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appeared healthy; there was nothing abnormal in the chest.Urine: sp. gr. 1022, clear, of a light-straw colour, acid, noalbumen, no cells, no casts.Feb. 5th.-The patient was placed under chloroform and

examined by Mr. Croft. No stone was detected. There

appeared to be a rounded body of small size to the innerside of the growth, possibly an enlarged gland. Urine:

sp. gr. 1035; very acid; excess of urea ; no sugar.7th.-The patient having been placed under chloroform,

Mr. Croft removed the right kidney. A slightly oblique in-cision was made between the crest of the ilium and the lastrib, about four inches and a half in length, ending anteriorlyin the linea semilunaris; this incision was carried down tothe peritoneum, when all bleeding points were ligatured.This incision not being large enough to admit of the tumourbeing extracted, a vertical one was made along the lineasemilunaris about four inches in length, opening the peri-toneum to the extent of two inches and a half; the tumourwas then brought out of the wound as far as the pedicle,which was rather short, would allow. The pedicle was thenligatured in two sections: the first ligature (of silk) includedthe vessels, and the second ligature (of catgut) was placed onthe ureter. After removal of the tumour, the peritonealcavity, so far as it had been exposed, was sponged out, andthe edges of the peritoneum brought together with con-tinuous catgut sutures, after which the skin flaps werebrought together with silk, a drainage-tube being placed inthe most dependent part. The wound was dressed withoiled-silk protective, iodoform, iodoform gauze, and salicylic wool, gauze bandages being used, and over all a flannelbandage. The carbolic spray was used from the time thatthe peritoneum was exposed. The patient was very sicktowards the end of the operation. The parts removed formeda mass as large as an adult fist. Examination showed thegreater part to have been replaced by a large sarcomatousgrowth, there being only normal renal structure on the cir-cumference of the growth, above and below. The growthwas soft, elastic, bulging on section, presenting in parts analmost gelatinous appearance; in others there were smallhaemorrhages. The growth projected into the pelvis of thekidney to some extent at one or two points, and also intothe renal vein. Later microscopical examination proved thegrowth of round-celled character.9th.-Has been going on very well since the operation,

having had neither pain nor sickness. Pulse 144; tonguerather dry, slightly furred. Taking milk, tea, and toast.Wound dressed yesterday and looking well.10th.-Pulse 114; bowels acted after an enema. Wound

dressed.12th.--Pulse 116. He had retention of urine for several

hours during the night, and this morning there is someepididymitis on the right side.15th.-Wound redressed, two stitches removed and the

drainage-tube shortened ; very little discharge.23rd.-Pulse 127. Fluctuation having been felt in the

right side of the scrotum an incision was made, giving exitto a small quantity of laudable pus. The operation woundwas dressed; the granulations were found to be on a levelwith the skin, excepting where the drainage-tube had been.March 11th.-Nitrate of silver applied to granulations on

the right side. Most of the wounds have healed, as also thewound in the scrotum.14th.-Got up.16th.-Wound in right side almost perfectly healed, there

being only a few small granulations not quite skinned over;is dressed with zinc ointment. The patient left on thefollowing day, being very lively and looking remarkably well.The highest temperature after the operation was 1020 at

3 A.M. of the morning after the operation. For eight daysthere was an evening rise, varying from 996° to 101’4°;after that it became lower, rising, however, on more than oneoccasion to over 100° ; this was in all probability connectedwith the epididymitis. The average daily quantity of urinewas about 17 oz. after the operation. The patient continuesin good health.in good mcamu.

Remarks by Mr. CROFT.-The rapid recovery in this casewas partly due to the fact that the operation was performedbefore the growth had infiltrated or attached itself to

neighbouring structures. Its enucleation did not neces-sitate dissection or the use of any force. Authors onnephrectomy have not laid down any rule for the closing ofthe peritoneal wound when this membrane has been disturbed in the course of the operation. It is worthy of observationin this case that the peritoneal wound was sutured inde-

pendently of the rest of the wound ; thus the cavity wasclosed against any exudations from the section of theabdominal wall. It would have been impracticable to havetreated this according to the rules laid down for closingwounds in the median line. The occurrence of epididymitiswas not easy of explanation, as the structural connexionbetween the parts disturbed or ligatured in the loin is notdirect or obvious. Retention of urine came on with theepididymitis, and had not existed before it. It would be

interesting to know if other surgeons have met with thiscomplication.

NEWCASTLE-ON-TYNE INFIRMARY.PRIMARY SARCOMA OF THE RETRO-PERITONEAL GLANDS;

DEATH; NECROPSY; REMARKS.

(Under the care of Dr. PHILIPSON.)J. H-, aged fifty-six, an auctioneer’s clerk, was

admitted on Nov. 22nd, 1884, complaining of pain in theepigastric region of about six months’ duration. His fatherand a brother died of consumption, and another brother ofspinal disease. The patient has had to lift very heavyweights; he has had good food and lodging, and has beenfairly temperate; has had three attacks of rheumatic fever.About six months ago he first experienced a dull uneasysensation in his right side and passing across the lumbar

portion of his back. Pain became more decided and wasgenerally worse at night; it came on in paroxysms withintervals of several hours. Gradually the pain becameworse and the intervals shorter, till now he has seldom tenminutes’ freedom from it. He did his work up to the timeof his admission.When admitted the patient was found to be a man of

5ft. 7 in. in height, and weighing 9 st. 2 lib. (he used toweigh 10st. 71b.). He is slightly cachectic, and has theappearance of suffering acute pain. The tongue is foul,appetite good, but accompanied by great thirst; the painrarely crosses the back now, but starts on the right side,crosses the abdomen at the level of the umbilicus, and endsin the left side. The pain is intensified by lying down, butis relieved by sitting up; the greatest relief, however, is gotby kneeling before the fire with his elbows resting on a lowchair; deep inspiration brings on or aggravates the pain.There is visible pulsation in the epigastric and upper part ofthe umbilical region ; in the right hypochondrium andepigastrium a hard resistant body is felt, reaching in themiddle line nearly to the umbilicus, and in the nipple-lineabout three fingers’ breadth past the free edge of the ribs.This body moves with respiration. As far as can be madeout, its surface is smooth and its edge regular, and it is nottender, though there is pain on deep pressure. There is nopulsation on the right side of the mass, but on the left themass rises and falls with the aorta; there is no expansilepulsation. There is continuous dulness from the seventhrib downwards to the edge of the mass. At the apex ofthe left lung there are distinct signs of consolidation andsoftening.December 5th :-Has lost 1 Ib. since admission. The pain

has become so bad as to necessitate injections of morphia.Temperature varies between 99° and 102° F.31st.-Is still emaciating. Does not complain so much

of pain, but shows decided dementia.January 24th.-Death.Post-mortem examination.-The liver extends down-

wards as felt during life. Its surface is smooth, except onthe under side, where there are two nodules about the sizeof peas. The anterior margin is unusually thin and coversa tumour about the size of the foetal head lying on thespine. This tumour is evidently glandular, and has thepancreas attached to its left side, in front of it the pylorusand four or five inches of the duodenum, and behind it theaorta. The outline of the tumour is fairly regular, but witlaglobular projections at parts. On section it is pretty firm,but with soft portions here and there. On microscopicexamination it proved to be a spindle-celled sarcoma.Lungs: The left apex contained some tubercular depositsand small cavities, while the right had a slight tuberculardeposit. Heart: Mitral orifice narrowed and curtainsthickened. Brain: Considerable amount of subarachnoidfluid. Kidneys : Normal. No other deposits besides thetwo on the under surface of the liver.Remarks by Dr. PHILIPSON.-The chief interest of this

case was in the differential diagnosis of a tumour situated

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in front of the abdominal aorta, from aneurysm. The non-existence of aneurysm was inferred from the absence of bruitin the left vertebral groove, and its pulsation being non-expansile. The existence of cachexia was in favour ofmalignant disease; the age of the patient strengthened thissupposition ; the smoothness of the surface of the liver andits uniform edge indicated that the swelling was glandular,rather than associated with that organ. Another point ofinterest was the coexistence of malignant disease andtubercle, cancer and tubercle being regarded as antagonisticone to the other. The nodules on the under surface of theliver were regarded as secondary, or consequential on theglandular condition; primary cancer of the glands beingrare, while secondary cancer is not uncommon.

Medical Societies.OPHTHALMOLOGICAL SOCIETY.

Ciliary Nerves in Certain Diseases of the Eye.-SpontaneousDisappearance of Diabetic Cataract. -Nævus of Cho-roid. Reflex Ophthalmitis.-Periodic Paralysis of ThirdNerve.- Coloboma.--Rupture of Eyeball.AN ordinary meeting of this Society was held on May 14th,

Mr. Jonathan Hutchinson, F.R.S., President, in the chair.The PRESIDENT intimated that the Local Government

Board had consented to receive a deputation from theOphthalmological Society on the subject of the preventionof blindness from ophthalmia neonatorum.

Dr. BRAILEY read a paper on the Condition of the CiliaryNerves in Certain Diseases of the Eye. Examinations in

ninety cases of the long ciliary nerves, usually of both theinner and outer sides, by sections taken at right angles totheir course in the sclerotic, showed the following results.It must be remarked that, being cases of excision for disease,the morbid process had been in every case severe, and inmost of considerable standing. In primary glaucoma(thirteen cases) the nerve might be perfectly normal, but inabout 22 per cent. there were indications of neuritis, thechanges being, however, usually so slight as not to be incon-testable. In a larger proportion (50 per cent.) the nerveswere swollen, their axis cylinders being large and in-distinct, or not visible at all. It was observable alsothat the average size of these nerves in eyes withglaucoma, whether primary or secondary, was consider-ably (almost 50 per cent.) beyond that associated withnormal tension. Probably this enlargement was due toswelling of the nerve fibrils, as it was found even where themicroscopical structure appeared to be quite normal. It

produced considerable absorption of the sclerotic throughwhich the nerve passed, so that this condition was indicated,especially in the case of the nerve of the inner side, by awide dark-bluish streak corresponding to the course of thenerve. In eyes exciting sympathetic disease the nerve itselfwas usually normal in structure, though it might show slighttraces of neuritis. But inflammation round the artery andnerve, more marked round the former, was found in themajority of cases (85 per cent.). In the sympatheticallyaffected eye it was also found, though not quite so commonly(66 per cent.). He had, however, but three cases of sym-pathetically produced inflammation to examine. In uveitisserosa-independent, however, of any relation to sympatheticdisease-inflammation round the artery and nerve alsooccurred, spreading evidently from the former to the latter.In the five wen-marked cases of suppurative panoph-thalmitis that had been examined, the condition was similarto that above remarked as found in eyes exciting sym-pathetic disease, except that the inflammation around theartery and nerve Was well marked in every case. Inother conditions, such as iritis and irido-choroiditis ofvarious origin, the condition varied, inflammation in andaround the artery and nerve being occasionally found, thoughfar more often absent. Two cases may be particularised :one, a non-suppurative iritis occurring after an iridectomypreliminary to cataract extraction; the other, with changeslike those of progressive myopia-viz., disseminated cho-roiditis at the posterior pole and posterior staphyloma afterleucoma adhaerens. In each of them there was round theartery much inflammation, which had extended into the

corresponding half of the nerve. It was inferred from theabove observations that inflammation of the ciliary nerveswas not the means by which sympathetic disease was trans-mitted ; also that inflammation round the nerves and theircompanion arteries was equally ineffective in this case, as itoccurred at least as strikingly and as commonly in sup-purating eyes. The corneal anaesthesia found in absoluteglaucoma was explained by the degeneration of the elementsof the nerve, which, together with the other changes notedin this disease, appeared to be secondary to the mechanicalpressure upon them.-Mr. NETTLESHIP remarked that serousiritis was not recognised as due to sympathetic irritation.He asked what clinical evidence there was in Dr. Brailey’spossession. Referring to cases of episcleritis about thefront of the eye, he would like to know whether the inflam-mation extended along the outer surface of the sclerotic soas to involve the optic nerve and structures at the posteriorpart of the globe.

Mr. NETTLESHIP read a note on the Spontaneous Dis-appearance of Diabetic Cataract. So far as his literaryresearches went he had found that cases of the kind werevery rare. Two cases were detailed in Dr. J. Seegen’s workon Diabetes Mellitus. Seegen’s first case was that of a managed thirty-nine, who in July, 1863, about six months afterthe appearance of diabetes, noticed that his sight began tofail; the lenses were cataractous and hazy.- Under treat-ment at Carlsbad the lenses cleared; the quantity of urinewas reduced to one-half, but the percentage of sugar re-mained the same. In the spring of 1865 the lens againbecame opaque. The second case was that of a woman agedfifty-five, who was first seen in the autumn of 1867, soonafter which the sight began to fail and became misty; shewas treated for diabetes in February, 1868, and whilst undertreatment the lenses became clear again. Dr. Tannahill’scase was that of a coal-miner, who was seen when in prison.He had suffered from diabetes for eleventh months; bothlenses were opaque throughout, the left more than the right.He was put on the ordinary diabetic diet, and had twograins of opium daily. Whilst under treatment his sightbegan to improve, the opaque lenses gradually cleared, andon inspection when he was discharged from prison no traceof cataract remained. No satisfactory explanation had yetbeen offered as the cause of diabetic cataract. The viewthat the lens contained sugar was a possible explanation,but the idea of a permanent degeneration was not borne outby the facts just narrated; moreover, there was a re-

appearance of the cataract in one case. The abstraction ofwater from the lens owing to an increased density of theblood or fluids surrounding the lens was a likely explana-tion.-Mr. HUTCHINSON said that congenital cataracts in

young rabbits sometimes cleared up.Mr. J. B. LAWFORD read notes of a case of Nævus of

the Choroid. The patient was a girl aged eight, who wasbrought to the hospital on account of pain in the left eyefollowing a blow. The mother did not know how long theeye had been blind. There was a capillary nasvus of theleft side of the face from the forehead to the chin. Therewere no nævi elsewhere. The left eyelids were involved,and presented a slightly puffy appearance. The right eyewas normal. The conjunctiva of the left eye was normal.The lens was opaque and yellow. There was no perceptionof light. The tension was + 2. The left eye was excised.On examination, the choroid surrounding the optic disc,and for a distance of 5 mm. to 7 mm. from its margin, wasthickened (5 mm. to 1 mm.), and spongy in appearance.Under the microscope this area was seen to be channelledthroughout with vascular spaces of varying size, whose wallswere formed only by the choroidal tissue. A few dilatedcapillaries were also visible. Beyond the limits of theneavus the choroid was normal. There was an infundibulardetachment of the retina. The lens was shrunken and itsfibres much disorganised. The iris was atrophied and ad-herent to the cornea at the periphery.Mr. SIMEON SNELL read the notes of a case of a Recurrent

Paralysis of the Third Nerve associated with attacks ofMigraine. The patient, a little girl aged eight, first came underobservation in Nov. 1883. A note made then states: "Thereis complete ptosis on the left side, with divergence of theeye and general paralysis of the third nerve; fundus oculinormal; refraction hypermetropic, about 1’5 D." It wasascertained that she had had a failing of the left eye sincecutting her eye teeth," at eighteen months of age; since thistime she has suffered from attacks of pain in the head andsickness, and at these periods the eye has closed, and after