mm. from the lashes, the skin was dissected back all around so that the finger and instruments could enter the orbit behind without opening into the conjunctival sac. The lids, exclusive of the reflected skin, and including the lashes, the globe, tumor, and all other contents of the orbit were then removed en masse. Hemorrhage was slight, and the operation occupied fifteen minutes. At the beginning of the fourth day, when oozing had practically ceased, the walls of the cavity were covered by strips of lint on which had been spread a paste of chloride of zinc of a strength of about three drams to the ounce, including about twenty grains of opium. This gave rise to no pain, and was left for three days, when it began to slough away. The temperature never rose above normal, and the patient made an uninterrupted recovery. The lids fell in and became adherent to the orbital walls within a week, while between two and three months later these were entirely skinned over, the results being more cleanly and comfortable than when the lashes are allowed to remain. Two years has now elapsed since the operation, and there are no symptoms of recurrence in any part of the body.

In 1891, Messrs. Lawford and Collins published (Royal London Ophthalmic, Moorfields, Hospital Reports, Vol. XIII., pt. II., Dec., 1891) the results of their investigations concerning 103 cases of undoubted sarcoma of the uveal tract which had been operated on in, and recorded in the books of, the Moorfields Hospital. In some of these the orbit was secondarily involved.

In 1893 I published, with full particulars of each case (Royal London Ophthalmic Hospital, Moorfields, Reports, Vol. XIII., pt. IV., Dec., 1893), the results of my own inquiry into all the cases of undoubted primary orbital sarcoma upon the books of the same hospital from 1858 till that date, mainly with the object of discovering the true prognosis in that disease which had not yet been ascertained. I was somewhat surprised to find that these numbered only twenty-eight, excluding a case of sarcoma of the lacrimal gland about to be reported by another surgeon. I had intended to incorporate with them cases from the Royal Westminster Ophthalmic Hospital, but time failed and I had to content myself with only one case from that hospitai which I had then frequently an opportunity of seeing. I had in several cases to appeal to the National Registration office at Somerest House, London, in order to discover whether or not the patient still lived, or what had been the cause of death. The results of these investigations show that sarcoma attacks both the uveal tract and the orbit in males and females, in about equal numbers; the average age in uveal sarcoma was forty-eight and one-half years, varying from fifteen to eighty-four, and in primary orbital cases the growth first appeared on the average at twenty-eight and one-sixth years, varying from three weeks to seventy-five years; there seems to be little tendency for the one side to be affected more frequently than the other; 14 of the 103 uveal cases had a history of "tumors" in near relatives, and in 38 others no notes had been made on this subject, while of the 29 primary cases 2 gave a history of the death of a parent from cancer, and in 15 cases no statement on the point was forthcoming; previous injury to the eye had positively been received in nearly 7 per cent. of the uveal cases and in 17.5 per cent. of the orbital. Recurrences took place locally, among the 79 uveal cases which could be traced, in 7 cases, and at times varying from a few weeks to three years after the operation. In three cases the recurrent growths were removed once, in one on three separate occasions. In three, and probably in four, of the seven, metastatic growths occurred. In every case in which recurrence took place the patient died of sarcoma, except in one who was alive twelve months after the second operation. In the primary orbital cases recurrence took place in 58.6 per cent., on the average twice for each of these cases, one undergoing as many as five separate operations. The average time elapsing between operation and recurrence was twenty months, but if one case be left out of account in which the primary growth was not microscopically examined and was removed thirty-eight and one-half years before the recurrence, which was a true sarcoma, the average age is reduced to eight months, while cases occurred at three and one-half, three, and two years after the first operation. We see here a marked difference between growths primarily affecting the uveal tract and those beginning in the orbit, for while in the former only 8.86 per cent. recurred in the region of the orbit and death in 32.9 per cent. was almost certainly due to metastasis, most frequently in the liver, in the latter when recurrence took place at all the orbit was always affected even when other organs were attacked. Lawford and Collins found no connection between the shape and arrangement of the tumor cells and the tendency to recurrence. All their growths were more or less pigmented. In the primary orbital tumors which recurred round cells predominated. No case is noted as having been pigmented. The results of operation in the primary orbital cases were that of the ten cases in which the growth alone was removed without clearing out the contents of the orbit, recurrence took place in nine, and the tenth had been under observation for only eighteen months after the removal of the growth. Where all the contents of the orbit were removed, sixteen cases, seven had had no recurrence after an average of four and one-sixth years, and in only three of these latter had a less interval than two years elapsed. This seems to point to a distinct advantage in making the removal as complete as possible. As for the prognosis Lawford and Collins took a three years immunity as a sign of probable but by no means absolute safety, and on that basis 25.31 per cent. of their uveal cases recovered. In the primary orbital cases youth seemed to predispose to a fatal termination, for I found that of eight cases under ten years of age four had already died, three were then under observation, having been recently operated upon for recurrences, and that one was quite well after operation seven years before. Of those older than ten 30 per cent. were dead and 70 per cent. were alive at an average interval since operation of over three years. Three years after operation at all ages some 17 per cent. were alive, but that is too short an interval to be a guarantee of absolute safety. It is therefore probably less dangerous to have a uveal sarcoma than a sarcoma of the orbit, as might be expected from the differences in environment.

THE RIGHTS AND THE WRONGS OF THE MEDICAL WITNESS IN COURTS OF JUSTICE.

BY JAMES B. BAIRD, M.D., ATLANTA, GA.

Unquestionably, the medical witness has some rights, and as surely does he suffer many wrongs.

The rights, briefly stated, refer to the proper treatment of the physician on the witness stand; to a just recognition of the relationship existing, or which ought to exist, between the physician and his patient; and to a true valuation of his expert services. The wrongs, in a word, relate to a misconception of his rights, or to an utter disregard of them.

The treatment accorded the physician on the stand depends, in great measure, upon the witness himself, and in part upon the court and the attorneys engaged in a given case. But few lawyers-none of the better class-will undertake to mistreat a medical witness who demeans himself with propriety, who actually possesses the information which he claims, or ought to have, and who gives his evidence or states his opinion in a simple, straightforward manner without seeking to magnify himself, to dazzle his hearers by a display of profound erudition, or by the assumption of a degree of knowledge which he does not possess. But few judges will permit a competent and sincere witness to be badgered, bullied or ridiculed, even if such tactics should be attempted by a discourteous attorney.

If the principal object of all legal proceedings in court should be to ascertain and to establish the truth, the task