[Extracted from Proceedings op Pathological Society op Philadelphia, Vol. XIII. 
Dilatation of ureter and hypertrophy of the bladder. 
Exhibited by Dr. J. Daland.^ 
M. S., set. 9 years, female, white. In 1880 had scarlatina, since 
which time she has complained of polyuria, frequent micturition, thirst, 
gradual loss of color and strength, slight irregular fever, rapid pulse. 
Usually passed four to six pints of urine daily, and examination of that 
secretion showed a moderate amount of albumen, no sugar, moderate 
amount of pus, no blood or tube casts. There was a temporary im- 
provement and then she became feverish, pulse rapid, vomiting. Remark- 
able over-action of the heart. She gradually grew worse and died. 
Autopsy, two days after death.—Kidneys small and shrunken. Left 
kidney measured two inches in length, and one and three-quarters inches 
in width. The calices, infundibula, pelves, and ureters were all enor- 
mously dilated. In places the ureters measured one inch in diameter. 
The walls wrere remarkably thickened, chiefly due to hypertrophy of the 
muscular coat. At the beginning, and just before they terminated in 
the bladder, the lumen of the ureters suddenly diminished, though still 
considerably larger than normal. The mucous membrane of the whole 
urinary tract seemed thickened. The vesical mucous membrane was 
covered all over with small grayish spots. These pigmentations may 
have been due'to old ecchymoses. 
The bladder was greatly enlarged and its walls thickened. Here, 
too, the muscular coat seemed the chief cause of the thick walls, which, 
in places measured two or three lines. The capacity of the bladder 
had increased fully threefold. The mucous membrane seemed slightly 
thickened. Urethra normal. There was no calculus and no history 
at any. time of urinary obstruction. The sequence of events seems to 
me to have been somewhat as follows: After the scarlatina in 1880, 2 
excessive urination occurred, and, this persisting, necessitated an increase 
in the capacity and thickness of the Avails of the bladder, and consecu- 
tively the same condition in both ureters and pelves. Frequently she 
Avould void more than a pint of urine at one time. The heart showed 
simple hypertrophy. The remaining organs Avere normal. The brain 
and spinal cord were not examined. May 27, 1886. 
Chronic interstitial nephritis, with enormous dilatation of the right 
pelvis, without apparent cause. 
Exhibited by Dr. J. Daland. 
A. H., merchant, white, set. 55, married. For some years past he had in- 
termittent albuminuria and occasional hyaline tube-casts. He emaciated 
rapidly, and soon became markedly anaemic. After ceasing work and 
carrying out a very careful plan of treatment he improved rapidly, and 
in eighteen months was in excellent health, though the urinary condi- 
tion still persisted. Feeling so well, he returned to active business life, 
and was soon overworking himself as he had done before. Soon it was 
noticed that his strength, flesh, and color began to fail, aud this condi 
tion progressed, with slight fluctuation, until his death. This case was 
not under my observation during life, hence this imperfect report. 
Autopsy, twenty-eight hours after death.—Body emaciated ; rigor mortis 
moderate. 
Lungs highly oedematous and congested; bronchial mucous membrane 
in a condition of chronic catarrhal inflammation. Slight old pleuritic 
adhesions on both sides. No pleural effusion. 
Heart normal in size, rather pale in color; consistency normal. The 
anterior mitral leaflet was rather thickened and shortened, the remainer 
of the valve normal. No pericardial effusion.' 
Liver pale in color, but normal in size and consistency. The hepatic, 
cystic, and common bile-ducts pervious. 3 
Spleen and pancreas normal. 
Stomach showed marked evidence of chronic catarrhal gastritis. The 
small and large intestine, including the appendix vermiformis, normal. 
The transverse colon was filled with soft feces which, during life, were 
mistaken for a cancerous tumor. 
Kidneys: The left kidney was elongated and narrow, measuring four 
and a half inches in length and two inches in breadth. In places the 
capsule was adherent; cortex rather thin; consistency increased. In 
certain portions of the kidney the changes due to chronic interstitial 
nephritis were more marked than in.others; this was particularly true 
in the superior third of the kidney. The pelvis of the kidney was enor- 
mously dilated, but there was no obstruction in either ureter, bladder, 
or urethra. No calculi were found, and the mucous membrane was 
normal. The right kidney was in the same condition as the left, but 
to a less degree. The right pelvis and ureter normal. No retention 
cysts. The suprarenal bodies and abdominal glands were normal. The 
brain and spinal cord not examined. January 27, 1887.