nema. Great tenderness
over bullet. The tenderness persisted over the bullet and also
in the right flank until the tenth day, when the bullet was
removed. At the end of a month the patient returned to England
well but during the third week there was occasionally blood in
the urine.

(201) _Wound of both kidneys (rupture of right) and
spleen._--Wounded at Magersfontein. _Entry_ (Mauser), (_a_) 1
inch to right of second lumbar spinous process; (_b_) above
angle of left ninth rib: _exits_, (_a_) 1 inch internal to
right anterior superior iliac spine; (_b_) in seventh
intercostal space in mid-axillary line. The wound on the right
side gave rise to a lesion of the lumbar bulb (see p. 315), and
the patient suffered throughout with retention. There was
complete paralysis of the right lower extremity, both motor and
sensory. For ten days there was haematuria, and very severe
cystitis developed, while the patient suffered with severe
abdominal pain. The cystitis persisted, also retention, which
gradually gave way to dribbling, while irregular rise of
temperature and tenderness in the loins pointed to ascending
inflammation in the ureters. The patient gradually lost
ground, and a month later suddenly developed signs of
peritonitis, severe vomiting, distension, and dulness in the
right flank; and in two days he died.

At the _post-mortem_ examination the following condition was
found:--On the right side general pleural adhesions, recent
lymph over ascending colon and caecum, [Symbol: ounce]vj of
bloody fluid in a localised cavity between colon, kidney,
stomach, and liver. Lower quarter of right kidney in half its
width separated from main part of organ, yellow in colour, and
enveloped in disintegrating clot. Blood-staining of psoas
sheath; no injury to vertebral column or to bowel detected.

On the left side recent pleural adhesions and consolidation of
base of lung, rent of diaphragm; spleen soft and disorganised
and presenting a yellow cicatrix at its upper end, and at
antero-external aspect of left kidney was a soft yellow
puckered spot about the size of a florin, dipping 3/4 of an
inch into the organ, which was otherwise healthy, beyond
congestion. The capsules of both kidneys were adherent, but
there was no sign of suppuration.