A man, aged thirty-eight years, had suffered for five years with pain and sickness after food. At first these symptoms had been intermittent, but for six months the pain had been more or less constant, and vomiting had occurred regularly from half an hour to an hour and a half after meals. When admitted into hospital he was very emaciated and vomited three times a day. There was no cachexia and the appetite continued good. The stomach was dilated and its lower border extended below the level of the navel. Four litres of fluid were removed by means of a soft tube, and the regular employment of lavage greatly relieved the symptoms. A sense of resistance could be detected on. palpation of the epigastrium, which was thought to be the left lobe of the liver. Three months later an ill-defined rounded tumour could be felt in the epigastrium and right hypochondrium. As fluctuation was present it was regarded as a hydatid cyst of the liver, and aspirated, with the result that 950 grammes of a mucoid bilious fluid were withdrawn. A month afterwards the cyst had regained its former size, and when punctured once more 700 grammes of brownish fluid were evacuated. The relief afforded by the operation was only temporary, since the abdominal pain and sickness soon returned and about the tenth day jaundice set in. At the end of three weeks the tumour was again prominent, and a trocar was inserted for the third time, with relief to the jaundice. After an interval of another three weeks, during which the icterus returned, a fourth aspiration withdrew 900 c.c. of a chocolatecoloured fluid containing pus. Although the jaundice disappeared and the patient felt much relieved, it was felt necessary to drain the cyst in a more efficient manner. Unfortunately general peritonitis was set up by the escape of some of the contents of the tumour during the operation, and the patient died.
The stomach was much dilated, and the pylorus was compressed by a large cyst connected with the lesser curvature and extending into the lesser cavity of the peritoneum. The cyst did not communicate with the stomach, but opened into a small cavity situated in the muscular coat of the viscus at the pylorus. The contents consisted of altered blood, mucus, and a little pus, and the icterus was found to have arisen from the pressure of the sac upon the gall-bladder and bile-duct at the hilus of the liver. The lining membrane of the cyst was extremely vascular.-Rendu.