CLINICAL CASES 381 



when she sprained her left shoulder and suffered severe 

 pain in it. On July 19, by the patient's request, 

 the treatment was discontinued, and an opportunity 

 thus arose of observing whether the benefit which had 

 resulted from it was maintained. There had been some 

 sciatica-like pains in the leg since the beginning of the 

 month, and during August these increased and the 

 swelling and pain in the hip returned. Some tender- 

 ness and a tumour, apparently arising from the medias- 

 tinum and which grew rather rapidly, appeared in the 

 mid-sternal region. By the first week in September, 

 she had relapsed pretty much into the condition in 

 which we found her at the time of her admission, but 

 with the added pain due to the thoracic growth. The 

 treatment has now been resumed. 



The second case was that of a woman aged 54, 

 who had suffered from indigestion for a considerable 

 period, but severely for three months. There had been 

 much vomiting, but never any blood. At the time of 

 her admission (February 9, 1911) ingestion of food 

 was immediately followed by severe pain, and often 

 by sickness. She was very wasted, worn-looking, 

 and anaemic. Weight 94 Ib. On examining the ab- 

 domen a swelling could be seen and felt above the 

 umbilicus. It was about the size of a tangerine orange. 

 It was extremely tender, and moved with respiration. 

 The stomach was very dilated, and presented peris- 

 taltic movements. There was pain on pressure over 

 the pyloric region, but no tumour could be felt there. 

 The stools contained altered blood (melcena). During 

 the first fortnight after admission, when she had milk 



