Case Shown at the F.R.C.S. Class.

History of present illness: Eighteen months ago she first noticed a painless lump above the left clavicle. It was about the size of a chestnut and had not increased in size since that time. Three months ago she began to have pain in the left shoulder which spread over the spine of the scapula and deltoid region and also down the outer side of the arm as far as the elbow. This pain was intermittent, usually aching in character, but occasionally it was sharp. It was not made worse by using the arm. She felt generally weak and lifeless, nervy, and was always sleepy. Appetite very poor. Bowels-obstinate constipation. Micturition normal. Had lost i4 stones in weight in the last three years.