Necrosis of Scapula

Nyab, a fairl}7, healthy-looking Pathan, aged about 20 years, came to the Parachinar Dispensary, in the Knrram Valley in July 1895, complaining of a swelling on the light side of his back of one year's duration. On examination there was found to be an oval fluctuating swelling extending upwards to near the spine of the right scapula, inwards to within about four inches of the spinous processes of the vertebrae, downwards to the ninth rib, and outwards to the mid axillary line. The skin over it was health}'-, freely movable, and contained some slightlj-dilated veins. The swelling was evidently overlapped below by the latissimus dorsi muscle. In the lower part of the swelling a hard plate which seemed about one and a half inches long and broad, could be grasped between the fingers and thumb and moved about freely in the swelling; also there was some soft crepitating material, feeling liIce lung but evidently free within the lower part of the swelling. He could remember no injury or other cause for his complaint. He said the swelling had been tapped three times and fluid like water