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suffering in the diseased eye. I advised that the patient be sent to me at once. On February 24, patient came to consult me. Found conjunctiva deeply congested. Tn. plus I; lens cataractions to about three-fourth its extent, the nasal side being comparatively clear. By oblique illumination I could get a reflex of the neoplasm, which now extended to the ciliary body on temporal side. I urged the immediate enucleation of the eye, and on the 26th of February the operation was made. Upon making a vertical section of the eye it was shown to be a band-like formation having its attachment in the sheath of the optic nerve and extending up the former about five or six millameters. The growth extended across the posterior chamber and was attached to the ciliary body on the temporal side. There was complete detachment of the retina. Contrary to the rule in these cases, there was no exophthalmos. The class of cases which have their attachment to the sheath are regarded as malignant; in fact, Meyers in his work on Diseases of the Eye, says that "All tumors of the choroid must be looked upon as malignant, likely to form secondary foci of disease likely to recur if removed, and most probably ending in death." Dr. E. F. Root, who made a pathological examination of the euncleated eye, submits the following:

"The external appearance of the eye is normal, except that it feels very hard, as if it were over-distended with fluid. The cornea and iris present normal appearance. I withdrew the aqueous and filled the anterior chamber with gelatin. Then withdrew the vitreous. Found it very thin and cloudy. Filled chamber with gelatin. On section found the retina completely detached everywhere excepting near the optic nerve. There I found a small dark mass somewhat flattened, which I took to be pigmented from the choroid or the choroid itself. I hardened this mass for microscopical examination. It presented the ap pearance of sarcoma having round nucleated cells throughout the stroma,and being filled with minute blood vessels. While I believe this to be malignant. I may possibly be mistaken for the normal choroid does contain these characteristic cells and vesgels. But this was a mass of tissue, certainly an abnormal growth, and the cells were very numerous, and for the most part seemed not to be encapsulated or intimately connected with the stroma."

It is a little too early to determine whether the growth may recur, or make its appearance in some other part, perhaps remote from the original site. The patient, in a note received from her mother but a short time since, was in good health. The photographic views here presented will give you an imperfect

idea of the gross appearance of this neoplasm. The one marked No. 1, represents the vertical section looking from before backwards, showing the complete detachments of the retina, and the bluish white neoplasm, with its attachment to the fundus or outer sheath of the optic nerve. (Case referred to me by Dr. William F. Smith, Mt. Home, Idaho.)

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Case IV.-Retinitis-Albuminurica.-In June, 1897, George G. Halleck, Nevada, consulted me, bringing a note from the family physician. The latter said that he suspected glaucoma, from the severe pain in head that the patient was suffering. Patient related that for several weeks his sight had been failing, and testing the vision showed me that for right eye, V counting figures at three feet. L. E.-20/xxx. Ophthalmoscope shows in right eye marked degree of neuro-retinitis and scattered over the ret

ina, white star shaped crystals and numerous recent hemor rhages. Left eye media slightly turbid, but could get a pretty good view of fundus; latter found studded with white crystalline deposits and numerous recent hemorrhages, and white plaques that showed hemorrhages that had cleared up. The fundus of each eye showed a typical picture of retinitis albuminurica. The urine was tested for albumen three different times before the lat ter could be detected. I am indebted to Dr. F. A. Meachem for the following:

"Analysis of Urine in Case of George G.-Color, average; reaction, slightly acid; odor, none; specific gravity, 1014; albumen, 4 per cent.; sediment, scarcely any.

"Microscopically-Oxolate of lime in great amount; red blood corpuscles; granular casts; epithelium from pelvis of kidney."

The patient failed rapidly and within three weeks he died at his home; the mother writing that he passed off quietly, and was conscious to the last. Dr. De Schweinitz, in the 1897 edition of his work on the Diseases of the Eye, gives the fol lowing as a typical picture of the fundus of the eye in the case of albumenuria retinitis: "Beginning in the macula or neighborhood and continuing to be most numerous in this region variously shaped and placed white spots are seen. These at first may have been small, and sharply separated, but later, or under other conditions they form a star-shaped figure, the rays of which surround the foci, but do not involve it. Occasionally, instead of stellate, the white spots and lines somewhat radially placed like the spokes of a wheel affect this neighborhood in part, but do not completely encircle it. At some distance from the papilla, and often surrounding it, large yellowish white or white spots are seen, which may coalesce, and form a ring-shaped zone around the nerve-head, broader than its own diameter. This striking wide white area has been compared to snow and has been designated "the snow-bank appearance of the retina." In general terms the white spots are caused by fatty degeneration of the fibre and granular layers of the retina, round cell infiltration, and varicose hypertrophy of the nerve fibres. The hemorrhages are another feature, but possesses no pathognomonic importance."

Optic neuritis is nearly always present, but in some cases may partake of the nature of intense hyperaemia. The only subjective symptom in these cases is the gradual failure of vis ion, and this may vary very much.

Prof. Haab, of the Zurich Clinic, as well as in his private practice, says that men of the poorer class die within two years;

that is, their percentage of death is 100, while among women of the same class the percentage is only 68; of private patients pos sessed of means among men, the death rate is 59, and among women, 53 per cent. This great difference between the poor and rich is due, according to Haab, to the habits of the former in taking such large quantities of alcoholic liquors. While the prognosis in these cases is bad the proper dieting and treatment of them may do much to prolong life. In the case above reported the patient succumbed to the disease in eleven weeks, and was selected from a considerable number that have come under my care, largely because of its acute course, as well as because of the typical features as regards the fundus.

Case V. Sarcoma of Nostril.-On February 23 last, J. S. H., aged 39, called at my office to consult me about an obstruction. Excepting an attack of typhoid fever his health had always been good. Family history also good. He relates that in August of the previous year he had noticed an increasing dif ficulty of breathing through the left nostril. There had been a discharge from the nostril of a watery nature. He had no pain or soreness in the nostril. Upon examination, found a large, brownish-colored obstruction springing from the turbinals, almost producing stenosis on that side. With posterior rhnoscopy found this mass extending back to the line of attachment of soft palate. The left eye slightly protruded and diplopia, due to pressure on the orbital plate of the ethmoid bone, was manifest. Trans-illumination showed that the antrum of Highmore was involved. I endeavored to remove the mass by means of the cold wire snare, but could not succeed in passing the loop over the growth. As the latter appeared to be quite firm, the electric gouge was made use of. This produced so much hemorrhage that for the time nothing further was attempted. At the next visit to me, ten days later, another attempt was made to engage the growth in the snare, but did not succeed, and the curette was used instead. The hemorrhage was so severe that it made me suspect a malignant type, and small fragments of the growth were preserved in alcohol and sent to Dr. E. F. Root for examination. The latter prepared the specimen and made eight or ten slides, and after a most painstaking examination of all these, he pronounced the disease a small round cell sarcoma. The patient was informed of the malignant nature of the growth, and acting under the advice of his family physician, specimens of the growth were sent to an eastern pathologist and examined, with the result that my diagnosis of malignancy was confirmed. I advised a radical operation for the complete removal of the growth, but the patient did not return to me for further treat

ment. I afterward learned that he went to one of the eastern cities where he was operated on successfully.

In regard to the causation of sarcoma, we have little in. formation. Catarrh is said to have an influence in the develop ment of this disease. Males are much more frequently attacked than females; this may be due to the fact that the former are more exposed to catarrh than the latter by reason of their outdoor occupations. Sarcoma of the nose differs in no material respect from sarcoma found in other parts of the body.

Regarding the pathology of this case, Dr. Root submits the

following:

"The specimen you submit for examination, taken from the mucous surface of the nose of Mr. H., is sarcoma of the small round cell type. The substance everywhere is filled with the characteristic small round cells. Very little connective tissue, small blood vessels very numerous. The fact that the cells are found throughout the tissues and do not seem to be encapsulated differentiates it from carcimona."

This growth is usually pedunculated and finds its attac hment to the septum and turbinal side of the nose with about equal frequency. In the case presented to you there were two points of attachment. Frequent hemorrhages are nearly always a characteristic of this disease and the blue gray color is a feature that is apt to attract one's attention. The prognosis of sarcoma of the nostrils is not good, though the early and radical removal of the growth may tend to lengthen very materially the life of the patient. Age is a feature that is noted in these cases. and most of the cases thus far reported have been under forty years of age. It is difficult to determine the average length of time that these patients survive after the disease manifests itself, as we cannot always follow them up during the time subsequent to our treatment.

In the treatment, the essential feature is to get rid of the growth, and it does not matter much what the particular form of instrument is, providing it fulfills our purposes. The cold wire snare, or the curette, or the galvano-cautery loop, each have their advocates, in such cases as involve the nose properly; but in those cases, such as the one under consideration, I believe a more radical method should be resorted to. This applies to cases where the accessory sinuses are involved. The removal of these growths in the first instance is but the beginning of the treatment, as the case requires careful watching for many months afterward.

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