depressions well marked, no irregularity no- ticed in clavicle or sternum. Lower part of left chest when viewed from front appears to be more prominent than the right, epigastric angle normal, 70*.
Posterior view of cheat, — Round shoulders, right inferior angle of scapula projects from the side, scapula not thickened. Angle of left scapula half an inch lower than the right. Lower part of the chest is very promi- nent, and the patient has a lateral curvature of the spine to the left involving the lower dorsal and upper lumbar regions. Spines of vertebrcB not enlarged, evenly distributed and freely moveable, except in the lower dorsal region which, together with the upper two or three lumbar vertebrae, form a scoliosis to the left.
Left erector spinte stands out in relief; no irregularities felt on ribs, left intercostal spaces much narrower than the right, tip of finger not able to be introduced.
The crest of the ilium, antr. supr. spine, &c., not involved.
Lunge. — Chest movements limited equally on both sides, percussion note normal, breath sounds normal.
Heart. — Apex beat in the fifth space half an inch inside nipple line, pulse 100 per minute, regular ; heart sounds normal.
Abdomen, — Spleen and liver not enlarged.
Nervous system. — Sensation in touch, tempera- ture, muscular sense, all normal ; slight tender- ness of muscles on firm pressure; muscular strencvth less than normal.
Reflexes. — Plantar i^flex diminished; abdo- minal reflex noimal; knee jerk exaggerated; ankle clonus absent; pupil reflex normal.
Eyes. — Field of vision and colour sense normal.
Ears, — Left not so acute as the right.
Urine clear, sp. gr. 10—16, acid in reaction, sugar and albumen absent.
Comments. — The case is interesting because of its rarity. I cannot find any records of a similar case in the hospital reports of the General Hospital, Madras. As to diagnosis, I think there can be no doubt that it is a case of pulmonary osteo-arthropathy without any pul- monary symptoms or physical signs. The only diseases with which it might be confused are acromegaly and osteitis deformans. In the former the changes which take place are almost entirely in the bones of the face, hands and feet, all the long bones being free. Again, the whole of the hand is involved, giving it the appearance of being overgrown ; optical symptoms are also common. As to osteitis deformans, it is essentially adisease of the fourth decade of life and is charac- terised by general thickening of the long bones, with bending of the same. Thickening of the frontal bone is also well marked, giving the characteristic appearances. From the descrip- tion of the case above it will be seen it does not '
comply with that of either acromegaly or mollities ossium, but will tally with the usual description of cases of pulmonary osteo^-arthro^ pathy, vide text-books — Osier.
The case remained in hospital for about two and-a-half months, during which time he iin<- proved in general condition under tonic treat- ment, but no diminution was noticed in the osseous enlargements. My thanks are due to Lieutenant-Colonel J. Maitland, i.M.a, for the photograph.
A SIMPLE WAY TO COMPRESS THE SUBCLAVIAN ARTERY.
By L. B. SCOTT, M.S. (CAMB.)
While examining a recruit's heart, I found a systolic murmur at the base. I traced it upwards and found it loudest beneath the outer half of the right clavicle. Here it was very loud, and with it were very marked thrill and pulsation. I also heard it along the brachial artery as far as the elbow. Was it aneurism ?
I found the same condition on the left side. I told the man to drop his shoulders, and the phenomena at once ceased.
They were due to compression of the sub- clavian arteries between the clavicles and first ribs caused by the position of attention, with shoulders pressed back, in which the man was standing. By pressing his shoulder back- wards and downwards I could obliterate his radial pulse.
I can produce the same conditions in myself, and have since found the same murmur and thrill in many recruits standing at attention, though never again so markedly as in the first man whose subclavians were abnormally ex- posed and palpable behind the costo-coracoid membrane.
OPERATION OF CAESARIAN SECTION: RECOVERY.
By J. STODART,
Captain, I.M.S.,
Aligarh.
SoNAZAN, a Bengali primipara at full term, age 30, was admitted on the evening of 23rd August 1903. She had been in labour since 3 A.M. I saw her at 7 p.m. and found her in an exhausted condition, the pains having practically ceased.
On examination I found prolapse of one arm. I tried in vain to return the prolapsed limb with a view to the operation of turning, but was quite unable to do so, both from the inelasticity and want of dilatation of the parts, and from the chifd being fixed nearly immovably in its position. After half an hour's hard work in t
attempting to turn I gave it ug, anddeclde^OQlC
