CASE. —A boy aged 12 years was admitted into the Liverpool Children's Hospital on Dec. 7th, 1882, having the day previously fallen out of a window a distance of eight feet. On admission he was suffering from pain in the side and there was blood in the urine. The hEematuria continued and there was much difficulty in urination from blood-clots. As these symptoms continued and cystitis super vened, on the seventeenth day after the injury the right kidney was cut down upon and found imbedded in a mass of clots. On these being cleared away the organ was found almost divided into two equal por tions by a transverse laceration. The torn portions were ligatured and removed by scissors. The operation was followed by considerable relief and urine was freely secreted. The cystitis, however, did not abate, and as the bladder appeared to be blocked with blood clots, lateral cystotomy was performed four days after the nephrectomy, which permitted the removal of a coagulum about the size of a wal nut. Two days after this it is reported that a large irregular-shaped clot, partially disorganized and foetid, was passed by the wound. The patient, however, gradually sank and died twenty-four days after the nephrectomy. At the autopsy the opposite kidney was found enlarged, and on section showed numerous points of suppuration. Both the pelvis of the kidney and corresponding ureter were con siderably dilated and filled with pus. The condition of the re maining kidney undoubtedly caused the death of the patient. It was also equally clear that the state of the bladder was alone responsible for the suppurative nephro-pyelitis which had ensued and caused death.
Though it is easy to be wise after an event, this instructive and im portant case indicates that, had nephrectomy been earlier performed, the hemorrhage and clotting within the bladder would have been pre vented. In the latter was to be found the cause of the cystitis and
urinary obstruction which eventually caused the destruction of the remaining kidney by disseminated suppuration.
Wounds of the kidney, as, for instance, those inflicted for surgical purposes, are occasionally, though rarely, followed by acute symp toms of septic poisoning of an exceptional nature. Mr. Dobson recorded a typical example which I will quote.
CASE.-" The case was that of a married woman, aged 35, who had Case.-" The case was that of a married woman, aged 35, who had for some time been treated for painful bladder troubles ; she was ad mitted into hospital, with a swelling in the left loin, connected with the kidney and probably due to pus. I incised the kidney with anti septic precautions, letting out pus which was in the pelvis, and after examining the interior of the organ with my finger, inserted a drain age tube. The operation took place at 1: 30 P.M. and occupied only a few minutes; at 4: 30 she was taken with a violent rigor, and at 5 o'clock her temperature was 106.4°. A dose of 15 grains of quinine was administered, and her temperature fell to 105° at 6 : 30; 104° at 7: 30; 103° at 8: 30; rose to 104° at 10: 30, and fell again to 103.2° at 12 P.M. She died at 5 A.M., about sixteen hours after the operation. There was neither loss of blood nor shock. The external wound, which was small, was dressed antiseptically." The case is not only of importance as a record, but as showing that the phenomena of urethral fever are not limited to lesions of the male urinary passage.