A man, aged twenty-three, received a severe crush in the upper part of the abdomen, which rendered him unconscious. When he revived he complained of great pain in the left side of the chest and abdomen and expectorated a little blood. The abdomen was found to be distended and very tender upon pressure, but no tumour could be detected. The urine was blood-stained, and subsequently the stools contained altered blood. There was slight pyrexia for three days. On the sixth day after the accident these various symptoms had subsided and the patient appeared to be quite well. During the third week, however, considerable pain.was experienced in the left side of the abdomen, and a tumour about the size of an apple, elastic and slightly pulsatile, was felt in the affected region. Vomiting now took place each night, the pain increased, and the tumour rapidly enlarged and extended to the right of the median line. Finally symptoms of intestinal obstruction appeared, vomiting was urgent, and the abdomen became distended. On puncturing the tumour three quarters of a litre of a gummy fluid containing altered blood was withdrawn, after which the mass disappeared and the abdominal symptoms subsided. After a short interval the tumour reappeared and the pain and vomiting returned. The appetite, however, remained good and there was no pyrexia. In the left hypochondrium, between the navel and the ribs, a large elastic swelling could be felt, the outline of which was fairly defined below and to the right but indistinct above. The tumour was dull on percussion, fixed, and apparently lay above the transverse colon. An exploratory operation was determined upon, and when the belly was opened the tumour was found to be a large cyst situated in the anterior wall of the stomach and beneath its serous coat. There were no adhesions. The wall of the cyst was two or three centimetres in thickness, and it contained three litres of black blood. Drainage was effected and complete recovery ensued.-Ziegler.
(5) Lymphangioma, or Chylous Cyst, has been described by Engel-Eeimers. The patient was a man about fifty years of age, who succumbed to haematemesis. After death an ulcer was found upon the posterior surface of the stomach, which was adherent to the pancreas. The lesser curvature was greatly contracted, and upon the outer surface there was a soft hemispherical swelling, covered by peritoneum, which contained a milky fluid. The contraction of the upper border of the stomach had probably obstructed some of the lymphatic trunks which traverse the subperitoneal tissue in that region of the organ.