged forty-one, wife of an Indian officer, seen with Dr. Theodore Williams, November 10, 1879. History. Had had eight children rapidly; and was much weakened by long residence in India, where on several occasions she had attacks of dysentery, also cough and expectora tion, with well-marked signs of phthisical consolidation of the left lung, for nearly eight years. Was much troubled by menorrhagia. For the last month has had persistent dysentery, the motions being frequent, accompanied by much tenesmus. The motions were scybalous, and accompanied by much blood. Tongue foul. Patient greatly emaciated. Pulse weak, but normal in frequency. Temperature normal. A well-marked area of tenderness and thickening, about the size of a crown, could be made out in left iliac region, over the sigmoid flexure. Some tenderness was also observable in the right iliac fossa. Various remedies had been tried-such as ipecacuanha in large doses, starch-and-opium injections, sulphate of copper and other astringents, but had failed. To have oil of turpentine, ten minims in capsule, three times a day. A week later the tenesmus and blood had quite disappeared, and the motions, though loose, were nearly natural. Case 4.-Chronic Dysentery, with Multiple Abscesses of B., a Hindoo male coolie, aged twenty-five, was admitted into Medical College Hospital on November 28, 1873. He states that almost six months ago he suffered much from "diarrhoea," from which, however, he completely recovered, and has been well until the last eight days, when an attack of dysentery had come on, and he is now passing ten or twelve stools in the twenty-four hours. Is much emaciated; pulse weak, soft, 132; temperature 99-8°. There is pain all over the abdomen, and tenderness on pressure, especially over the sigmoid flexure. The spleen and liver can both be felt enlarged, and on pressure tender. The stools are from ten to twelve in number in the twenty-four hours, passed with a good deal of pain and straining. They consist of a little thin fæculent matter, with a good deal of rosy and shreddy mucus. condition did not improve in spite of varied treatment, and, two days after admission, bronchitis with a good deal of congestion of the lower lobes of both lungs setting in, prostrated him still more. He thus died exhausted on October 7, 1873. His Treatment.-Dover's powder with bismuth and soda three times a day, with a stimulating expectorant mixture every three hours, anodyne enemata, etc. Post-mortem Examination (October 8, 1873; twenty-two hours after death).-Body emaciated. Rigor mortis only present in the lower extremities. Brain and membranes pale and anæmic; slightly softened in consistency. Lungs: Hypostatio pneumonia of both bases; general congestion. Heart: Nothing remarkable; peritoneum healthy; no fluid. Liver large; surface irregular, presenting a series of circumscribed, yellowishred, slightly projecting nodules, which occupy chiefly the upper surface of the right lobe, and a few also in the left lobe. These vary in size from a pea to a pigeon's egg, and on section are seen to be distinctly circumscribed abscesses, containing from a few drops to nearly a drachm of thick, greenish-yellow pus; each is surrounded by a dark, well-marked hyperemic zone. The liver-substance is abnormally soft, and exhibits throughout similar circumscribed suppurating foci; in addition to which there are numerous circumscribed points of so-called "red softening" (acute inflammation running into suppuration). No reaction given with iodine. Weight of liver 3 lbs. 13 ozs. Gall-bladder contains about half an ounce of thick brownishyellow bile; ducts free. Spleen large and heavy; the capsule in parts thickened; substance moderately firm, dark reddishbrown; trabecular structure well marked; weight 1 lb. 2 ozs. Kidneys a little fatty, particularly the cortical structure; nothing else remarkable. Stomach small; mucous membrane corrugated, pale; that of the whole of the small intestine also pale; no affection of the glandular structures. mucous membrane of the large intestine from cæcum to anus presents an almost continuous series of transversely placed dysenteric ulcers: the surfaces of some are covered by dark, shreddy and easily-detached sloughs; the majority, however, are quite bare and raw-looking, exposing freely the muscular coat. The sub-mucous tissue is here and there irregularly pusinfiltrated, and throughout thickened. The ulcers become larger and more numerous as the rectum is approached. The surrounding unaffected mucous membrane is thick, and for the most part pale or having but a faint rosy blush. Many of the ulcers seem to be of considerable standing, presenting an indolent condition, with pigmented edges. The mesenteric glands are slightly enlarged and soft. The Case 5.-Liver-Abscess and Chronic Dysentery and Diarrhea. (With Mr. Adams.) M. J. G., aged forty-five, a man of temperate habits. Had two attacks of dysentery during the last year in Afghanistan, and was left behind at Safed Jung when his regiment marched to Jellalabad. The second attack was slighter than the first, and occurred on the march down-country. On both occasions he complained of severe pain over the edge of the liver, particularly just below the region of the gall-bladder, and behind under the short ribs. Since the last attack he has constantly been ailing, now from ague, again from diarrhoea, and occasionally from both together. Occasionally pills and aperient draught were prescribed, but up till his arrival in Bangalore in October he was not put under any regular course of treatment. On the day of his arrival at Bangalore he had rather a severe attack of fever, and the diarrhoea increased in severity, the motions being frequent, light-coloured, frothy, and accompanied by a good deal of pain both in the bowels and anus. The pain over the edge of the liver also became much more severe; his appetite also failed, and his nights became restless and disturbed. At first ordered him a bitter tonic, but on the 23rd, after consultation, prescribed-ipecac. co. gr. xx., hyd. c. cretâ gr. xij., sod. bicarb. gr. xx., pulv. iv., one night and morning; also R. Acid. nit. mur. dil. Ziss., tr. aurantii 3iv., inf. calumba 3viij., m.; one tablespoonful two or three times daily. These he continued to take, but with no apparent benefit; on the contrary, he is becoming weaker day by day. His motions frequent, very loose, light-coloured, and frothy. Taste and appetite gone. Sent to England. (The above is an abstract of his case.) He I saw him on December 18, 1880, with Mr. Adams. had arrived at Southampton on the 15th, and came to London on December 18; was much fatigued by the journey. He was emaciated and sallow; his skin hot; pulse rapid, 130, feeble; tongue dry, smooth, glazed; bulging and fluctuation behind eighth and ninth ribs; side greatly enlarged; a large liver-abscess was pointing and near the surface; no abdominal pain except over the edge of the liver. Next morning (December 19), after rest and sleep induced by a morphia draught, the abscess was opened, under strict antiseptic precautions, by Mr. Adams, assisted by Mr. S. Watson, who made a free incision between the ninth and tenth ribs, in a line corresponding to posterior fold of axilla. The matter was near the surface, and one pint of thick pus, with clots of thicker pus, was evacuated. The edge of tenth rib was found to be necrosed, and a drainage-tube was inserted. He was relieved by the operation: his temperature fell; his breathing, which had been much oppressed, was relieved. On May 3 the dressings were changed. The discharge through the drainage-tube was free, but thick; no putrefaction. He slept fairly, and took nourishment well. The bowels acted occasionally; the excreta were fluid and very offensive. On the 25th he died rather suddenly, after some symptoms of orthopnoea. There had been an increase in the discharge, with some blood. The post-mortem examination took place on December 27, at 9 a.m. The right lung was condensed by pressure into a dense, impervious mass, the lower part adherent to the diaphragm. The left lung was healthy. The heart was healthy, but the right ventricle contained a firm white clot, moulded into the pulmonary artery and extending into both divisions for two inches or so. The right pleura contained a quantity of recent lymph. The diaphragm was adherent to the liver below, the lung and the thoracic wall above. The liver was fatty, but it contained only one abscess, which had contracted to the size of a small orange. The liver was closely adherent to the parietes; and the aperture between the ninth and tenth ribs opened directly into the cavity, which was lined with flocculent, semi-puriform lymph. The spleen was about twice the normal size, and rather soft. Kidneys apparently healthy. A careful examination was made of the morbid parts by Mr. Alban Doran, of the Royal College of Surgeons, and the following is his report: "December 29, 1880.-I have examined the intestine to-day. 1. The valvula conniventes are absolutely normal, excepting in the lower part of the ileum where they are nearly effaced; there they are deeply congested. 2. The mus cular and mucous and sub-mucous coats of the transverse colon are much thinner than normal; in the ascending colon there is atrophy of the same coats, but to a less marked degree. 3. The appearance of the mucous membrane is so altered by decomposition that the slaty colour characteristic of amyloid degeneration cannot be distinguished. 4. Peyer's patches have almost entirely disappeared. In the middle of the ileum large shreds of desquamating mucous membrane hang into the lumen of the intestine. Some of these shreds are discoloured, others quite dead-white, precisely like the epidermis when desquamating from sunburn or after scarlatina. 5. There are a few superficial ulcers in the sigmoid flexure, but not elsewhere. The mucous membrane of the rectum is abnormally puckered. 6. The muscular coat of the rectum is much thickened. 7. There appears to have been contraction between the descending colon and the sigmoid flexure, but the intestine had been opened when I examined it. 8. Weight of livre and adherent part of thoracic wall 6 lbs. 11 ozs. 9. The liver-substance is pale and very soft and greasy. 'Looking at the specimen from the thoracic aspect, with the diaphragm placed in its normal position, and then passing a catheter through the wound in the chest into the abscesscavity, none of the catheter can be seen, and it appears to run clean into the liver. Hence, as you say, the lower part of the diaphragm, with a reflection of pleura, must have become fused to the liver and the chest-wall. About one inch and a half of the tenth rib is necrosed and denuded of periosteum.' This is a very instructive case. The previous history appeared to point to the dysentery and diarrhoea as the cause of H |