and a half inches deep. It contained eighty-three ounces of clear fluid, having a pale lemon colour and urinous smell. Sp. gr. 1002, very slightly acid, with the faintest trace of albumen, and presenting under the microscope a few brokendown cells of large size. The mesenteric glands were enlarged and hard. Intestines healthy. Liver weighed sixteen ounces, healthy, except that on its upper and under surface were a few small tubercles. There were also a few on the peritoneal aspect of the diaphragm. Spleen weighed one ounce six drachms, and contained tubercles on the surface and a few in its substance. Heart weighed two and three quarter ounces, healthy. Lungs contained miliary tubercles scattered throughout their substance. The lower lobe of the right lung was collapsed. Brain. On the upper surface of right hemisphere, extending also between the falx and the hemisphere, binding them together, was a little lymph of recent date. The convolutions were flattened and had a fluctuating feel near the anterior part of cerebrum. The anterior lobes were rather softer than normal, but not redder; both lateral ventricles were filled with a large amount of clear fluid. All the central parts of the brain were softened, the right anterior lobes near the corpus striatum were almost creamy. In the centre of the left corpus striatum was a small body about the size of a pea; the nerve substance around was soft, but not red. It was firm and contained a creamy matter. Under the microscope the creamy matter looked like degenerated nervecells; there were no pus-globules visible. At the base of the brain there was lymph near the olfactory nerves, around the optic commissures and to a less degree around the pons and the nerves arising from this part. There were granules of tubercle in Sylvius's fissures. Remarks. The post-mortem examination quite confirmed the diagnosis which was made during life. As was supposed, the great distension of the abdomen was due to an obstruction in the right ureter, causing an enormous accumulation of urine in the pelvis of the kidney. The exact nature of the obstruction could not be ascertained during life. It was either congenital or occurred almost immediately after birth. It was not of such a character as at all times to prevent the passage of fluid from the kidney to the bladder, because there was distinct evidence that occasionally the obstruction was overcome for a time, when distension had been very great. The obstruction was found to be due to an abnormally small ureter, a congenital stricture, through which fluid did not usually pass, although it might do so under extreme pressure from dilatation. The pelvis of the left kidney was also somewhat dilated, as was anticipated, though not to so great an extent. The dilatation on this side was due to a formation of calculous matter, which occasionally clogged up the ureter. The patient died from acute tuberculosis. With the experience derived from this case I cannot see that any fresh indications for treatment in a similar case are to be obtained. The extirpation of the right kidney was discussed; but it was considered to be an unjustifiable proceeding, especially in a patient of such a feeble constitution as this boy. The fatal results which have attended extirpation of the kidney in animals tend to discourage any attempts to adopt this operation in the human subject. Tapping was attended with temporary relief, but fluid rapidly reaccumulated, and after a short time irritative fever was set up, and the fluid became purulent and albuminous. During the later period of his life the operation was not repeated, for although the distension was very great it seemed not to increase beyond a certain point. There was probably a small escape of fluid through the constricted ureter constantly going on. INDEX. Acid, carbolic, new double salts of, as agents for the treatment ALTHAUS (Dr.) on certain points in the physiology and patho- Amputation at the shoulder-joint, successful, in a case of sub- PAGE 139 27 206 Aneurism, double, of the right external iliac and femoral, and 309 of the femoral artery, treated by long-continued compres- 317 subclavian, fusiform and tubular, successfully treated by 277 successfully treated by direct compression (Mr. Corner) 303 successful case of amputation at the shoulder-joint 306 dissecting, of the aorta (Dr. H. Fagge) 341 341 Aorta, case of dissecting aneurism of (Dr.. H. Fagge). Artery, right external iliac, femoral, and right popliteal, see femoral, see Aneurism. subclavian, see Aneurism. BARNES (Dr. R.) on the operations for the relief of chronic in- case of aneurism of the femoral artery treated by long- 317 Bladder, on fission and extroversion of, with epispadias, treated Calculus, renal, nephrotomy as a means of treating (Mr. T. PAGE 85 211 Cape of Good Hope and Natal, endemic hæmaturia of (Dr. 379 139 Carbolic acid, new double salts of, as agents for the treatment successful indirect digital, in a case of fusiform and tubular 309 317 277 successful direct, in a case of subclavian aneurism (Mr. 303 CORNER (Mr. F. M.) case of subclavian aneurism successfully 303 DICKINSON (Dr. W. H.) on the enlargement of the viscera 359 Dislocation of the head of the femur, complicated with its 133 Elevated regions, treatment of phthisis by prolonged residence Enlargement of the viscera, which occurs in rickets (Dr. Epispadias, and extroversion of bladder, treated by plastic of the knee, results in thirty-nine cases of Extroversion of bladder, with epispadias, treated by plastic 225 359 85 1 4-8 13 21-3 85 FAGGE (Dr. Hilton), case of dissecting aneurism of the aorta |