Case ReportA forty-six-year-old Russian woman was admitted for the first time to Beth Israel Hospital on Nov. 6, 1929. She had been in the United States for twenty-one years.The chief complaint was long-standing digestive troubles, which obviously had nothing to do with the kidney lesion. Aside from influenza in 1918, the patient did not remember ever having been ill. Four weeks previously, while suffering from a severe cold, she had cramps in the abdomen. During the last three weeks she had had a dull ache in the left flank, but a few days before admission this pain ceased. She had also had irregular pains in the left lumbar region. She had lost fourteen pounds in two months. Two weeks before admission she had discovered a lump in the abdomen.The patient was a fairly well developed and well nourished woman, but was pale and worn looking. The abdomen was distended, and there was a marked bulge in the left upper quadrant. A moderately hard, somewhat elastic mass extended from above the left costal margin to about 3 cm. below the level of the umbilicus. It reached the midline and extended laterally well into the flank. The mass was freely movable and moved on respiration. It was not tender. Except for glaucoma in the left eye, the physical examination was otherwise negative.