MEDICAL MEMORANDA in the right iliac fossa for the preceding 24 hours, but this passed off after defaecation before the boy arrived at the hospital. He admitted to twinges of similar but less severe pain at times in the past. There was no fever, the right side of the scrotum was empty, and the testis was not palpable in the inguinal canal. He returned on November 17 with recurrence of the symptoms, especially on lying down, and tenderness to pressure in the right iliac fossa.On examination no real tenderness was demonstrable and the patient was afebrile. He attended again the same evening because of an aching pain in the right groin. There was marked tenderness over the right inguinal canal, and there was a slight swelling of the right groin compared with the left. There was also a small lump presenting at the internal ring, with a definite cough impulse. His temperature was 990 F. (37.2°C.) and pulse 104 a minute. Subacute torsion of an undescended testis was diagnosed.At operation a small congenital hernial sac with a wide neck was disclosed, with the right testis emerging into the inguinal canal through the internal ring. The right testis was three-quarters the size of the left but otherwise apparently normal. Arising from the caput of the epididymis was a small pedunculated gangrenous appendage wrapped in omentum. The appendage was excised and orchiopexy performed. Macroscopically the appendage was a dull, plum-coloured ovoid mass, 7 mm. long by 4 mm. wide, which from the site of attachment of its pedicle appeared to be an appendix epididymis. Microscopical examination showed: " A tubular columnar epithelium, rather like that of epididymis but spoiled by autolysis. The outer covering is completely missing, probably for the same reason. It does not resemble the available specimens of torsion of the hydatid of Morgagni, none of which has internal tubules."Comment.-This case demonstrates the confusion which can occur in diagnosing this condition. Whether the cause of the torsion was the obvious attempt of the testis at descent is a matter for speculation. There seems to be no previous record of torsion of the appendix epididymis associated with maldescent of the testis.I am indebted to Mr. R. Parkinson and Mr. J. T. Fathi for their permission to publish these cases, and to the latter for encouraging me to do so. I would like to thank Dr. J. W. A Rare Complication of Twin Delivery CASE HISTORY A woman of 47 who had previously had eight full-time pregnancies and one abortion was found to have a twin pregnancy. At the 32nd week she was admitted to hospital for a period of rest as a precaution against very premature labour (Bender, 1952), remaining for over two weeks without untoward signs or symptoms. At the 36th week she developed marked oedema of the legs but no hypertension or albuminuria, and she was readmitted.At 4.15 a.m. on February 22, 1961, 27 days before her expected date of confinement, there was spontaneous rupture of the membranes and strong contractions followed immediately. The first twin was presen...

Apart from vomiting in early pregnancy, vaginal bleeding is the commonest symptom for which the general practitioner is consulted before the 28th week-that is, before foetal viability. A patient may, honestly or otherwise, give a menstrual history which appears to exclude pregnancy; nevertheless whenever there is abnormal bleeding at any time between menarche and menopause a complication of pregnancy must always be considered a possibility. Conversely, not every instance of amenorrhoea followed by vaginal bleeding is an abortion; yet women are occasionally classified as habitual aborters after two or three such episodes where products of conception have never been confirmed, and the basic problem of primary infertility is thereby obscured. For the purpose of this article it is presumed that pregnancy is confirmed or suspected.

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