reasonably justify. The urinary organs thus exposed, were then brought still more into view by inflating them through the urethra, that a plaister cast might be taken of them. Nothing else occurred in the examination worthy of notice. The cast represented in plate No. 14. and the inflated preparation afterwards made of these organs, were placed in the Anatomical Museum of the University.

The result of this dissection is such as fully to explain the symptoms, but whether it will justify the opinion I have formed, that the malady had its origin in a deficiency of that structure, by which the coats of the bladder act as a valve upon the urėters, remains for consideration. The earliest remarks upon the health of this child occurred during his infancy, and led, even then, to the supposition of some derangement in the urinary passages, and that too of so serious a kind, as to be regarded as the cause of his unthrifty condition. His symptoms, though occasionally intermitting and varying in severity, continued in after years to preserve such a general uniformity of character, that little doubt could be entertained of their connection with those of his infancy, and still less of their appertaining to some disease of the urinary organs. It is therefore most probable that the conjectures which, in his earliest illness, attributed his symptoms to some disease of the urinary apparatus, were so far correct, and that the appearances disclosed by the dissection were the consequence of that primary affection. That the valvular connection of the ureters with the bladder was destroyed in the first instance by obstructions from calculi, may be justly doubted; for his symptoms commenced at so early an age, that had calculi ever passed, they could not have escaped the observation of his mother. Besides, it is unfavourable to such an opinion, that both ureters should present the same appearances, although, on the other hand, it may be

said, that a disposition to calculous concretions would be manifested equally in both kidneys. It is certain, however, in this case, that no tendency to this disease was ever discovered, though the attention of the mother had been directed to it from his earliest age, from the belief that his disorders were situated in these organs. As to the suppurative process in the kidneys having been the cause of obstruction to the ureters, it should rather be regarded as the consequence of it. But to explain our own views of this case, let it be supposed that this malformation of the ureters did actually exist at the time of birth. It would then follow, that the urine flowing guttatim into the bladder would at length accumulate until it caused that degree of contraction which, in a perfect bladder, would not be sufficient for micturition, though in the instance before us, sufficient to repel it into the ureters; it would therefore be driven back towards the kidneys, and remain in the ureters as long as the action of the bladder lasted. But when the useless effort of that organ ceased, the urine would descend again into its cavity, and the same ineffectual contraction be repeated, until it had at length accumulated so much beyond the capacity of the ureters to contain it, as to acquire from the bladder an impulse sufficient, with that from the abdominal muscles, to overcome the resistance of the sphincter vesicæ. In the natural construction of these parts, the muscular power of the bladder is thought sufficent to finish the evacuation of its contents, unaided by the abdominal muscles, they having first assisted the bladder to overcome the resistance of its sphincter; in the case before us however, there would be this difference, that unless that pressure upon the ureters by the abdominal muscles were continued after the sphincter vesicæ had yielded, no more urine could necessarily be propelled per urethram than the excess above what the ureters were capable of holding. It must then be manifest

according to this view of the case, that, although the ureters would occasionally be evacuated of part of their contents by this simultaneous action of the bladder and abdominal muscles, still they would not only be often greatly distended, but in process of time would become the ordinary reservoir for the urine. In the examination of this child it occurred to me as very remarkable, that so abundant a secretion of urine should be capable of being carried on by so small a portion of the kidneys as that which remained. I then regretted that his urine had never been submitted to chemical analysis during his residence in the Hospital; for, from its appearance, I should conjecture that it differed very much from healthy urine in the proportions of its constituent parts, and that it might even have been found to be entirely destitute of some of them.

Cambridge, Sept. 10, 1821.

JOHN OKES.