Pulmonary Platelet Thrombo-embolism

was demonstrated radiologically. Apart from a symptomless mitral stenosis, examination revealed no other abnormality. Nine years previously a right radical mastectomy had been performed for a scirrhous carcinoma; the axillary lymph nodes were tumour-free and a careful follow-up did not show evidence of either local or distant recurrence. At the time of admission the blood picture was as follows: Hb 7.1 g., R.B.C.s 3,960,000/c.mm., C.I. 0.6, W.B.C.s 12,700/c.mm. (polymorphs 10,600, lymphocytes 1,800, monocytes 180, eosinophils 120). Platelets were increased in number and were larger than usual, and the red cells showed anisoand poikilocytosis, with some macrocytosis. Gastrectomy had been advised after two years' conservative treatment with diet and iron preparations, because, in spite of temporary relief and a rise in the haemoglobin level, the patient had had further episodes of melaena. The operation was performed under epidural anaesthesia and the ulcer located, when her pulse stopped. Intracardiac adrenaline was administered, and cardiac massage and artificial respiration were temporarily successful, but 15 minutes later her pulse again failed and she was dead.