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Upson claims that reduction of the gold can be effected with greater certainty by the careful employment of one of the following methods:

Method No. 1.—The piece of tissue from which the sections are to be cut is hardened in Müller's fluid for from two to five months; it is then washed in water, placed for two days in fifty per cent. and then for two months in ninety-five per cent. alcohol; it should remain in the alcohol until it has a greenish tinge; it is then imbedded in celloidin by the usual process, and sections are cut. The sections should remain in eighty per cent. alcohol for periods varying from a few days to several weeks before staining. The section to be stained is first rinsed in water and then placed into an aqueous solution of gold chloride, one per cent., for from ten to thirty minutes; it is then washed superficially in water and then immersed for half a minute in a ten-per-cent. solution of sodium hydrate; it is then again rinsed in water, and then placed in the reducing fluid, made as follows: Sulphurous acid,

- C. C. V.

- gtt. v-x.

Tr. iodin, five per cent., Solution ferric chlorid., thirty-seven per cent. (officinal), gtt. j. Here, after a few minutes, it assumes a red color; it is then again washed in water, dehydrated in alcohol, and mounted in balsam.

The sections should be handled with platinum needles or some non metallic substance, as an iron needle will streak the specimens. The reducing fluid should be always freshly made before using.

Dr. Upson says that the changes which take place in this process are as follows: "The potassium bichromate of the Müller's fluid is converted in the tissue to a brown chromium dioxide or a green chromic oxide; the oxides of chromium are replaced by the gold salt, which is converted into a trihydioxide by the sodium hydrate, and into a red oxide by the reducing fluid. In specimens stained in this way the stain varies with the length of time that the cut sections have been in alcohol. If they are stained immediately after being cut, the stain is more or less diffuse, but differentiates after being mounted about a week; if they have been in alcohol a few days, they take a lighter stain, which is almost confined to the ganglion cells, axis-cylinders, and myelin-sheaths. If the sections have been a week or so in alcohol, they take a stain which is confined to the axis-cylinders and myelinsheaths, the ganglion-cells not being stained. If the sections have been longer than a week in alcohol, the stain is very apt to be confined to the myelin-sheaths and finer axis-cylinders, and these sections very much resemble those stained by the Weigert method."

◄ Henry S. Upson, Cleveland, Ohio: Journal of Nervous and Mental Disease, November, 1888.

The sections of the cord, in specimens Nos. 20 and 21, are stained by this method. They had been in alcohol over a week, and you will see that they resemble somewhat the sections stained by the Weigert hæmatoxylin method.

Method No. 2.-Dr. Upson his devised another method, the details of which, I believe, have not yet been published, and which I have not had an opportunity of trying. In this method he brings the sections, soon after cutting, into the one-per-cent. solution of gold chloride for half an hour; they are then washed superficially in water, and then placed for from a half to one minute into a fifteen-per-cent. solution of sodium hydrate, to which has been added, just before using, a trace of chromic acid; they are again washed, and then placed into the reducing fluid, made as follows:

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The tin solution is made by adding 1 to 2 grms. of protochloride of tin to 30 c. c. of a one-per-cent. tincture of iodine.

The iron solution is made by making a five-per-cent. solution of the phosphate of iron-using the soluble scale salt.

This reducing fluid should be made fresh immediately before using, and the ingredients added in the order named."

After all has been said, I believe that the hæmatoxylin method of Weigert is the most reliable of the methods mentioned, inasmuch as it is, with a moderate amount of care in hardening and the selection of carefully prepared solutions, uniformly certain in its results.

AN INTERESTING CASE OF PYELONEPHRITIS FOLLOWING DISPLACEMENT OF THE RIGHT KIDNEY.

BY LOUIS F. CRIADO, M. D.

Read at the Annual Meeting of the Brooklya Pathological Society, Jan., 16, 1890.

Under normal conditions the kidneys are held in their natural position by an abundance of adipose tissue, over which the peritonæum is reflected. Oftentimes one or both of these organs are found to have deviated from their natural position and to have become fixed, or to possess such a degree of freedom as to permit considerable mobility and change in its position. Many of these cases become mere patho

5 Since the reading of this paper I have done some work with this method, and find it much more reliable than the Method No. 1. I find that in the use of the first method one is more apt to get the purple oxide in the tissue, while in the use of the second method the red oxide is almost uniformly produced.

logical curiosities from the fact of their being subject to little or no inconvenience or disturbance; in others, however, the amount of suffering is quite severe and even compromises life. The most frequent seat of malposition of a displaced kidney is the umbilical region; in fact, a tumor found in this region should always arouse suspicion. Likewise, a kidney may be found in the inguinal or hypogastric region, and even within the pelvic cavity. These malpositions are oftener met with amongst females than in the opposite sex, and the organ on the right side appears to be the one most frequently displaced. Oppolzer, Rollet, Ebstein, Hare, Roberts, Landau, Hahn, Newman, Becquet, and many others have reported and collected a large number of cases. Of 96 cases collected by Ebstein, 82 occurred

in females and 14 in males. In 91 of these cases there were 65 in which the right kidney, 14 in which the left kidney, and 12 in which both organs were found displaced. Roberts reports 70 cases collected, 61 of which were females and 9 males. In 65 of these cases there were 42 in which the right, 9 in which the left, and 14 in which both kidneys were found displaced.

As a rule, considerable inconvenience and suffering follows a noncongenital displacement of the kidney. There is generally an expression of anxiety, depression of spirits, a feeling of dragging, as if there was something wrong in one side of the abdomen, and much aggravated by standing, walking or riding; dyspepsia, nausea, vomiting, neuralgic pains, and pains varying in intesity, radiating towards the loins, around the waist, extending to the shoulders and down the thighs; fainting, and even collapse. In the majority of cases the patient discovers the tumor, which when the physician's attention is called is recognized by its shape, size, elasticity, smoothness, and on account of its being more or less movable; and, when pressed upon, by the peculiar pain caused, which can similarly be produced by pressing upon the lumbar region corresponding to the other organ. It is said that the lumbar region corresponding to a displaced kidney appears flattened and sunken in, and that whenever the organ is replaced it becomes as prominent as the other side. I am inclined to regard this observation as of more theoretical value than clinical. There is a liability to the development of peritonitis and a considerable amount of inflammatory exudation, the kidney thus becoming fixed. The tendency is usually towards recovery; but it frequently occurs that as a consequence of an injudicious jump, a fall, a blow upon the displaced organ, a prolonged walk, fatiguing exercise, per se, the kidney twisting upon its own axis, or for some unknown reason an inflammation ensues, producing an obstruction of the ureter, and subsequently a pyelitis or a perinephritic abscess; the tumor thus becoming

enlarged and encroaching upon the inferior vena cava, is apt to cause an interference in the circulation, as reported by Ryer, in which case it obliterated that vessel.

It is both possible and probable that the displacement of one or both of these organs occurs much more frequently than is generally believed or admitted, inasmuch as the diagnosis is oftentimes not only difficult and uncertain, but because the fact of such a possibility is frequently overlooked; and, again, because the subjective symptoms vary greatly. The fact of a kidney being displaced does not invariably give rise to symptoms; indeed, post-mortem examinations have proven the existence of a displaced kidney which had not been suspected during life. With this very object in view, Walther examined a number of persons, and detected the above abnormality in many cases in which there were no symptoms whatever. Rollet states, that of 5,000 persons examined by Oppolzer, displacement of the kidney was discovered in the proportion of one in every 250. This organ has been found lying between the bladder and rectum, besides the uterus, and thus mistaken for a diseased ovary. Ebstein mentions a case in his practice which was mistaken for a mesenteric hydatic cyst. Rayer cites a case in which on two occasions this organ was found displaced and lying on one side of the psoas muscle during labor. Edes mentions another, which led to an attempted removal of a supposed ovarian cyst, and which proved to be a displaced kidney. Trauseau mentions a case which was mistaken for peritonitis, and another in which an abdominal tumor was supposed to be of malignant nature, and proved to be a displaced kidney. A case has been reported in which a woman with an enlarged displaced kidney was for some time believed to be preg

nant.

The history of the present case is as follows:

Marshall A., aged two years and ten months, on attempting to de cend a flight of stairs, lost his balance and fell head first the entire flight, turning two or three somersaults and striking forcibly against a wall. He was taken up from the floor almost senseless, and household remedies resorted to until the next day, when, on account of nausea and his being very irritable and feverish, a physician was summoned, and the belief entertained that "perhaps it might prove to be the measles" On the following day the child's relatives noticed that he complained of pain whenever they touched his abdomen; the attending physician, however, concluded that the child was suffering from an attack of pneumonia (not the measles), continued attending him five or six days, and it then became evident that the child did not only complain of pain in the abdomen, but that there actually was a hard tumor that could be felt. On the eighth day, the family consulted

another physician, who examined the patient, and believed that there was some intestinal difficulty. On or about the eighteenth day the physician who first attended to the child was again summoned, and his attention called more especially than ever before to the tumor; he examined the child and concluded that the tumor was due to an abscess of the liver, making it known at the same time the advisability of an operation. The family objected, and, becoming much alarmed, brought the patient to my office for advice. I learned that he had, of course, been taking medicines, and had been ordered a strict diet in the supposition of the foregoing diagnosis. The child was very fretful, unable to stand, much emaciated, feverish, and urinated frequently. On physical examination, I discovered an elastic, smooth tumor, of about the size of a lemon, lying obliquely, a little to the right of the umbilical region. I informed the relatives that my belief was, that the child had suffered a displacement of the right kidney; that the tumor would not disappear, inasmuch as the organ could not be replaced (it had become fixed), but that I thought he would improve in health, regain his strength, and be as well as usual. I advised them to allow the child his usual food ad libitum, ordered elixir of calisaya, and anointing the abdomen with warm camphorated oil, cautioning them at the same time that, should the child improve, not to permit him to run, jump, or indulge in any active exercise as children are apt to do. I saw the patient three times within three weeks. He had markedly improved in health generally, his appetite was excellent, he was playful, slept well, and appeared as well as he had ever been before. The last time I saw him the supposed kidney could be felt in the same region; in other words, the tumor had not disappeared, increased nor diminished in size, but it was no longer painful; in fact, the family had become quite forgetful of the child's previous condition, and did not believe him otherwise than in his usual good health, until about four and a half months after the accident, when he contracted bronchitis on the day following a bath, and shortly afterwards suffered a severe blow on his abdomen, by having accidentally been thrown out of his baby-carriage and fallen against a curbstone. From the time I last saw him after the first fall to the time he contracted bronchitis and sustained another injury by falling, a period of two and a half months, the child had enjoyed his usual good health and never complained. About a month after the second accident the patient was again brought to my office, the family having previously consulted a large number of physicians and many more afterwards. I ascertained that he had had

considerable pyrexia ever since the day following the second fall; that he had lost his appetite, cared not to play, complained of pain at the seat of the tumor, perspired very freely, had an intense thirst, and wanted day and night to be rocked on the mother's lap.

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