liver is a rare malady in which the liver forms an abdominal
prominence that may be moved about, and which changes its situation as
the patient shifts the attitude. The condition usually arises from a
lax abdominal wall following repeated pregnancies. The accompanying
illustration exhibits a typical case verified by postmortem examination.

Hypertrophy of the Liver.--The average weight of the normal liver is
from 50 to 55 ounces, but as noted by Powell, it may become so
hypertrophic as to weigh as much as 40 pounds. Bonet describes a liver
weighing 18 pounds; and in his "Medical and Surgical Observations,"
Gooch speaks of a liver weighing 28 pounds. Vieussens, the celebrated
anatomist, reports an instance in which the liver weighed 20 pounds,
and in his "Aphorisms," Vetter cites a similar instance. In 1811 Kraus
of Germany describes a liver weighing 25 pounds; modern instances of
enlarged liver are too numerous to be quoted here.

Rupture of the gall-bladder, although generally followed by death, is
not always fatal. In such cases bile is usually found in the abdominal
cavity. Fergus mentions a case in which, after this accident, the
patient was considered convalescent and was walking about, when, on the
seventh day, peritonitis suddenly developed and proved fatal in two
days. Several cases of this accident have been reported as treated
successfully by incision and drainage (Lane) or by inspiration (Bell).
In these cases large quantities of bile escaped into the abdominal
cavity. Peritonitis does not necessarily follow. Cholecystotomy for
the relief of the distention of the gall-bladder from obstruction of
the common or cystic duct and for the removal of gall-stones was first
performed in 1867 by Bobbs of Indianapolis, but it is to Marion Sims,
in 1878, that perfection of the operation is due. It has been gradually
improved and developed, until today it is a most successful operation.
Tait reports 54 cases with 52 perfect recoveries. Cholyecystectomy, or
excision of the gall-bladder, was first practiced in 1880 by Langenbuch
of Berlin, and is used in cases in which gall-stones are repeatedly
forming. Ashhurst's statistics show only four deaths in 28 cases.

At St. Bartholomew's Hospital, in London, is a preserved specimen of a
gall-bladder which had formed the contents of a hernial sac, and which,
near the fundus, shows a constriction caused by the femoral ring. It
was taken from a woman of forty-five who was admitt