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The examination for disease in the gastrointestinal system commences with the inspection of the lips and oral cavity. An assessment is made of the general state of the teeth as well. The abdomen is divided into 9 areas by drawing two horizontal lines, one at the level of the lower costal margins and the other between both anterior superior iliac crests. The areas are designated as follows: (1) right hypochondrium, (2) epigastrium, (3) left hypochondrium, (4) right lumbar region, (5) umbilical region, (6) left lumbar region, (7) right iliac fossa, (8) hypogastrium, and (9) left iliac fossa. The abdomen is examined with the patient lying comfortably, hands by his sides, and head on one pillow, the bladder ideally having been emptied. To ensure that any mass felt is within the abdominal cavity and not in the abdominal wall, the patient's abdominal musculature is contracted by asking him to flex his neck against resistance by the examiner. Intra-abdominal masses become less easily palpable.

The sixth example of "centrifugal lipodystrophy of infants" is reported. A Japanese girl aged 3 years exhibited a well-defined large depressed lesion of the skin accompanied by slight redness of the surrounding area. This appeared in the left inguinal area seven months after birth and spread centrifugally to the navel region and left lumbar region. A biopsy specimen showed a decrease of the subcutaneous fat and an inflammatory infiltrate In the lower dermis and subcutis.

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[This report of a brief illness of Dr. Osler's was recorded by the attending physician, Thomas B. Futcher, and was found by Dr. Palmer H. Futcher in his father's files.] Patient: Dr. William Osler Dec. 31, 1904 Address: 1 W. Franklin Street Age: 55 Condition: Married Sex: Male Diagnosis: Renal colic, gouty diathesis. Nat.: Canadian Family History. —Not taken. Personal History. —With few exceptions has always been a healthy man. No previous attacks similar to the present one. Present Illness. —While reading at the Medical and Chirurgical Library an article on "Strangulation of the Bile Ducts by Round Worms," by Ebstein, patient began to have pain in the left lumbar region of back. He immediately started for home, hailing a cab on the way. Pain gradually became more severe and was intense by the time he reached home about 6:30 p.m. It was so intense that he felt faint. He

The author describes a case of acute pancreatic necrosis, in whose clinical picture the appearance of sharp blue-green spots first in the left lumbar region and then in the circumference of the navel and spreading further was noticed.

In January, 1899, a classic case of exstrophy of the bladder in a boy 13 years of age was brought to the writer's notice. The condition of the kidneys was such that rectal implantation of the ureters as a means to relief was not to be considered. The urine discharged from the left ureter contained crystals of the salts of urates and phosphates in great abundance, blood casts, epithelium and epithelial and granular casts. Traces of albumin were also present. The urine from the right kidney was much clearer, of very little more than normal specific gravity, and contained a few granular casts and some epithelium. There was continual pain in the left lumbar region. In view of these facts, the Sonnenberg method was chosen as the one most suitable for application in this particular case. The operation was made in February, 1899. It consisted in the detachment of the

This case is presented because of the unusual lesions observed in the spine. Tuberculosis of the spine usually presents a typical roentgenologic picture and its diagnosis is ordinarily not difficult. REPORT OF CASE History.— A white woman, aged 50, entered Glen Lake Sanatorium, Nov. 18, 1931, with the following complaints: (1) discharging left ear and enlarged cervical nodes; (2) loss of weight and weakness; (3) a mass in the left lumbar region; (4) fever and chills accompanied by occasional night sweats. The cervical adenitis was first noted in July 1931, following a mastoid operation. However, it was later recalled that a few slightly enlarged glands were present before the operation. The left ear had been discharging since the mastoidectomy. Loss of weight amounting to 25 pounds (11.3 Kg.) and weakness had been gradual over a period of two years. The mass in the lumbar region to the left of the

[This report of a brief illness of Dr. Osler's was recorded by the attending physician, Thomas B. Futcher, and was found by Dr. Palmer H. Futcher in his father's files.] Patient: Dr. William Osler Dec. 31, 1904 Address: 1 W. Franklin Street Age: 55 Condition: Married Sex: Male Diagnosis: Renal colic, gouty diathesis. Nat.: Canadian Family History. —Not taken. Personal History. —With few exceptions has always been a healthy man. No previous attacks similar to the present one. Present Illness. —While reading at the Medical and Chirurgical Library an article on "Strangulation of the Bile Ducts by Round Worms," by Ebstein, patient began to have pain in the left lumbar region of back. He immediately started for home, hailing a cab on the way. Pain gradually became more severe and was intense by the time he reached home about 6:30 p.m. It was so intense that he felt faint. He

CONGENITAL NEUROFIBROMATOSIS (Von Recklinghausen's disease) is quite variable in its clinical manifestations.1-3Although the skin, subcutaneous tissue, nerves, vessels, gastrointestinal tract,4and bone may be involved singly or in combination,2acute problems are apparently rare.5The case reported herein is of interest, not only because an acute complication in this condition is rare, but also because this patient demonstrates a serious aspect of the disease, complications from which may attend the surgical management of any patient with neurofibromatosis. Report of a Case A 27-year-old woman was admitted to the emergency room on June 21, 1962, with a painful, enlarging mass in the left lumbar region. At about 5 o'clock that evening, the patient reported that she had squeezed a pustule in this region and a few hours later had noticed a painful, tender, enlarging nodule measuring 3 cm in diameter. The nodule had continued to enlarge