IN January, 1916, a private, serving in Egypt, strained himself lifting ammunition, and subsequently he noticed a left inguinal hernia. I n July of the same year, in France, a n explosion rendered him unconscious for two days. He was subsequently admitted to the Maudsley Hospital on account of shell-shock; afterwards he was transferred t o the 4th London General Hospital, and next to a convalescent home, where, after three weeks, he was operated upon for left inguinal hernia. The prolapsed omentum was transfixed and ligatured tightly. I l e got up after three weeks, and was considered fit for active service.Five wceks after the operation for hernia, in November, 1916, he was seized with difficult micturition without apparent cause, and a swelling was found in the hypogastrium which was not removed by the passage of a catheter. His temperature rose to 102O. There was a tense swelling in the centre of the hypogastrium, reaching two-thirds of the distance from the pubes to the umbilicus. It was dull to percussion, could be swayed from side t o side, did not bulge into the rectum, and remained unaltered when a catheter was passed, through which less than 2 oz. of urine escaped.After making an incision and separating the recti, indurated tissue was reached, but on scratching through this the bladder was opened. After suturing the walls of the bladder an opening was made just above, when a quantity of greenish-blue thick fluid escaped from a smooth-walled sac situated within the peritoneal cavity. No actual clot was met with. T h e cavity was drained for a few days, after which the wound healed without complications.It is not clear whether the strain or the explosion was the cause; there is a third possibility-haemorrhage from the stump of omentum after the hernia operation ; but there was no sign of omentum in the abscess. At any rate, the condition passed unnoticed until infected from the intestine.It was supposed that he had an abscess in the cavum Retzii.
ENDOTHELIOMA OF THE LEFT KIDNEY EXTENDING DOWN THE URETER AND PROJECTING INTO THE BLADDER: REMOVAL: DEATH FOUR MONTHS LATER.BY W. G. SPENCER, LONDOX.ON June 15, 1915, a woman, age 45, was admitted t o the Westminster Hospital complaining of hzmaturia and a lump in the left loin. For two years she had passed blood in the urine a t irregular intervals, but in her mind this was confused with equally irregular attacks of menorrhagia. She had had pain in the left loin on and off for six months, and for a fortnight had noticed a lump there. The left loin was filled by a firm tumour of the shape of the kidney and about three times its size ; i t was not tender, and had the descending colon in front of it. Through the cysioscope a cauliflower-like growth was seen projecting from the left ureteral orifice. The base of the bladder was free from induration, but through the rectum the left ureter could be traced upwards, forming a cord the thickness of the finger.On June 25, a transverse incision was made immediately above the pubes, and continued outwards, parallel to Poupar...