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the iiiere opening and manipulation of -the peritoiieuim could induce an extension of inflammatioil from tlle ureter to the serous memibrane. Tlhere seeims to be no douLbt that suclh an extensiona tool place and caused the intestinial adhesiolns, the vermiforill appendix being involved secondarily. It is obvious that at the second operation a shortcircuiting of tlle bowel would lhave relndered the tlird, fourtlh, and sixtlh operations unnecessary, and possibly the need for the neplhrectorny would lnot lhave arisen, but if the adlherenit coils lhad not been separated a pus focus might lhave been left, and whlen the absence of aniy such condition was ascertained the patienit, never strongr, had become so feeble that the course. adopted seemed the safest. Rlemoval of the kiidney was essenitial for lhealth and comifort, so the development of -the renal symptonms was not regretted after tlhey-lad been successfully dealt witlI.

ACUTE SEPTIC MENINGITIS DUE TO B. COLI FOLLOWING SKULL WOUND