fairly good, though it is liable gradually or suddenly to become seriously involved or even, though seldom, lost; but it is as an indication of his approaching end that in these cases albuminuric retinitis has its chief importance. If the patient live for twenty-four months after its discovery he survives beyond the average time, for many die within a very few months. Cases have been recorded, however, of the prolongation of life to several, even to twelve, years. This depends, of course, somewhat on the period of its discovery and upon the patient's circumstances. The wealthy classes who can choose their environment are known to live longer than the poor. There is not time to consider the diagnosis, which, however, rarely presents difficulties. I have seen it hard to say whether the ocular appearances were due to renal mischief or to a cerebral tumor, and this has been the experience of others. Between albuminuric retinitis and that associated with diabetes the ophthalmoscope can really make no proper distinction. Diabetic cases are not infrequently also albuminuric; and it should be borne in mind that, though kidney changes are undoubtedly secondary and variable in kind and degree, they are always present in diabetes. These consist of one or more of the following: enlargen.ent and fatty degeneration; contraction of the whole organ and thinning of its cortex; not uncommonly all the histological appearances of granular kidney; hvaline transformation of the epithelium of Henle's tubes; tubercle, lardaceous disease, and even gangrene have been found. The treatment is that for the disease preceding the ocular affection, and, without going into particulars, may almost be summed up in the words, purgation, diaphoresis, climate and hygiene. While, in the short time properly allowed for these papers, we naturally, when dealing with the relationship of albuminuria to eye diseases, consider first and chiefly albuminuric retinitis, it would be a great oversight to omit entirely those others which are equally closely related to it, and are indeed dependent upon the same cause. I shall, in closing, say merely a few words concerning them. They may very well be divided into those which depend upon lesions of the visual apparatus, first, outside the brain, (among which is of course albuminuric retinitis itself), and, second, within the brain. Among the former are ædema and hæmorrhage in the lids and conjunctiva, hæmorrhage into the optic nerve and into the orbit. Embolism or thrombosis of the central vessels of the retina is probably less uncommon than has been supposed. Iritis and cataract are probably little if any more common in albuminurics than in the general population. Among intracranial lesions hæmorrhage into the nuclei or trunks of the nerves supplying them has been said to produce temporary paralysis of some of the external muscles of the eye. Uræmic amblyopia is more frequently met with. It is probably the result of extreme cerebral anemia due to vascular contraction caused by the irritation of poisonous matters in the circulation. The resulting blindness usually affects both eyes, and may be incomplete and transient, or absolute, vision returning only after some hours' duration, though it may be delayed for three or four days. The pupils generally react to light, which indicates the cortical origin of the attack, but occasionally they do not, and then the nerve or optic ganglia are involved. In these latter cases the optic disc is likely to be found swollen. When recovery of vision does not fully take place there must be some organic lesion, and post-mortem examinations have shown that apparently functional cases have sometimes had their origin in small hæmorrhages. It should also be noted that central amblyopia is not infrequently accompanied by other nerve symptoms, such as hemiplegia. SARCOMA OF THE ORBIT. BY ALEX. W. STIRLING, M.D., M.B., C.M. (EDIN.), The diseases most likely to be confounded with orbital sarcoma are chronic abscess or periostitis, distention of the frontal sinus, meningocele, protrusion of only one eye in exophthalmic goitre, other tumors originating in the eye or orbit, or outside them, gumma, dermoid or hydatid cysts, exostosis, carcinoma, foreign bodies, erectile growths, and varix appearing some time after accident, especially fracture of the base of the skull. Neuroma, lipoma, and fibroma are extremely rare. It is not intended that this short paper should deal with any of these. The differential diagnosis is sometimes easy, but in other cases it can be made only by operation or by microscopical examination. My remarks to-day will deal with sarcoma, the most common of orbital tumors, and chiefly with the view of determining their prognosis. I shall have to refer also to sarcoma of the uveal tract. As a typical illustration of primary orbital sarcoma I cannot perhaps do better than recite the symptoms and treatment of the case, the contents of whose orbit I now pass round for your inspection. Miss M. A., aged 13, a twin, seen first in May, 1897. Has a good family history. No cancers in the family except in the cases of a great aunt and a second cousin. Her own health has always been good, no history or appearance of syphilis. She has never received a blow near the eye. About three years earlier the left eye had begun to protrude, and this had gradually become more marked, though it gave no trouble till quite recently, when pains began to occur in, and at the back of, the eye. Proptosis was more marked when the patient was warm, and a few days before I first saw her a little blood had oozed from the outer canthus. On inquiry I was told that during the previous two years she had appeared to become mentally rather dull. Her condition was that of a tall, healthy, but rather stupid-looking girl, in whom the right eye was deeply set, but the left, when looked at from above, the upper lid having been retracted, was visible nearly to the equator. Movements upwards, downwards, and outwards were rather limited, but not markedly so. The conjunctiva was congested, but not actually inflamed, opposite the palpebral fissure; the cornea quite clear; the pupil, which acted slowly in a dim light, was smaller than that of the right eye, but larger than it with good illumination. There was very little pain from pressure on the globe, which did not then recede. When the finger was pushed into the orbit to the upper and outer aspect of the globe some pain was complained of, and here also an elastic, non-pulsating swelling could be made out. There was no enlargement of the premaxillary or other glands. The ocular tension was normal, R.V. 6/6. H.M. .75, D.6/6 The fundus was normal, with a deep physiological cup. L.V. p. 1. Media clear. O.D. white, and seen with + 14 D., periphery of retina seen with + 2D., and between these with + 6D. or + 8D. The veins were rather large, some of them slightly tortuous; one small tortuous vessel on the dise had given rise to a minute hemorrhage. The vessels were seen to curve to a lower level on leaving the dise. Three days after the examination, ether having been administered, a preliminary exploratory incision was made through the upper lid just beneath the eyebrow, and through it a firm growth was made out with the finger. An incision was then carried through the skin of both lids 3 |