Dr. Marion Sims attributes to Dr. Handfield Jones, and I think correctly, the merit of first suggesting that the liver and gall-bladder should be included within the field of surgical practice and to my good fortune it has fallen to be the first to follow out Dr. Handfield Jones' idea and Dr. Sims' plan successfully.
" Elizabeth M. --aet 40 was admitted to the (Birmingham) Hospital (for Women) on August 18th. 1879. on account of an abdominal tumour.
" She had been married eighteen years, had borne six children, her menstruation had always been normal and she had enjoyed perfectly good health until the summer of 1878. At this time she began to suffer severe spasmodic pains in the right side, these being always aggravated by walking or by lifting even slight weights. In September she noticed swelling at the seat of pain and this slowly increased. During last winter her pain became much more intense, her appetite failed, she lost strength and flesh rapidly and on admission she presented an emaciated and almost cachectic appearance. She also suffered at that time from incessant headache and sickness and obstinate constipation. The seat of pain was over the right kidney where there was a heart-shaped tumour, firm and elastic, in which no fluctuation could be detected, and which was extremely tender to the touch. On examination under ether this tumour was found to be perfectly moveable towards each side, indeed, it could be pushed completely across the middle line to the left side. All round it a note of intestinal resonance could be produced. When pushed over to the left side, its heart-like shape became very apparent, and when it lay on the left side of the vertebral column, with its apex directed downwards and to the left, its base evidently retained a connection with the right side.