rapid (140); no rise in temperature. She was admitted to the Columbia Hospital and the abdomen opened the same afternoon. A pint and a half of blood was found, most of it of a dark color. The right tube, about the size of a man's thumb, was filled with dark blood-clot. The pain during the last attack was probably due to the effort on the part of the tube to expel this clot. The tube was removed. No fetus was found and no membrane that could be detected by the eye. Dr. James Carroll examined the specimen and pronounced it an ectopic pregnancy; the chorion villi were distinct. The interest in this case is the shortness of time which elapsed between the time the menstruation was due and the rupture; the continuance of the symptoms during the month, and the same symptoms coming on again because of the blood-clot occupying the tube. The specimen consisted of the fallopian tube longitudinally bisected through the opening of rupture, and showing the place of attachment of the ovum; this, however, had probably escaped. The period of pregnancy could not have been more than a week or so. TWO CASES OF CALCULOUS PYONEPHROSIS By F. R. HAGNER, M. D., AND STERLING RUFFIN, M. D., Washington, D. C. DR. HAGNER'S CASE.-R. S. G., a business man, age 39, was first seen May 24, 1906; referred by Dr. Richardson. Family history negative. Patient had gonnorrhoea ten years ago, lasting two months, and without complications. No syphilis. Was treated for pulmonary and laryngeal tuberculosis by Dr. Richardson ; recovered completely after treatment in the Adirondacks and in North Carolina. When 17 years old he was refused life insurance on account of pus in the urine. For 15 years he has had frequency of urination both day and night, rising two or three times during sleeping hours. There has always been more or less irritation *Reported, with specimens, to the Medical Society, October 24, 1906. referred to the neck of the bladder and glans penis during urination. At times this amounted to terrible burning, causing much inconvenience. If the pain came on during the day there was some relief on lying down. He never had any pain in the back or symptoms of renal colic. The stream was never suddenly cut off and he never passed any calculi. The urine for 22 years has been cloudy, clearing up to a certain extent at times, but never perfectly clear; it has contained blood and he has passed clots. He has at times what he thinks is malaria. He was treated in Philadelphia for five years for cystitis, during which time he was twice cystoscoped and from what he says he was thought to have vesical tuberculosis. I also thought from his history and before examination that he had tuberculosis. He was fairly well nourished. The testicles were normal; the prostate was small, regular, and the cleft was present; the seminal vesicles were not enlarged. The first urine passed was pussy and contained a number of heavy, irregular and thread-like shreds; the second urine passed was cloudy with numerous large scaly shreds. On allowing the urine to settle it contained between onethird and one-fourth pus by volume. He never had any symptoms referable to the kidney. On palpation the right kidney was found to be enlarged and was not movable. Cystoscopic examination, June 1, 1906. Bladder capacity 300 cc. First washing was slightly cloudy and contained irregular shreds. After three washings the fluid came away clear. Cystoscopic examination revealed slight inflammation of the bladder mucosa, but nothing to account for the enormous quantity of pus present. No ulcers nor tuberculous deposits could be demonstrated. Left ureteral orifice was normal; right orifice greatly inflamed, as was also the trigone on that side. It was impossible to introduce the ureteral catheter into right ureter, on account of the swelling and irregularity of the right ureteral orifice. From the left ureter the urine collected by catheterization contained a normal percentage of urea; it contained no pus nor blood. The catheter went up to the pelvis of the kidney without difficulty. On inspection there was seen to flow from the right ureter at intervals of 10 to 15 seconds wormy-like masses, which would curl up and break off. The diagnosis of tubercu losis was practically excluded as there was no sign of any tubercular infection of the bladder; if tuberculosis had been present it would surely have shown in the bladder, as the patient had had pus in the urine for 22 years. The diagnosis of pyonephrosis and probably kidney stone was made. Examinations of catheterized specimens from the bladder showed pus and blood but no tubercle bacilli; in fact, no organisms were demonstrated. The x-ray picture was taken by Dr. W. H. Merrill. He reported that he did not believe stones were demonstrated in the skiagraph; but a faint shadow can be made out in the light of subsequent findings. The operation was done June 26. Under ether, an incision about 10 inches in length was made along the lower border of the 12th rib. The dissection was made behind the peritoneum and a very much enlarged kidney exposed. Great difficulty was experienced in removing the organ, during which the peritoneal cavity was twice opened and the abscess ruptured; one of the peritoneal openings was sewed up and through the other was introduced a drainage tube. The kidney was found to be extensively diseased, contained about a pint of pus, and before opening felt very much like a bean-bag, on account of the numerous small stones within. The patient made a good recovery, but was much troubled by hiccoughs for a time; these were probably due to reflex irritation from the drainage tube. After the operation, the urine on the Ist day was bloody, on the 2d day almost clear, and on the 3d day 52 ounces in quantity. Dr. R. S. Blackburn examined the stones and found them to consist of amorphous urates and a small quantity of uric acid. The interesting feature about this case is that a patient could have such a kidney condition without ever having any symptoms referable directly to the kidney. Of course such cases are not unheard of; in fact, all writers on the subject speak of such cases, and the possibility of vesical irritation being of kidney origin should always be considered. DR. RUFFIN'S CASE.-The man was seen by me four years ago, and at that time he had no symptoms referable to the kidneys; a fact made significant by the recent developments of the case, however, was that eight years prior to his first examination, he had an attack of colic suggestive of calculus. The urine was examined at this first consultation (with negative results) on account of frequent headaches; the other symptoms-lassitude, bodily fatigue on slight physical exertion, and mental fatigue on slight mental exertion-pointed to neurasthenia. He passed from under my care and went West, but recently, on account of persistent headache, and an acute illness characterized by lumbago, fever and sweats, he came East again. The symptoms which suggested kidney involvement were pyuria, lumbago, fever and sweats. Dr. H. A. Fowler catheterized the ureters from the left ureter normal urine was obtained; nothing escaped from the right, the catheter becoming plugged. The x-ray picture showed a remarkably accurate shadow of the stone. Dr. W. P. Carr removed the right kidney, which was found to contain a large dendritic calculus and much foul pus; the odor of the pus suggested colon infection, but this point was not proven on account of the failure to obtain a specimen by ureteral catheterization. The most interesting features about the case are that the patient surely had had renal calculus for twelve years, perhaps for a longer period, and that during this time his symptoms had been of the neurasthenic type-headache, easily induced mental and physical fatigue, none pointing to kidney disease. During the past four years he has been doing continuous hard work, with continued symptoms of neurasthenia. All the time he appeared to be in good health. The circumstance of pyuria, with septic symptoms, called attention to the kidney as the source of the trouble. Nephrectomy was performed because of the extensive destruction of the kidney. If Dr. Carr said that both cases were remarkably alike in that both had had no renal symptoms, although both had large collections of pus with stones in the kidneys. The explanation of the absence of symptoms lies in the large size of the stones. they had been smaller there would have been an attempt at expulsion with the production of colic. There is ordinarily no pain in kidney disease unless there is an effort to expel some solid mass. In Dr. Ruffin's case no specimen was obtained through the ureteral catheter because the stone so blocked the ureter that no urine nor pus could escape. Dr. Carr remarked upon the remarkably clear definition of the outline of the stone and also the kidney in the x-ray negative. The stone, a single one of the antlered variety, filled every calyx except two which were distended with pus. Dr. Hagner had spoken of the difficulty of avoiding tearing the peritoneum while removing the kidney in his case; this had been prevented by Dr. Carr by peeling the kidney out of its capsule. He put in a drainage tube, but to his surprise the wound healed without any discharge. Later a little fluid had to be evacuated, but it appeared to be broken-down fat. It was evident that the kidney had not been secreting for some time; the post-operative history of the case proved that compensatory function had already been established in the other kidney, and that it was proper to remove the diseased one. Dr. H. A. Fowler said that he had examined Dr. Ruffin's interesting case. Up to within a few weeks of the operation the urine had contained much pus. When the patient came to Dr. Fowler, however, the voided urine was clear in all three glasses. The cystoscopic examination was remarkable in several respects there was not the slightest irritability of the sphincter upon introduction of the instrument, and upon inspection, a beautiful picture of a perfectly normal mucosa presented. The trigone was normal; no catarrh nor injection of the mucous surface anywhere. But from the right ureter a little ribbon of pus could be seen escaping, though no urine. The catheter was passed in the right ureter to the pelvis of the kidney, but no specimen was obtained, on account of immediate plugging of the catheter. The foul character of the pus found at the operation probably indicated colon infection; but in the small amount of pus obtained from the lumen of the ureteral catheter no organisms could be found. It would seem, therefore, that the pus was completely shut in the kidney by the stone and on that account could not descend to the bladder. Dr. Hagner said that in his case everything was so matted together that there was no possibility of stripping the kidney out of its capsule. PROCEEDINGS OF THE MEDICAL SOCIETY OF THE DISTRICT OF COLUMBIA. Wednesday, October 3, 1906.-Dr. Jas. Dudley Morgan, President, in the chair; about 65 members present. The Board of Censors reported favorably upon the following applicants for active membership, and they were elected: Edwin H. Behrend, Georgetown University, 1894; Henry C. Coburn, Jr., George Washington University, 1903; Emma Lootz Erving, Johns Hopkins, 1902; W. Ashby Frankland, George Washington, 1896; Francis E. Harrington, George Washington, 1904; George H. Heitmuller, University of Pennsylvania, 1894; Arthur Le |