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pressure, but the tenderness was general and not localised toany one part. The breathing was moderately rapid, theupper part of the chest only being used. Nothing abnormalcould be detected in the chest. The temperature was 102° F.and the pulse was 125 per minute. The boy’s general aspectwas one of pain and anxiety. As I was by no means clear inmy mind as to the cause of these symptoms I awaited furtherdevelopments The following morning the boy was aboutthe same but the abdominal symptoms were not so marked.There was less rigidity of the abdominal muscles and theknees were at times extended. The temperature was higher(103°) and the breathing was more rapid. In the evening finecrepitations could be heard at the base of the right lung andthe case ran the usual course of one of lobar pneumonia.On the third day after the onset the abdominal symptomshad quite disappeared. The patient made an uneventfulrecovery.

I have had the opportunity of seeing a similar case of anadult exhibiting the same apparently acute abdominal

symptoms which gradually gave way as the physical signsof pneumonia manifested themselves.

Leicester.

SARCOMA OF THE FEMUR.

BY FRANK A. ARNOLD, M.B. LOND.

THE following notes of a case of sarcoma of the femur mayinterest those who study the pathology of disease in peopleother than Europeans.A yo; ng adult native was admitted into the Memorial

Hospital, Bulawayo, on Oct. 15th, 1898, suffering from alarge swelling over the lower third of the left femur. Hestated that he first noticed that his thigh was swollen at

Christmas, 1897, and that the swelling had since steadilyincreased. On admission a large tense tumour was foundover the lower third of the femur, attached to both the boneand the skin. There was no fluctuation. The skin was brokenfor an area of about the size of a half-crown and the woundso formed was very foul. The swelling was about six inchesacross at its widest diameter and was fairly well defined androunded. It was very painful but not tender to the touch.The veins of the skin over the swelling were not muchenlarged. The glands of the groin were not more enlargedthan would be accounted for by the skin wound. The

"boy" had been picked up on the veldt and was

weak although not emaciated.’ Examination showed no

affection of any other part of his body. Amputation at theupper third was at once performed. Three days later the

patient complained of pain in the right lung and he had acough and slight hoemoptysis. Examination revealed crepita-tions all over the front of the right chest but no appreciabledulness. The pain was very great. The chest symptomsbecame more marked and in about 10 days definite dulnessover the lower lobe of the right lung could be made out andfrom this time onward the signs of lung affection becamemore and more marked. The superficial veins of the bodybecame enlarged and the face and neck, especially on theright side, became oedematous. There was no ascites. Thepatient died on Feb. 12th, 1899.Examination of the amputated thigh showed that the

growth had started inside the shaft of the bone at itsjunction with the condyles and had eaten through theanterior surface of the femur, splitting off the internal

condyle from the rest of the bone. Haemorrhage had takenplace into the centre of the growth which was well definedexcept at the junction with the bone and the point where theoverlying and adherent skin had given way. The post-mortem examination showed that the bases of both lungs andthe mediastinal glands were occupied by a firm whitesecondary deposit. Elsewhere both lungs were studded withwhite isolated patches, some rounded and dimpled and otherslarge, irregular, and undergoing cystic degeneration. Onlysmall areas of healthy lung tissue were to be found in eitherlung. All the other organs of the body were healthy as wasalso the bone with the marrow of the stump. Microscopicalexamination showed the original growth in the femur to bea myeloid sarcoma and the secondary growth a spindle-celledsarcoma.

!<’ The point of interest in this case is that it shows that amalignant growth in a native may be identical in its origin,progress, and structure with a similar growth in Europeans.The boy" was assumed to belong to the Zulu tribe.

o Although his skin was somewhat lighter in colour than ise usual I do not think that either of his parents was a1 European. It is possible that there was a strain of European. blood in the patient but if so it must have occurred two ort three generations back.1 Memorial Hospital, Bulawayo, South Africa.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

ST. MARY’S HOSPITAL.A CASE OF PERFORATION OF GASTRIC ULCER; OPERATION;

RECOVERY.

(Under the care of Dr. SIDNEY PHILLIPS andMr. A. QUARRY SILCOCK.)

Nulla autem est alia pro certo noscendi via, nisi quamplurimas etmorborurn et dissectionum historias, turn aliorum turn propriascollectas habere, et inter se comparare.-MoRGAGNi De Sed. et Ca2ce.Morb., lib. iv. Proaemium. -

THE following case presents several features of interest.In the first place, 33 hours elapsed from the time at whichthe perforation occurred to the time of operation and yet the

, patient recovered, and this successful result cannot be attri-buted to the absence of the gastric contents for only an hourpreviously to the perforation she had partaken of a meal andpeptonised milk was given even later. The fortunate issuemust be ascribable in part to the smallness of the apertureof perforation and the rapid formation of peritoneal adhesions.We have on several recent occasions pointed out the rarityof a successful result in perforation of the stomach whenmore than 24 hours have elapsed between the perforation andthe operation. This case also illustrates the great value ofa gauze drain, for its presence, rendered harmless the failureof the first attempt at closure of the perforation. The occur-rence of parotitis in abdominal cases is always of interestand Mr. Silcock’s suggestion as to the cause of this complica-tion is very ingenious and may serve to explain many at leastof the cases, if not all. We consider his recommendationsas to the prophylactic treatment to be well worthy of trial.A girl, aged 20 years, had in September, 1896, an

attack of pain in the upper part of the abdomen with vomit-ing and kept her bed a week ; since then she had beensubject about every three months to attacks of the samecharacter but of less severity and without vomiting.Between the attacks she had been free from pain and hadnot restricted her diet in any way. She had an attack inFebruary, 1898, and one in May of the same year. Therehad never been any hasmatemesis. The attacks were

regarded as hysterical. She was unusually well duringAugust and until Sept. 14th, 1898; on the 13th she ate araw apple as she had frequently done before and had no dis-comfort after it. On the 14th she ate breakfast as usual andat 11 A.M. she took some cocoa and bread and butter ; onehour later she experienced severe pain in the upper part ofthe abdomen and lay down on the floor. Soon afterwards shevomited. Dr. A. B. Rendel, who saw her in the afternoon,found her somewhat collapsed, and he had a bed made upfor her in the room where she was taken ill. She had pep-tonised milk and ice to take. The evening temperature was100&deg; F. ; during the night there was pain in the abdomen andshoulders and she vomited twice. She was sent to St. Mary’sHospital on the 15th at 5 P.M. Dr. Phillips saw her at7 P.M. She was a well-nourished, healthy-looking girl. Theface was nusbed, there were slight dark areolse under theeyes, the features were a little pinched, the tongue wasclean, abdominal movements were a little restrained, andthere was hypersesthesia over the whole abdominal surface.She complained of pain in the right iliac fossa, but therewere no dulness on percussion, no tumour, and no tendernessin this region ; there was, however, acute tenderness over anarea of about two square inches immediately to the left ofthe linea alba just above the level of the umbilicus; herethere was more resistance than elsewhere and slight defect inpercussion resonance. Liver dulness could be mapped out in