The autopsy was held that afternoon and revealed nothing but the condition in the genito-urinary organs. The bladder contained about 2 oz. of urine, was much distended and hypertrophied. On pressure it was impossible at first to empty it because of a tight prepuce. When this was loosened the urine flowed readily. The ureters were normal in size from the pelvis to the vesical opening. The right kidney showed a widely dilated pelvis which contained urine and at its ureteral extremity showed a few white sand-like calculi which were examined for me by Mr. Johnson of the Northwestern University Medical School Chemical Laboratories and were found to be composed of phosphates. The left kidney showed a slight dilatation of the pelvis. After the removal of the calculi urine passed freely through the right ureter, there was no obstruction present in the left. The urine found in the bladder was examined but contained only an occasional pus cell. On three occasions the sudden changes in weight were such as to suggest a sudden loss due to some cause for which the clinical picture did not offer adequate explanation. On April 15th the weight was 6 lbs., 13 oz., on the 19th, 6 lbs., 5 oz., and on the 20th, 6 lbs., 14 oz. On the 5th of July the weight was 9 lbs., 7 oz., on the 13th, 8 lbs., 11 oz., and on the 15th, 9 lbs., 4 oz. On the 29th of July, 7 lbs., 821⁄2 oz., on the 30th, 7 lbs. 4 oz., and on the 31st, 7 lbs., 10 oz. During its stay in both Provident and Wesley Hospitals the history sheets show frequent urinations. We have here a case of hydronephrosis, double, larger in the right than on the left side. Although there was present a phimosis, tight enough to cause distention and hypertrophy of the bladder this was not sufficient to cause a secondary distention of the ureters. In all probability the hydronephrosis was due to the presence of the phosphatic sand in the pelvis of the kidney which though not large enough to cause complete occlusion at least could set up enough irritation to bring about a contraction of the ureter with temporary distention of the pelvis. As an evidence that this factor had been at work we may mention the attacks of crying without apparent cause, the presence and then disappearance of the abdominal tumor, the sand found on the diaper after urination and the sudden changes in weight which occurred on these occasions. Death in all probability was due to uremia. 103 State St., Chicago. BIBLIOGRAPHY. 287. Ausset et Chatelain.-Echo méd. du Nord, Lille, 1898, II, 321. Bernard.-Arch de med. d. enf., Par., 1898, I, 343. Bidder.-Berl. klin. Wchnschr., 1885, XXII, 118-120. Blackwood.-Edinb. M. J., 1895-6, XLI, 919-921. Broca & Lesne.-Bull. soc. de péd. de Par., 1905, VII, 287-297. Courvelain.-Bull. et mem. de la Soc. anat. de Par., 1900, 6e s, II, Delastre & Haret.-Bull. et mem. soc. anat. de Par., 1900, LXXV, Engler.-Inaug. Diss., Kiel, 1900. Eppinger.-Mitth. d. Ver. d. Aerzete im Steiermark, Graz., 1893. XXX, 63-72. Erdmann. Ann. Surg., 1906, XLIII, 929. Froeblich.-Rev. méd. de l'est, Nancy, 1905, XXXVII, 274-276. Fuchs.-Inaug. Diss., Zurich, 1900. Gardiner. Ann. of Surg., 1908, XLVIII, 575-605. Launay. Bull. soc. anat. de Par., 1894, LXIX, 892-900. Martin.-Rev. de chir., Par., 1895, XV, 324-332. Pehu.-Lyon méd., 1905, CIV, 801. Rabot & Bertier.-Lyon méd., 1904, CII, 869-885. Reinach.-Jahr. f. Kinderheilk., 1903, LVIII, 260-275. Schwarz.-Inaug. Diss., Kiel, 1891. Seiffert.-Jahr. f. Kinderheilk., 1898, XLVIII, 17-19. Shirlaw. Brit. M. J., 1901, II, 1462. Simpson.-Glasgow M. J., 1867-8, 3. s. II, 332-342. Ventura.-ref. Jahr. f. Kinderheilk., 1908, LXVIII, 506. BRIEF REPORT OF TWENTY CASES OF STAPHYLO COCCUS INFECTION TREATED WITH KILLED BACTERIA. BY ALEX C. SOPER, JR. INSTRUCTOR IN PEDIATRICS, RUSH MEDICAL COLLEGE, CHICAGO. The efficacy of the so-called opsonic treatment of certain diseases is by this time well known, and needs no special defense or description; its application to diseases of children, however, has so far been limited. Various experimenters have shown the efficacy of subcutaneous inoculation of killed bacteria for certain systemic diseases of children and adults, and in the past year several have recorded encouraging results in furunculosis, acne, sycosis, and other skin diseases having an apparent systemic origin. Whitfield (1), Harris (2) and Wells (3), report such treatment of such cases; Whitfield describes the treatment of skin diseases by inoculation after the opsonic method, and while making a clinical classification into primary diseases (such as boils, carbuncles, sycosis), and secondary, (such as acne, chronic septic eczema, and septic ulcers), declares that he obtained amelioration, in a considerable number of the primary affections; in his hands no treatment of furunculosis prior to the introduction of the Wright vaccine therapy had ever produced the slightest results. In all cases treated there was complete and durable success; in no case was it found necessary to give over eight inoculations, i. e., a treatment lasting about twelve weeks. Harris (2), says a staphylococcic boil usually yields at once to bacterial inoculation, and that in most staphylococcic infections a common stock vaccine will suffice, but that it occasionally happens that it is necessary to make a specific vaccine from the par ticular infecting organism. He gives 100-1000 million every ten days. Turton (4), says he gives usually 200-1000 millions,—the smaller doses for acute cases, every 5-10 days, the larger for the chronic cases, every 12-21 days. He advocates surgical removal of pus, and the use of autogenous vaccine, but does not believe the taking of the opsonic index is necessary; he reports fifteen cases, none of them in children. Fordyce (5) never takes the opsonic index, uses invariably stock vaccines of aureus, albus, and citreus, and finds them most useful in general furunculosis; his initial doses for a six months' child were 50 million, for a ten year child 100 million. Illman (6) and Duncan report that they used Staph. Pyog. Aureus in doses of 5-10 billion, usually buying stock vaccine of the two large drug companies now marketing it; when this failed, they used the autogenous. Kelly (7) believes the doses generally too large, and prefers 10-20 million even for adults; he notes that the opsonic index. follows the clinical manifestations. He also administers the emulsions by the mouth and reports that cases so treated showed the same indices and results. Matthews (8) says he prefers to follow up the treatment with the opsonic index, but can go by the clinical symptoms; he gives succeeding doses according to clinical behavior-smaller if worse, larger if better or if not improved. The object of this paper is not so much to present anything new or novel in opsonic therapy as to record some observations on its application to bacterial infections in infancy and childhood. The majority of the cases were furunculosis in children. whose ages ranged from 2 months up to 7 years, the remaining cases were staphylococcic infections of various sorts and in each case the staphylococcus was isolated before beginning the treat ment. The stubborn character of furunculosis in babyhood is too well known to warrant description here-as well as the lack of a satisfactory treatment, occurring most frequently in ill |