fluid, and both the costal and the pulmonary pleura were coated by a recently-formed false membrane. The lung was adherent to the side at a spot corresponding to a cavern, which existed immediately beneath the pulmonary pleura in the middle lobe. On the left side of the chest there was likewise a turbid serous fluid in the pleural cavity, and both the costal and the pulmonary pleura were covered with false membrane, but the inflammation had not been so intense as on the right side.

"The right lung was carnified in great extent, and on its middle lobe being cut into, a gangrenous cavern was found, lined by a thin false membrane, and containing a diffluent substance, of repulsive smell, which, when subjected to a stream of water, left a rough, irregular mesh of partly mortified pulmonary substance. In the vicinity of this cavity, there were three others, which were smaller, but like it in other respects. There was also a small collection of pus in this lung.

"The left lung contained a great many small cavities, lined by a delicate cyst, and containing a thick yellowish matter, like concrete pus or softened fibrine, which was insoluble in water, but was easily washed away. These existed in all parts of the lung, but seemed to be most numerous near its surface and edges. This lung also was carnified in great extent. No tubercles existed in either lung. There was some fluid in the pericardium, but the heart was healthy.

"The liver, which was of natural size, contained three yellowish-white bodies, which projected a little above its surface, and were attached to the walls of the belly by bands of false membrane about three inches in length. The smallest of these tumors was about the size of a Spanish nut, and was situated at the acute margin of the left lobe. The largest of them was situated at the junction of the right and left lobes, and appeared to be made up of several smaller ones, each of them contained in a cyst. They do not appear to have had any influence on the hepatic substance, as that part of it which is in immediate contact with them does not seem to be denser than natural.

"The stomach, the intestines, the kidneys, the uterus, the mesentery, and the peritoneum lining the pelvis, were all healthy. The internal iliac veins were healthy, and contained no pus."

A portion of the liver containing one of the tumors, which was sent me by Dr. Inman, is now in the Museum of King's College. (Prep. 326.) This tumor, which is as large as a moderate sized potato (see Plate III. Fig. 2), is widest at the surface of the liver, and projects slightly above it. It is round, but has an irregular surface, not unlike that of a mulberry calculus. The knotty projections are not distinct tumors, as Dr. Inman supposed, but mere excrescences. They are all included in a common cyst, which, although very thin, is readily distinguished, from its being more transparent than the substance it contains.

The tumor was evidently formed in a portal canal. A portal vein of considerable size can be traced into its capsule, round which it winds for some distance. The substance of the tumor is precisely of

the same character as that of the tumors in the liver which was sent me by Mr. Busk. It is of a dead white, or rather faint yellowishwhite, firm, smooth when cut, and apparently homogeneous, not unlike firm white cheese. As happened in the tumors before described, it adhered firmly to the inner surface of the cyst. Under the microscopic, it exhibits a granular matter, and some small free oilglobules, but no plates of cholesterine. The granular matter is rendered a little more transparent, but not much more so, by the addition of a drop of acetic acid. The substance of the tumor contains less oil than that of the tumors of the same kind which I had before examined. A particle picked out from the centre of the tumor showed small orange-colored masses, which seemed to be composed of the coloring matters of bile. The substance of the tumor exhibits no trace of organization-no fibres or cells. A small slice of it, weighing 4.6 grains, which was dried by my friend, Dr. Miller, at 200° F., left an ash amounting to 0.15 grains.

In May, 1846, I met with several tumors of the same kind in a girl 18 years of age, who was brought into King's College Hospital with dropsy from granular disease of the kidney, and died 24 hours after her admission. On inquiry, I learnt that she was a prostitute, that she had drunk hard of spirits, and that she had long been an out-patient of the hospital on account of secondary syphilis. The tumors that reached the surface of the liver were all covered by false membrane.

In the Museum of King's College (Prep. 328), there is another preparation, showing a portion of liver which contains three tumors, evidently of the same kind as those just described. No history of the case is given. The tumors are about the size of hazel-nuts, and reach the surface of the liver, which at those spots is covered by a false membrane. The material composing them is more friable than in the former cases, and exhibits under the microscope irregular granules, with here and there an orange-yellow mass, apparently consisting of biliary matter; a few plates of cholesterine; and some round solid globules, which refract light strongly, and some of which exhibit faint rays proceeding from the centre. These globules were most of them dissolved when a drop of ether was put on the glass under the microscope, and were probably composed of margarine.

A fresh section was made of two of these tumors, and a small mass of concrete biliary matter was found in the centre of each, exactly as in the tumors which were sent to me by Mr. Busk.

In this specimen, there is a good deal of green biliary matter in the hepatic substance, and at a spot near the tumors a small biliary concretion.

From the examination of these tumors, it would seem that they are analogous to the glairy cysts described in a former chapter, and that they result from dilatation of portions of the hepatic ducts by matter secreted by their mucous membrane. This explains their being encysted, and also another circumstance, which I noticed when examining them—namely, that the cyst is not thicker in the large tumors than in the small. It explains, too, the presence of biliary matter in the centres of all these tumors. The circumstance that, in all the specimens, an old false membrane covered the tumors which reached the surface, but not other portions of the liver, showed that an inflammatory process attended their formation.

It would appear, therefore, that the disease commences as inflammation of the mucous membrane of the hepatic ducts-that, in consequence of this, a duct becomes closed at some particular point, and the portion behind distended into an irregular pouch by the matter subsequently secreted. This origin explains the absence of any trace of organization in these tubera. The matter which is poured out on the free surface of an inflamed mucous membrane is not susceptible of organization; but, if it be pent up in a closed cavity and do not contain much pus, it forms at length a cheese-like mass, as in these tubera.

The cheese-like matter of a scrofulous gland originates in the same way from inflammation of the mucous membrane of the gland. Encysted cheese-like masses of the same kind are occasionally found in the lung; and they may also form in the kidney.

Small tumors containing a cheese-like matter are now and then found under the skin, especially on the inside of the upper arm; and probably originate in circumscribed inflammation of the lymphatic

vessels.

Tubera of this kind can only form in mucous tubes which are small, and which—as the lymphatics, the hepatic gall-ducts, and the small bronchial tubes-have, in fulfilling their natural office, but a feeble current through them.

Abercrombie, in his work on the stomach and intestines, has given a short chapter on tumors of the kind under consideration, and has classed them with glairy cysts of the liver. The chapter is headed,

"Tubera of the liver without other disease of its structure."

He

says: "These tubera present externally a surface elevated into irregular knobs, of a yellowish or ash color, and perhaps from two or three inches in diameter. Internally they exhibit a variety of texturesin some cases fibrous, in others tuberculous or cheesy, and frequently there are cysts containing a viscid fluid. It appears that they produce marked symptoms only when they are numerous, or accompanied by enlargement of the liver or disease of its general structure; but that, when the structure is otherwise healthy, they may exist without any symptoms calculated to give a suspicion of their presence. Of this I shall only give the following example."(Diseases of the Stomach, 2d edit. p. 367.)

The example given by Abercrombie is the case of a gentleman, aged 80, who had enjoyed uninterrupted good health until a few weeks before his death, when he became one day suddenly incoherent. This disorder of intellect was removed by purgatives, and he had not shown any other symptom of disease, when one morning he was found dead in his bed. "No morbid appearance could be discovered to account for his sudden death, except that all the cavities of the heart, the aorta, and the vena cava, were completely empty of blood. On the convex surface of the liver, there was a tumor about three inches in diameter, elevated into numerous irregular knobs; on cutting into it, a cavity was exposed capable of holding about 3viij, and full of an opaque ash-colored fluid, which could be drawn out into strings. The liver in other respects was perfectly healthy."

For a more particular account of these tubera, Abercrombie refers to the work on the morbid anatomy of the liver, by Dr. Farre, in which, however, only cancerous tumors of the liver are described.

SECT. II.-Hydatid Tumors of the Liver.

HYDATID tumors, like cancerous tumors, are more common in the liver than in any other organ.

They consist of a sac, of peculiar character, which is closely lined by a thin membranous bladder, or cyst, and filled with fluid, which is usually colorless and limpid as the purest water. In some cases,

on a superficial examination, nothing more than this appears; but generally, in hydatid tumors in man, there are found floating in the liquid a variable number (sometimes many hundreds) of globular bladders or cysts, similar to that which lines the sac, but of various sizes, from that of a small pea to that of a walnut. To these bladders, Laennec gave the name Acephalocyst; from ȧxipaan xvozis—a bladder without a head.

The sac, which seems to be formed of condensed hepatic tissue and the remains of obliterated vessels, has just the same character, whether it contain merely the cyst which lines it, or many floating acephalocysts besides. Its thickness varies with the size and age of the tumor, and perhaps also with the degree of resistance which it has experienced in its growth. In small and recently formed tumors, it is very thin; but in large tumors of long standing, it has sometimes a thickness of four or five lines. It is then white and tough, very much like cartilage, and is easily separable into many layers. The surrounding hepatic substance adheres to it closely, and when this is scraped away, the sac is left hanging on the side towards the transverse fissure, by fibrous threads (the remains of obliterated vessels), which are lost in its coats. The inner surface of the sac is generally rough and fretted, and often presents, here and there, yellowish spots, which to the naked eye are very like the yellow spots so frequently found on the inner surface of arteries.

The membranous bladder, or acephalocyst, by which the sac is in all cases closely lined, is not adherent, and may be readily drawn out by the forceps. Its coats, which are friable, and of the firmness of hardened white of egg, are very finely laminated. The layers are, indeed, far too fine to be seen by the naked eye, or even by low powers of the microscope.

Nothing varies more than the fertility, if so it may be termed, of acephalocysts. Sometimes, and such is almost always the case in the hydatid tumors of the lower animals, the cyst which lines the sac contains no floating hydatids; in other cases, even of long standing, it contains only a few-perhaps eight or ten; while, now and then, it is literally crammed with them, and these, again, may, it is said, contain another generation.

When the floating acephalocysts have plenty of room, they are all globes or spheroids; but when closely packed, they assume various other forms, in consequence of their mutual pressure.

The floating hydatids have a uniform smooth surface, and are very