narrow tube (ureter) which connects this organ with the bladder; or occurs during the passage of the stone from the kidney into the urinary bladder. It is more common in men, and in late or early life. The attack begins suddenly with agonizing pain in one side, more particularly just below the ribs in the narrow part of the back, but also in front in the corresponding situation, that is, in the belly just below the ribs on the same side. The pain is also sometimes felt all over the belly and even in the chest; but what serves to distinguish it from the other colics is that the pain shoots down into the groin, inner part of the thigh, and testicle in front. There is, in addition, tenderness on pressing firmly on the small of the back, just below the ribs on the painful side. The pain is accompanied usually by vomiting, cold sweats, and feeble pulse. The passage of urine is frequent, painful, and often bloody-a very important point-although it may look perfectly natural. Occasionally the urine is scanty or entirely lacking. There may be a chill at the onset of the attack and the temperature may be raised to 102° to 103° F. The pain may last an hour, or even a day or more, with intermissions. If the urine be carefully examined, the stone may be found within a week or so after the attack of colic. Soreness and tenderness remain for a time in the affected side, and if the stone lodges in the bladder, there may be frequent urination and some pain in the lower part of the belly. Occasionally the stone remains in the

bladder and gives rise to inflammation of this organ, with frequent and painful urination and the appearance of pus or thick, white sediment in the urine. More often after the stone has escaped from the ureter into the bladder, it is expelled in the urine without the knowledge of the patient. Very rarely does it become lodged in the passage (urethra) leading from the bladder outside of the body. The location of the pain is one side serves to separate renal colic from intestinal colic; while the extension of the pain into the thigh and testicle, with drawing up and tenderness of the testicle, distinguishes it from all the other colics. In gallstone colic the pain is in the right side, and the pain extends up rather than down, as in renal colic. The presence of blood in the urine, with intense pain in the side shooting down into the thigh, makes the existence of stone in the kidney or ureter practically certain.

Treatment.-Relief from pain may be secured by following the treatment recommended for colic generally (p. 519). There may never be a recurrence of an attack of renal colic, or attacks may be frequent. This follows because after one stone escapes, more may remain in the kidney or ureter. A stone in the kidney may cause no trouble at all during the course of many years, or during the patient's life, or may give rise to inflammation with more or less frequent attacks of pain and escape of blood and pus in the urine. If the attacks of pain are severe and frequent, or if the

urine is not clear, but contains pus or blood for any length of time, the only curative treatment of any value is the surgical removal of the stone from the kidney or ureter. The operation, while grave, is not attended with much danger if done by surgeons experienced in this work. In cases where the attacks are mild and infrequent, the patient should drink about two quarts daily of distilled water or filtered rain water or other pure water, as Poland, Bedford, or Buffalo, and take three grains of lithium citrate in tablet form dissolved in a glass of water three times daily. No medicine or mineral water will have the slightest effect in dissolving a stone already formed in the kidney or urinary passages, but large quantities of fluid may assist in washing stones out of the urinary tract and relieve the irritation caused by them; while with medicine, the effect of much water drinking is to prevent further stone formation. Out-of-door life and exercise are also necessary in effecting a cure, as also the absolute avoidance of alcohol in all its forms.

Meat should be eaten in moderation; not oftener than once daily. The existence of stone in the kidney and ureters is often most difficult to determine when there is absence of special pain to locate them. Fortunately, we have some exact methods to prove their presence, as the X-ray in thin persons, and methods of exploring the urinary passages even so far as the kidney without any cutting operation. For this work expert genitourinary surgeons are, of course, required.

Thus, as in the case of appendicitis and gallstone colic, the treatment of renal colic must often be surgical. But while appendicitis demands instant surgical attention, it is only in the more severe cases of gallstone and renal colic that this is necessary.

COLIC IN BABIES.-This is commonly due to ⚫ the fermentation of undigested food in the bowels, with the formation of gas, as in intestinal colic in adults. It is due to the food being unsuited to the digestive capacity of the infant, and one usually should dilute the feedings with more water, feed less at a time, or not so often. The dilution of the feedings is the best treatment in most cases. Colic may occasionally arise from chilling of the surface, and it is well for babies subject to it to wear a warm flannel band and socks.

Symptoms.-The baby cries persistently and is continually doubling and straightening his body, and bending and straightening his arms and legs. The belly is often swollen and hard. Relief is sometimes rapid after an escape of wind from the bowels or mouth.

Treatment.-Give a few drops of brandy in a little hot water, or dissolve a soda-mint tablet in hot water and give this. If pain still continues, give an injection of warm soapsuds-a cupful at a time-and if it comes away without escape of gas or bowel contents, repeat until the result is satisfactory. Gentle rubbing of the surface of the belly will often afford relief. Do not feed the baby while it has colic, and at the next

feeding dilute the food with an equal quantity of water.

SUDDEN OBSTRUCTION OF THE BOW. ELS.-This condition in adults is more commonly caused by compression of the bowel at some point, as in the opening through which a "rupture" occurs; or by compression from a band of tissue resulting from former attacks of inflammation. It may result from operations or from unnatural conditions originating in the development of the patient before birth. Another frequent cause of obstruction of the bowels in children is a slipping of one portion of the bowels into a neighboring part, as one joint of a telescope slips into another. Twisting of the bowel on itself is still another source of obstruction, and even an almost knotted condition may at times occur. The existence of an accumulation of hardened excrement in the bowels may give rise to complete obstruction. Very rarely the presence of foreign bodies, which may have been accidentally swallowed, or of gallstones, may obstruct the bowels. Obstruction of the bowels is an exceedingly rare occurrence.

Symptoms. The pain is usually in the neighborhood of the navel; beginning suddenly, it is at first intermittent, but later becomes continuous. It varies in intensity from moderate to excruciating pain. Vomiting is also a prominent symptom. First, the contents of the stomach are expelled; then greenish, bilious matter; and, finally, after a day or two, a brownish