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Aberdeen Royal Infirmary about midday on April 28th, 1902.He was sent in from the country as ’’ an urgent case ofappendicitis with probable abscess. " His illness beganabout a fortnight before admission and was the first time hehad had any trouble in the region complained of. The first

symptom was colicky pain at first centred around theumbilicus but by the next day localised to the right iliacregion. It was increased by movement of the right leg. Ashis bowels had not been moved for several days (a frequentcondition) his medical attendant prescribed repeated dosesof sulphate of magnesia. Movement of the bowels, however,produced no relief. He began to feel sick but did not vomit.About the eighth day of the illness there was first felt asmall tumour which had developed in the right iliac fossa.The patient himself had never noticed any swelling in thatregion before. During the next few days it rapidly in-creased in size and became much more tender. Poulticingdid not relieve the pain. Finally, after a little delay fromreluctance on the patient’s part, he was removed to hospital.On examination the temperature was 97.4° F., the pulsewas 99, and the respirations were 24 per minute. A ratherfirm and very tender sausage-shaped swelling, about fourinches long by two inches broad, was felt deeply set inthe right iliac fossa. It lay somewhat obliquely with its

long axis directed downwards and inwards and it hadits middle point rather below and external to McBurney’spoint. There was slight bulging of the skin over it but nodiscolouration or, indeed, any sign of an abscess. Arectal examination disclosed the same hard, tender mass.There was no fluctuation between the fingers. The rectumwas packed with hard fæcal masses. On making the routineexamination the right half of the scrotum was found to beempty. Nothing was to be felt as far as the external ring.A large soap enema was given and at once produced a copiousresult. This was repeated with like success at seven o’clockand a small dose of saline aperient was subsequently given.After the first injection the pain began to abate and sub-sided steadily during the following days. The bowels were

fi eely opened with castor oil. By 10 days the swelling wasonly about as large as a walnut, and it had entirely dis-

appeared when, at his own request, he left the hospitalwards three weeks after admission.

Medical Societies.MEDICAL SOCIETY OF LONDON.

President’s Opening Address.-Ovarian Tumour secondary toCancer of the Breast.

A MEETING of this society was held on Oct. 13th, Dr.W. H. ALLCHIN, the President, being in the chair.The treasurer’s report and balance-sheet for the year

ending Sept. 30th, 1902, as passed by the auditors, werepresented and showed the society’s finances to be in a

satisfactory condition Votes of thanks to the retiringPresident (Dr. W. H. Allchin), the retiring secretary (Dr.A. F. Voelcker), and the retiring members of the councilwere then proposed and carried by acclamation.Mr A. PEARCE GOULD, the incoming President, then took

the chair and delivered his opening address. He com-menced by conveying the thanks of the society to Dr. W. H.Allchin for the presidential badge which he had presented tothe society. In opening the 130th session of the MedicalSociety ot London Mr. Gould made reference to the losswhich they had suffered by the death of Professor RudolfVirchow who had exercised so marked an influence upon twogenerations of pathological observers. Reference was madet Professor Virchow’s breadth of mind and the wide extentof his knowledge and interests. It was doubtful, the Pre-sident remarked, if the medical profession always took itsrightful part in the political life of a nation. The advancein medical science during the last century was then referredt" and the great lack of knowledge which still existed. Buta review of the past formed a basis for hope that furtheradvance would be made in the future. The President con-cluded by emphaising the value of medical societies in

general for the diffusion of knowledge, for criticism

encouragement, and the interchange of ideas. Mr. J. BLAND-SUTTON read a paper on a case of Large

Ovarian Tumour secondary to Cancer of the Breast. The I

patient was a woman, aged 35 years, the mother of onechild, from whom the right breast was removed for cancer inJanuary, 1894. This was followed by recurrence three year;-,and again four years, afterwards, removal being resorted toon each occasion. In January, 1899, the left breast becameinvolved and it was in turn removed. The patient remainedquite well for two years, but in January, 1902, a tumourappeared in the abdomen which was removed in March ofthis year. The patient had made satisfactory progress upto the present time. Five gallons of fluid were removedin addition to the large, solid ovarian tumour exhibited.The tumour measured seven inches in its two chiefdiameters, was dense, hard, and presented the microscopic

structure of mammary cancer in its most typical form. Thecase presented the most remarkable example of a cancerousgrowth in an ovary secondary to cancer in the breast whichhad come under his (Mr. Bland-Suttons’) notice It alsoraised the question of the relative frequency with whichcancer attacked both breasts concurrently or after an

interval of months or years. Both conditions were veryunusual in Mr. Bland-Sutton’s experience. He had come tothe conclusion that when a woman had one breast removedfor cancer she was five times more likely to have secondarydeposits of cancer in one or both ovaries than in the remain-ing breast.-Mr. JONATHAN HUTCHINSON, jun., remarked onthe size of the tumour exhibited and its limitation to one

ovary. He had twice met with recurrence of cancer in theovaries secondary to the breast, b-:t both were smaller thanthe specimen shown. Details were given of one of two easeswhich was remarkable for the rapid and widespread depositof nodules in the skin. The recurrence of cancer in the

opposite breast was undoubtedly rare. It was formerlyregarded as a contra-indication to operation, but he (Mr.Hutchinson) had known such operations performed upon thesecond breast to be followed by the most successful results.-Dr. J. VINCENT BELL (Rochester) referred to a case in whichrecurrence took place in the opposite breast in a womanabout 35 years of age No further deposits had occurredsince the operation which was performed five years ago.-The PRESIDENT remarked that the specimen was unique inits size. As to the frequency of recurrence in the oppositebreast he could not agree that it was altogether rare. Themost interesting question was whether the tumour whichoccurred in the opposite breast was a de novo formation or atrue secondary deposit, and he inclined to the former view,cases being referred to by way of illustration in which thestructure of the tumour of the second breast differed in someway from that of the tumour in the breast first involved.He-would -certainly advise operation on the second breastwithout delay. He asked Mr. Bland-Sutton on what data

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his statistical estimate of the relative frequency of secon-dary deposits in the ovary and breast was based?-Mr. BLAND-SUTTON, in replying, stated that malignantdisease in children exhibited a tendency to involve organsbilaterally, but in the adult unilaterally. In reply to thePresident’s question he said that as the result of his inquiriesinto cases of mammary cancer at the Middlesex Hospitalwith the late Mr. Leopold Hudson he (Mr. Bland-Sutton)had come to the conclusion that whereas the probablerecurrence of the disease in the ovaries was 10 per cent., itwas only 1 or 2 per cent. in the opposite mamma.

CLINICAL SOCIETY OF LONDON.

Presidential Address.—Unilateral Atrophy of the OpticNerve associated with Hemiplegia of the Opposite Side.—The Nasal Treatment of Asthma.A MEETING of this society was held on Oct. 10th, Mr.

HOWARD MARSH, C. V. 0., the President, being in the chair.The PRESIDENT inaugurated the session by some remarks

on the various ways in which new lines of work might beopened up for the society which, he reminded them, wasestablished for the furtherance of clinical science, based ondirect observation and analysis of cases. He pointed outthat medicine was not necessarily an inexact science, thoughit had sometimes been so described. It was founded on

biology and other exact sciences and could itself be madeexact. He admitted, however, that progress might appearto be slow and by no means commensurate with the amountof energy and time spent in research work. This was notthe fault of the workers or their methods but depended onthe fact that while seekers after truth in astronomy,chemistry, and similar sciences had solid ground from whichadvance could be made, in medicine the basis of solid

grounds was ever shifting. Turning to the methods andwork of the Clinical Society he suggested that it might bewell to submit certain subjects of current interest to smallsub committees which after full discussion in the society andadequate investigation would give an authoritative opinionthereon.

Dr. LEONARD G. GUTHRIE and Dr. FREDERICK E. BATTENcommunicated a paper on Unilateral Atrophy of the OpticNerve associated with Hemiplegia of the Opposite Side,illustrated by lantern dides. Three cases of this rare con-dition were described, which had, Dr. Guthrie and Dr.Batten remarked, to be distinguished from those in whichatrophy of the optic nerve was bilateral, descending, anddependent on damage to the optic tract on one side of thebrain. In these cases the atrophy of the nerve was uni-lateral, ascending, and due to injury of the nerve itselfby occlusion of the ophthalmic artery or one of its branches,similar to the blockage of the middle cerebral artery,which caused hemiplegia of the opposite side. The firstcase was that of a woman, aged 25 years, anæmic, and

subject to headaches. Sixteen months before admissionto hospital she had a fit during the night and next

day she was paralysed down the right side and hadlost the sight of the left eye. On admission 12 monthslater she was still hemiplegic on the right side andthe left optic disc was completely atrophied. The heartand urine were normal. She died after being in hos-

pital three months, during which time she sufferedseverely from left-sided headaches, vomiting, and con-

vulsive seizures affecting the right side. At the necropsyocclusion of the left middle cerebral artery was found,’causing atrophy of the convolutions supplied by that vessel, ’

together with atrophy of the left optic nerve. The degenera-tion could be traced back into the left optic tract and alsoacross the chiasma into the right optic tract, whilst the rightoptic nerve showed no degeneration, in accordance with thefact that a lesion of one optic nerve gave rise to ascending idegeneration in both optic tracts. The occlusion of vesselsin this case was probably thrombotic and due to ana?mia..The second case was that of a boy, aged 12 years, who fractured his left femur in October, 1900. In February, 1901, after the union of the fracture was complete, he had a ifebrile attack of doubtful nature which lasted about a week and was associated with pain in the left thigh. No cause for the pain could be discovered. A month later he became gradually and partially paralysed on the right side. In May there were slight signs of optic neuritis (retro bulbar) in the left eye and vision was very defective. In June f

the left optic disc was atrophied. By October, 1901,the hemiparesis had entirely disappeared, but the atrophyof the disc remained, although vision had improved. The

boy was anaemic but showed no evidence of endocarditisor of rheumatism. Partial thrombosis of the left middlecerebral artery and of some of its ophthalmic branches wasprobably the cause of the symptoms. As in Case 1, thesymptoms at one time were suggestive of new growth in theleft cerebral hemisphere. The third patient was a woman,aged 22 year.-, who had three eclamptic seizures nine daysafter giving birth to a child. After the third fit she became

hemiplegic on the left side. Several fits occurred duringthe following three months. They then ceased. Threemonths after the first fit the woman found that she wasalmost blind in the right eye. When she came under obser-vation four months later the left arm and leg were in thecondition of hemiplegic mobile spasm and there was atrophyof the right optic disc, which suggested to Dr. RaynerBatten the existence of post-retro-bulbar neuritis rather thanembolism of the arteria centralis retinas. Her urine andheart were normal and she showed no evidence of syphilis.The condition might have been caused by embolism or

thrombosis of the right middle cerebral artery and of its

ophthalmic branches. Other cases of somewhat similarnature were referred to and the pathology and anatomy ofthe condition were discussed. It was concluded thatuuilateral atrophy of the optic disc associated with hemi-

plegia of the opposite side was suggestive of a vascularlesion.

Dr. ALEXANDER FRANCIS (Brisbane), introduced by Dr.Greville MacDonald, made a communication on the NasalTreatment of Asthma. The association of asthma and naaldisease had been noticed from the earliest times, but thegeneral opinion among physicians at the present day seemedto be that little hope of obtaining permanent relief fromasthma could be got from nasal treatment, even in caseswhere nasal lesions were found. Most rhinologists, on theother hand, had faith in the local nasal treatment of asthmawhere obvious trouble existed, but none had suggested theadvisability of treating the nose in cases of asthma when theorgan was apparently normal ; and yet, in Dr. Francis’s

opinion, such were the cases where the most hopeful pro-gnosis could be given. Of the 402 cases recorded, 346 had noapparent nasal lesion, and of these eight only obtained norelief from nasal treatment, while six cases were unrelievedby treatment among 56 which had polypi or other grossnasal lesions. In addition to these failures, in 17 cases theresult of treatment could not be ascertained. From treatingthese cases Dr. Francis had come to the following conclu-sions : 1. That asthma was due to reflex spasm of thebronchial tubes. 2. That the irritation might originate inthe nose ; this was inferred from the intimate associationbetween hay fever and asthma, as disclosed in various cases,and was shown more clearly by the immediate onset ofasthma after certain injuries to the nose, examples of whichwere referred to. 3. That asthma was not directly due toany mechanical obstruction of the nasal passages and wasnot commonly caused by any gross nasal lesion. ’J heassociation of asthma and polypi was not so common as

was generally supposed. When they occurred together hebelieved they were more probably the result of some commonfactor than that they had any direct causal relationship.The best results in cases of polypus had been obtained bycauterising the septum without touching the polypi, whereasin some cases complete eradication of the polypi in-tensified the asthmatic condition. In other cases, wherenasal obstruction from engorged turbinates and asthmaoccurred together, the difficulty of breathing through thenose and the dyspnoea were unrelieved by rendering thenasal passages mechanically free but were both instantlyremoved on applying cocaine to the septum 4. That some

part of the nasal apparatus had a controlling influence uponthe respiratory centre, or there was in the nose, as it we] e,an agency through which the afferent impulses must pass.Numerous cases, some of many years’ standing and of greatseverity, were recorded where cauterisation of the septumremoved all signs of asthma in patients where the excitingirritation was apparently gastric, cardiac, or bronchial in

origin. Full details of the 402 cases were submitted to the

society. The nose was apparently normal in 346 cases,

polypus cases numbered 32, and other gross lesions 24 cases.Complete relief had been obtained in 194 cases, completerelief till lost sight of or i-till under treatment in 30 cases,great improvement in 73 cases, great improvement till lost