ligatures bad included the vagus ; (there was no obvious effect at the time of tying them), and there was pneumonic consolidation of the riglit lower lobe.— (Wards of Lieut.-Col. R. H. Charles, M.D., I.M.S.)
Alveolar Sarcoma of Femur. — M. U., male, oet. 20, Mussalman. Fall from horse about six weeks before admission; falling first on to his arms, and then the knees striking the ground ; there was some pain in the knee from the time of the accident, but no swelling was noticed until fifteen days later, which swelling has gradually increased. He was quite able to walk during this period, but from the increasing size he began to get lame. On admission the right knee was semi-flexed and much swollen, the swelling being more prominent on the inner side of thigh and extending backwards, filling up the whole of the popliteal space; it was elastic hut not fluctuating. No pulsation or egg-shell crackling. Slight oedema of the foot, and the pulsation of the pos- terior tibial artery was slightly diminished. Aspiration was performed, but only serous fluid and blood were withdrawn; no sarcoma elements were distinguished. The thigh was amputated at the junction of upper and middle thirds.
On dissection the popliteal surface of the femur ; was eroded, and springing from it were masses of soft yellowish white growth which had broken down, with the formation of cavities containing blood or serum. The popliteal artery and vein were normal. Microscopically the growth was a typical alveolar sarcoma. — (Wards of Lieut.- Col. R. H. Charles, M.D., l.M.8.)
Oangrenous strangulated inguinal hernia, — B.L., male, est. 42, Hindu. Had a right reducible inguinal hernia for two yeai-s. Four days before admission it became strangulated with the usual symptoms. On admission patient not looking very ill, abdomen slightly distended, and coils of intestine visible through the belly wall ; medium- sized hernia, tight and tender. No reddening or oedema of the skin. The sac c<mtained a small quantity of sero-purulent, slightly offensive fluid and the csecum and terminal portion of the ileum. The gut was purple and its walls much thickened; on the anterior surface of the caecum was an oval area of gangrene occupying the position of the anterior longitudinal band, about an inch long and ^th inch broad. The stricture was divided and the gut pulled down and the neck of the sac shut off with gauze ; the gangrenous area was excised, the cut surface bleeding and the gap closed with interrupted silk sutures through all the layers, and with a line Of Lembert sutures. From the thickening of the walls of the gut some difficulty was experienced in reduction, so the canal was partially slit up and a gauze drain put down to the sutured area. One suture was put in the canal. The after progress was satis- factory, gauze drainage discontinued on the third day; bowels opened on the seventh day by enema, and discharged on the sixteenth day. — (Wards of Lieut.-Col. R. D. Murray, m.d., i.m.s.)
CASE OF PULMONARY OSTEOARTHROPATHY.
By T. H. SYMONS,
CAPTAIN, I.M.S.,
General Hospital, Madras.
Anna Mal6, cet 22 years, weaver. Complains of tingling and pain in the joints. Illness of 3 years' duration. Place of birth and residence, Rani, North Arcot. Admitted, 21st February 1903. Examined, 7th March 1903.
Family history, — Parents living, keeping good health, no special disease in the family ; none in his family ever had any complaint similar to what he has now. No history of tubercle in the family.
Previous health. — He had small-pox when seven months old ; no illness of any kind after it, — no syphilis or gonorrhoea.
Social histoty. — Weaver by occupation, tem- perate in habits, always well provided for, unmarried.
History of present illness. — Three yeai*s ago the patient noticed some swelling of the knee- joints, the lower parts of the legs and ankle joints. The swelling, which was least marked in the niorning, used to increase during the day, reach- ing its maximum in the evening, always dimin- ishing somewhat during the night This continued for about two months, at the end of which the parts reached about one and-a-half times the present size. Afterwards the swelling gradually and steadily went down and in six months the parts reached the present size, since which time they have remained stationary. OriC or two months he felt tingling and pain in the parts, which symptoms have persisted up to the time of admission. For the last one year he noticed a symmetrical swelling of the lower part of the forearm-bones and the hands, similar to those of the lower limbs, accompanied with the S'lme tingling and pain.
Since the commencement of the illness, free sweating has* been a prominent symptom, occur- ing during sleep and during the day when the patient is at rest He tires easily on the slightest exertion.
During the last two years he has been very subject to chills, always followed by marked diuresis. His ap|)etite has always been good and bowels regular.
Present state. — The patient is thin, 5 feet 5 inchtfs in height. When the patient stands and the arms are hanging by the side, the left arm appears to reach almost to the upper border of the left patella, while the right reaches a point 1 or 1^ inches higher. There is a symmetrical enlargement of the legs and toes as well as the lower part of the forearm and hands and fingers, all of which enlargement is bopyi in character-
