mammoth tube was employed, the rays " passing vertically from a distance of 20 inches. The interest of the case would seem to be centred in the following points. 1. The absence of symptoms, with the exception of the girdle pain, until the day of his accident. In a young individual symptoms are rare at first, but when the sufferer has reached the age of the patient under discussion pressure symptoms are commonly present. 2. The possibility that the accident had resulted in partial dislocation of

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... the cervical rib, so inducing an acute onset of the typical symptoms. 3. The great length of the cervical rib as shown in the X ray photograph. 4. The explanation of the distribution of the pain. The pain down the inner side of the arm and affecting the inner fingers, as described above, was due to pressure upon the lower nerve trunk of the brachial plexus, resulting in sensory disturbance in the areas of skin supplied by the lesser internal cutaneous, internal cutaneous, and ulnar nerves. The pain spreading in girdle fashion round the left ribs, which had been attributed to dyspepsia. was probably reflex in origin, passing from the lesser internal cutaneous to the second intercostal nerve by way of the intercosto-humeral nerve which communicates with both. R.A.M.C. (T.F.), 4TH NORTHERN GENERAL HOSPITAL. As peritoneal or omental fibromata are not very common it seems worth while placing the following on record. The patient, a married woman aged 37, was sent to me by Mr. H. H. Ballachey, of Heckington, and admitted to the Lincoln County Hospital on May 9th suffering from an abdominal tumour. She had had four children (three now living), one miscarriage 11 years ago, the last child having been born seven years ago. For eight years past she had noticed a "lump" growing in the left iliac fossa. In September, 1915, this suddenly increased in size and became more centrally placed in the abdomen. She complained of a good deal of abdominal pain (rather vague, dragging and referred to the epigastrium), and had had several attacks of vomiting. Neither of these had borne any time relation to food. The bowels generally were rather confined, and there had been some loss of weight. She was anaemic and emaciated. A plainly visible tumour occupied the entire umbilical, lower part of the epigastric and the major part of the left iliac fossa, moving with respiration. It was very freely movable within the abdomen, attended with little discomfort to the patient. It appeared to consist of a hard central portion, surrounded by a very soft but not exactly fluid peripheral part. No pulsation was felt in the tumour. The percussion note over the whole tumour was dull, otherwise the abdomen was normal. Examination per vaginam: Uterus normal in size, freely movable irrespective of the tumour. Right ovary felt to be normal; left one could not be felt owing to the left fornix being occupied by the new growth. As she was menstruating operation was delayed until Mayl5th. A central incision about 6 inches long was made with its centre at the umbilicus. The tumour presented itself at the wound directly the peritoneal cavity was opened. It was possible to lift the tumour bodily out of the abdominal cavity, when it was found to be attached to the great omentum, which covered it entirely, by a flattened pedicle about 1 inch wide and several inches in length (joined on to a piece of small intestine), which carried two large arteries and two large veins which were continuous with the vessels of the great omentum. This pedicle was ligatured, cut, and the tumour, which weighed 6 lb., removed. Beyond a clot of coagulated lymph in the pouch of Douglas and some engorgement of the omental vessels, the contents of the abdominal i cavity seeried quite healthy ; the uterus, ovaries, and uterine ligaments certainly were so. The wound was closed, the peritoneum being sewn up with continuous catgut sutures and the skin wound with intermittent silkworm gut sutures. The operation lasted 25 minutes. Open ether was administered as the anaesthetic. The patient made a speedy convalescence and was discharged one month after the operation, having gained 1 st. in weight. The tumour was sharply divided, apparently into two entirely separate zones. The outer cortical one had obviously undergone complete colloidal degeneration, and was soft and gelatinous in consistence. The inner part or medulla of the tumour was hard, white in colour, and friable in parts. The entire tumour was distinctly nonvascular, except for the vessels at and in the pedicle. The Clinical Research Association reported on it microscopically as follows: "The tumour is composed of a connective tissue stroma with cell elements varying in different parts. The general structure is that of a fibroma, undergoing degenerative changes, with large areas of necrosis. There is no evidence that it is a malignant growth." For the notes and for kind and skilful assistance at the operation I have much pleasure in thanking our resident medical officer, Mr. A male child aged 15 days, very emaciated and apparently dying, was admitted to Clayton Hospital under the care of Captain J. W. Walker, R.A.M.C. (T.), senior honorary surgeon. The history obtained was that for four days the child had vomited everything given, had seemed in great pain, and had had no motion for that period in spite of aperients. On admission, the vomiting was frequent and fsecal, and a left irreducible inguinal hernia was found. Captain Walker operated immediately on the child. Under chloroform the sac, which was tightly strangulated, was found to contain large bowel in just good enough condition to be returned to the abdomen. The testicle was found to be gangrenous, probably from pressure, and was removed. The child made an uninterrupted recovery. The interesting points of the case are: The extreme youth of the patient; his moribund condition on admission ; the length of time during which, judging by the symptoms, the hernia had been strangulated and the fact that the vomiting was fseeal; and the necessary removal of the testicle. In the circumstances the recovery was very satisfactory.