695

On March 1st a diuretic mixture, consisting of tincture ofdigitalis, acetate and citrate of potash, with syrup of squills,was ordered; and the haemorrhage, after another applica-tion of the nitrate, ceased entirely.March 13th.-The haemorrhage returned. As there was

aching pain over the loins, fulness of the head, and othersymptoms usually present when the catamenia appeared, itwas regarded as the normal monthly period, and no localtreatment was resorted to.16th.-The haemorrhage ceased, and her condition gene-

rally became much improved.Having explained to her the importance of giving up

stimulants, she lessened the amount considerably, and pro-gressed fairly until the next catamenial period.

April 18th.-She had been very ill for a week, com-

plaining of numbness in the legs, pains in her joints, ex-treme nervousness and restlessness, and inability to standor walk. She was very hysterical. The bowels had againbecome confined, and the urine was scanty and high-coloured ; on examination it was found to be highly albu-minous. Diuretics and saline aperients were prescribed.From this date the nervous symptoms increased. She

became exceedingly hysterical and excited; one day com-plaining of being blind with one eye (the pupil acted per-fectly on exposure to light), then of her mouth being sore,then of pains all over, though when her attention wasdiverted she bore pressure without flinching.On April 26th, the pulse was 102; temperature 99 3c F.

She screamed violently at times, without any apparent ex-citing cause. Cerebral symptoms rapidly developed them-selves ; there was marked strabismus; the eyelids remainedunclosed, and a thick, purulent secretion accumulated in thecorners; she dozed in a semi-conscious state, screaming atintervals, but answered rationally when spoken to.On the 27th the pulse was 144, very feeble; temperature

1000; tongue and buccal muoius membrane covered withaphthae, the former dry and brown in the centre, red andsodden at the edges. The urine, not being passed volun-tarily, was drawn off ; it measured twelve ounces; specificgravity 1035; clear when warm, becoming turbid on cooling;on boiling it deposited one-tenth albumen ; motions passedunder her.From this time the symptoms increased in severity. She

became unconscious, gradually passing into coma. The

pupils were equal and responded to light. The urine wasalmost entirely suppressed, one ounce being drawn off bythe catheter, thick, turbid, and highly albuminous. The

breathing became much oppressed; the chest loaded withmucus; and she gradually sank, and died in the evening ofthe 28th, ten days after the urgent symptoms commenced.No post-mortem was allowed; but the history of the case

points very clearly to granular degeneration of the kidneys,and the case is recorded as exemplifying a cause of menor-rhagia too frequently overlooked. The patient had beenaddicted to spirit-drinking for some years past. Frequentattempts had been made to check the menorrhagia by ergot,gallic and sulphuric acids, iron, &c. ; but the cause of themalady had been quite overlooked, and not recognised.

BRISTOL GENERAL HOSPITAL.RENAL ABSCESSES FROM CALCULI.

FoR the following notes we are indebted to Mr. ThomasElliott, M.B., house-surgeon.Rosina H-, aged nineteen, was admitted on March

25th. Illness commenced four days ago with a rigor andpain in the left lumbar region. Two years ago she had asimilar attack to the present. Has never had scarlet feveror dropsy. On admission the body was greatly wasted; faceexpressive of much suffering ; pulse feeble ; no vomiting.The patient complained of intense pain near the crest ofthe left ilium. There was no abdominal tenderness, exceptin the region of the pain. No pain or tenderness over theright kidney. There was frequent desire to make water.Urine contained blood, albumen, and pus, and had a fetidodour. No casts to be seen under the microscope ; onlyblood and pus-cells.March 27th.-Still complains of pain, which, she says, is

of a dragging kind.30th.-Remained in much the same state till about 3 P.M.

to-day, when she suddenly became much worse and died.

Autopsy.-Body greatly emaciated. On opening the ab-domen, and after removal of the intestines, a large fluctua-ting tumour was seen in the left lumbar region representingthe kidney, and in the right lumbar region another tumour,but much smaller, representing the right kidney. Fromboth these tumours, the ureters, considerably enlarged,emerged. The left kidney weighed 27 oz., and resembledon section a multilocular cyst, filled with fetid sanious pus.Its substance was totally disorganised, the cortical portionbeing reduced to a thin membrane. One or two small calculiwere seen floating about, whilst a calculus, larger than acherry-stone, occluded the commencement of the ureter.The right kidney weighed 6 oz. Here, too, almost the samecondition existed. A small calculus was also found block-ing the commencement of the ureter. The bladder weighed2 oz., and was empty and contracted, and tolerably healthy.There was nothing particular about the other organs. Thebrain was not examined.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

THE meeting of this Society on the 10th instant-Mr.White Cooper in the chair-was occupied by an able andelaborate paper by Mr. SAMUEL WEST, B.A., Radcliffe

Travelling Fellow, upon the subject of the Elimination ofUrea in certain diseases. The subject was very ably workedout by the author, who employed a new method for the-estimation of the amount of urea, the apparatus for whichwas exhibited, and its mode of employment demonstratedat the close of the meeting. This method has been de--scribed by Mr. West in a paper read by him in conjunctionwith Dr. Russell before the Chemical Society, and a full ac-count of it will be found in the journal of that Society forAugust. It is based upon the reaction of urea with hypo-bromite of soda, in which the urea is decomposed into car-bonic acid and nitrogen. The decomposition is effected in avery ingenious apparatus devised by Mr. West, in which asolution of the hypobromite in caustic soda is allowed tomix with a given quantity of urine in a glass tube fixed intothe bottom of a pneumatic trough; the reaction takes placevery rapidly, and of the gases evolved the carbonic acid isabsorbed by the caustic soda solution, whilst the nitrogencollected in a graduated tube over water gives the measureof the amount of urea. The method is very simple andrapid, and requires no difficult calculations ; and, if itshould prove sufficiently accurate, will no doubt greatlyfacilitate the estimation of urea in everyday practice, espe-cially if, as the author believes, the whole amount of urineneed not be collected for examination.The cases of disease on which the paper was founded’

included three of pneumonia, four of rheumatic fever,two of Addison’s disease, and one of diabetes mellitus.The examination of the urine from day to day gave thefollowing results. In pneumonia the author found thatthe total volume of the urine was much reduced duringthe fever, returning to the normal during convalescence,whilst the percentage of urea was always high duringthe fever, and fell suddenly at its termination. No defi-nite relation, however, could be discovered between thepercentage of urea and the temperature, but when therewere marked nervous symptoms the percentage was belowthat observed in the other cases. As an instance of theabsence of definite relation, in one case, whilst the tempera-ture was 104 2°, 14-85 grammes of urea were excreted; whenat 104.3°, 20 91 grammes; at 104°, 17.5 grammes. The totalamount of urea excreted during the fever was below normalin all cases, and was markedly reduced when compared withthe nitrogen taken with food. A change of food was alsofound to influence, almost immediately, the amount of urea.The author suggested, as possible explanations of the appa-rent disappearance of the nitrogen-first, and most probably,