DISEASES OF THE EYE

thereof to the right lumbar region. Some of the uterine bleeding had been excessive, six diapers being used in one day. After the more severe bouts of pain it was noticed by the patient that unusually large quantities of urine were passed. The pain radiated at times to the back in the region of the twelfth rib. The bowels were open. The patient stated that she had lost three pounds in weight in the last month. The patient had five children, the eldest aged fourteen years, the youngest aged seven years. She had had puerperal sepsis fourteen years ago, a miscarriage six years ago, and typhoid fever twenty years ago. She was otherwise healthy, although her husband volunteered the fact that she had been irritable and "out of sorts" for the past eighteen months. On physical examination the patient was seen to be a very thin woman, weighing six and a half stone; she was pale and appeared ill. She had pyorrhosa ; but examination of the various systems revealed no abnormality. The right shoulder joint was normal. The abdomen was fiat and movement appeared normal. Extreme tenderness was present over an area two inches to the right and one inch above the umbilicus. Some tenderness was present, to a varying degree, over the whole abdomen, and pressure almost anywhere caused considerable pain in the region above described. True rigidity was absent. There was moderate tenderness in the right renal angle. On careful and gentle bimanual palpation in the loin a definite tumour could be readily felt, but it did not appear to move with respiration. It was decided, after several examinations, that it was this mass which was painful and tender. The patient's tongue was clean. Her temperature was 98° F. and her pulse rate was 80 per minute. Vaginal examination revealed nothing of' note. The fornices were not especially tender. Several special examinations were carried out. A blood count gave the following information: the erythrocytes numbered 3,750,000 and the leucocytes 10,000 per cubic millimetre. The heemoglobtn value was 70%. A blood smear revealed no abnormality. The erythrocyte sedimentation rate, estimated by means of Westergreen's 200-millimetre tube, was 80 millimetres after one hour and 106 millimetres after two hours. The phenomenal drop in red cells, it was later concluded, must have been due to a doubtful sample of sodium citrate used. All specimens of urine were chemically and microscopically normal. There was no reaction to the Casoni test. A plain skiagram revealed no abnormality. An excretion urogram revealed an abnormal right kidney. It was thought possible that a renal neoplasm was present. These films were sent to a radiologist for interpretation. A radiological examination of the gall-bladder was made; the gall-bladder failed to fill.