pieces of apparatus for applying pressure locally while patient is held extended, and two pieces of apparatus for applying side pressure while the patient lies prone. If patient can hold correct position from one treatment to another, apparatus is not used. If patient shows a tendency to slip back between the treatment, and at the beginning of each treatment is in a less correct position than at the end, some form of retentive apparatus is used. Patients of this grade do not exercise in class, but receive individual appointments, and have the attention of one teacher for half an hour every day from one to four times a week. Home work also forms a part of this treatment, with patients whose parents are intelligent enough to carry it out. (2) The severest cases, which are treated by forcible correction and plaster jackets, are treated by the use of apparatus for exerting pressure to correct both the side deviation and rotation. Jackets are applied in succession until as much correction as seems possible has been gained. The last jacket applied is then used as a torso, which is moulded to exert pressure where it is wanted, and a permanent jacket of leather made to be worn continuously by the tient, removing it only for exercising. Apart from this point, the treatment does not differ from that pursued in the medium grade of severity, namely, to increase flexibility in desired direction, and exercises to improve muscular

condition.

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Although in so long continued an affection as lateral curvature it is difficult to secure the attendance of the patients for a sufficient time and the individual co-operation of the parents, on the whole the results have been satisfactory. In the cases of milder grade improvement has been the rule, and such cases have been excused from active treatment and placed wholly on home work, reporting occasionally. In cases of the medium grade marked improvement has been made in some, others remained where they were, while others from one reason or another have increased. In the severest condition the results of the forcibly corrected jackets have been satisfactory, and much improvement secured in them. The organization of the clinic is given, not because it is by any means what is desired, but because it represents a working scheme which gives fairly satisfactory results in the large number of cases treated in insufficient quarters.

ARTICLE XLVII.

OBSTRUCTIVE RENAL RETENTION WITH ANURIA, AND ITS TREATMENT.

54

BY FRANCIS S. WATSON, M.D.

OF BOSTON.

READ JUNE 7, 1904.

OBSTRUCTIVE RENAL RETENTION

WITH ANURIA, AND ITS TREATMENT.

THIS communication deals with those forms of renal retention only with which anuria is associated, and which originate in complete closure of the ureter or of the outlet of the renal pelvis.

As used here, anuria is intended to denote the reduction of the urinary secretion to a few drops in the course of each twenty-four hours; that is to say, the anuria which is termed absolute.

The phenomena which are observed in the kidney when its urinary outflow is completely obstructed, are as follows:

1. Increased intrarenal pressure.

2. Congestion and oedema of the organ under the influence of which it becomes enlarged.

3. Rapid diminution of the urinary secretion and change in its chemical character; the latter consisting in a marked reduction of its solid constituents.

After the obstruction has existed a few hours, the urinary secretion is almost absolutely suppressed, a few drops only being secreted in the course of each twenty-four hours. Owing to this latter fact, hypernephrosis in a marked degree is seldom seen in connection with complete, continuous obstruction. The enlargement of the organ is almost wholly due to congestion, and the urinary accumulation plays but a secondary part in its production.