The following case seems interesting because of its rarity and the fact that the condition escaped unrecognized for many years.The patient, a woman of forty, single, a native of Canada, presented herself at the Highland Hospital, Fall River, for treatment. Her family history and past history were both good. Her present trouble began fifteen years ago and has consisted solely of pain in the third finger of the left hand. It was of very gradual onset, soon became persistent and steadily increased in severity. There was no history of injury nor was there any reason to suspect that her occupation, a dressmaker, contributed to the cause. For five years she had not worn a glove on the affected hand, inasmuch as contact of the finger tip with any object caused acute pain, as did also gently tapping the end of the finger. Motion of the finger, however, caused no added discomfort.For the past three years it had been severe enough to keep her awake unless she took aspirin. At first five grains were sufficient, but at the time that she entered the hospital, it required fifteen grains to control the pain so that she could obtain sleep. She was never awakened by the pain.Various local treatments and internal medications had been tried, and section of the digital branches of the median nerve along the sides of the finger had been proposed.Local examination was negative, except for acute pain which was caused by tapping the finger tip. In the routine physical examination, however, a small, hard, fixed mass was found just above the left clavicle. It was not tender, but pressure on it increased markedly the pain in the finger. Physical examination was otherwise not remarkable. X-ray examination excluded the possibility of a cervical rib and showed a faint outline of the mass, apparently connected to the superior surface of the first rib.At operation an incision was made over the mass and dissection carried down to the brachial plexus, one trunk of which was found resting upon an indurated nodule, 2 cm. in diameter, involving the first rib. The nerve trunk was retracted and the nodule together with a portion of the rib, 3.5 cm. long, was resected. Subsequent examination of this specimen showed a periostitis. Her convalescence was rapid and uneventful.She reports now, a year following the operation, that sho has had no recurrence of the pain in her finger, and feels perfectly well.-The secretary of the Michigan State Board of Health has informed the health officer of Benton Harbor that the state has no provision for the care of lepers and cannot, therefore, assume responsibility Free fascia transplantation in plastic operations is a procedure which has proved of value in a number of applications. Ach1 has employed it successfully in fixation of the rectum and of the kidney.In the treatment of floating kidney the steps of the operation are as follows: A vertical incision is made over the edge of the sacro-lumbalis eight to ten centimeters long, exposing the kidney. The necessary displacement is easy. A longitudinal incision is made ...
