whatever could be traced for this condition: no injury or pressure; no known inheritance of disease; no disturbance of the general health, past or present.

With the help of the hot douche, warmth, and friction, the swelling of the arm very gradually subsided; and, as it did so, the cord-like feeling of the obliterated axillary vein became more distinct. A year elapsed before the vein regained its completely natural condition; but it has now for more than five years been well.

Very similar to this case was that of a regimental servant, 27 years old, previously healthy, and very active, who was sent to me on April 12th, 1855, by Mr. Bossey, on account of the condition of his right arm. This was swollen, and, when it hung down, he had a feeling of weight and fulness as if the blood could not return from it. The arm was indeed about a quarter or a third larger than the other; but its chief enlargement felt as if due to great muscular development. Besides this, however, it had probably some general swelling, which might be from slight œdema of its deeper tissues; its subcutaneous veins were all over-full; there were small bluish spots over the deltoid, as if from small clusters of varicose veins, and the veins over the right pectoral muscles were fuller than those over the left. This condition of fulness extended as high as the deltoid's origins:—the shoulder especially was remarkably broad and large, and there were fulness and some prominence of the upper part of the right great pectoral. The heart's action and sounds were natural; so was the pulse at both wrists, equal and moderately full. It was uncertain how long this state of the arm had existed; it had been

observed only a week; its rate of increase was unknown. The patient remained in about the same condition till May 4th, when he was taken into the hospital, and ordered milk diet; six leeches every third night; and three grains of mercury with chalk every night and morning. He was under this plan for about a fortnight, and certainly improved, the arm decreasing, and its veins becoming less full. Then he had an attack of scarlatina, and while this was running its course all signs of the affection of the arm disappeared. It regained its natural size; the veins were scarcely fuller than in a healthy man; he lost the sensation of numbness, and believed himself well at the end of May.

A marked feature in both these cases was the apparent, and, I believe, real enlargement of the muscles of the limb. I referred to this in a paper published in the Medical Times and Gazette' of March 1858, and soon afterwards received a letter from the late Professor Laurie of Glasgow, from which the following is an

extract:

'I am the subject of one form of that peculiarity which I suspect is not very common, and which depends, as you hint, on diseased or varicose veins.

'In the year 1831, I had an almost fatal attack of Typhus. During convalescence, I was seized with phlegmasia dolens of my left lower limb, attended with exquisite pain in the ham and calf. When the pain bed and dress, I

subsided, and I commenced to leave my was astonished to find that while my right thigh and leg were emaciated, as they usually are after such an illness, my left was nearly, if not actually, as large as

when I took to bed. It was not in any way mis-shapen. or oedematous-simply plump, and full sized. When I recovered so far as to be able to walk, I found the veins enlarged, and, by night, the whole limb oedematous, but in the morning the soft swelling had disappeared, and the muscular enlargement round the calf remained. The excess was at least an inch. For many months I was unfit for much walking; indeed, but for a large laced stocking, I should have been compelled to relinquish my profession. I wore one for two or three years, and then was able to lay it aside, but as I got older, I was obliged to return to its use, and for years back I have worn an elastic stocking. The veins are now decidedly varicose, and the limb becomes oedematous after unusual fatigue. The soft swelling readily disappears under rest, and, as formerly, the muscular enlargement remains. It is, however, now less obvious than formerly, as I am unhappily much less muscular than I was ten years ago.'

The occurrence of acute phlebitis during, or at the beginning, of pyæmia is well known. It is, I think, less considered that cases of the less acute forms of phlebitis are frequent after all the suppurative phenomena of pyæmia have passed by. Some instances of this were related in the last volume of the Reports (vol. i. p. 5). I would not maintain that such cases are peculiar sequences or residues of pyæmia. They may rather be reckoned among a class of cases of what may be called 'post-febrile phlebitis;' for after any illness attended with acute fever, and often without any very marked exhaustion, it is not rare to find one or more veins of the limbs becoming almost

suddenly painful and hard, and then to see oedematous swelling of the parts beyond them. Such attacks of phlebitis seem especially common after

typhoid fever.

They usually subside without treatment. Among many instances, I have seen nothing worse than an interruption or a delay of convalescence, followed by permanent enlargement, but not disability, of the limb.

The overgrowth of parts whose veins are obstructed, to which I have referred, is very notable in the rare instances of phlebitis in young children. I have lately seen a child five years old, whose right lower limb has for three years been growing larger than the left. In the day, and when long dependent, it becomes oedematous ; but during the night the oedema disappears, and the limb only looks much too large. Many parts of the and part of the skin

thigh are mottled, dusky, and pink, at the knee is coarse-textured and warty. The whole aspect of the limb is like that of the limbs of adults in which, as in Professor Laurie's, the femoral or common iliac vein has been long obstructed. One might suppose it a case of simple hypertrophy, but that the limb is cold, not over-warm; or one of obstructed lymphatics, with growth from retained lymph, but that the blotches on the skin are characteristic of obstructed veins.

310

RESIDUAL ABSCESSES.

UNDER the name 'residual abscesses' I would include all abscesses formed in or about the residues of former inflammations. Most of them are formed where pus, produced long previously, has been wholly or in part retained and become dry, or in some form ‘obsolete.' But some of them, it is probable, are formed in the thickenings, adhesions, or other lowly organised products of inflammation long past.

Abscesses thus formed are probably well known to many; but, to give them a name and separate illustrations may help to show that they are of more frequent occurrence than is commonly supposed, and are often important in diagnosis.

Suppuration among the products of a former inflammation is probably an illustration of what may be held as generally true concerning many relapsing inflammations, namely, that they are due to the disturbed or interrupted nutrition, not only of the tissues deteriorated in previous inflammations, but of the new materials that were formed among them. Thus, in the frequently relapsing inflammations of testicles, and joints, and other parts that one sees in a constantly fretful' state, the weakness,' low