80 Philippine Journal of Science 1920 
sleep. When this happened several successive nights, she felt 
particularly uncomfortable the day following from loss of sleep; 
she also lost appetite. According to the patient, when she was 
still at home there were nights when she lost practically all of 
her sleep, having to get up from fifteen to twenty times to void 
only a few cubic centimeters of urine. This happened espe- 
cially when she had been engaged in somewhat heavy labor 
during the day or else when she had undergone some strain. 
The urine had no definite character; sometimes it was abun- 
dant, and at others scanty. Its color on many occasions was 
somewhat whitish, not amberin, pale and simply cloudy, and at 
other times, it was lighter, less cloudy, or less opaque. Realizing 
that her condition grew from bad to worse, she decided to enter 
the hospital. 
Her physical examination revealed: Chest normal in shape, 
fairly well developed but expanding rather poorly; voice sounds 
and tactile fremitus apparently normal; left pulmonary apex 
showed slight impairment in resonance, but no rales of what- 
ever kind could be heard in any region of the lungs. Heart ex- 
amination was negative. 
The abdomen, aside from slight tenderness in the left hy- 
pochondrium elicited only on deep pressure, was practically nor- 
mal. Extremities, negative. 
Loin examination: The left lumbar region upon percussion 
was somewhat tender. By combined palpation, one was able 
to feel the lower pole of the left kidney, which did not wander 
even by changing the position from supine to sitting or even 
standing posture. The right loin showed some second-degree 
nephroptosis, but without inconvenience to the patient. 
Cystoscopic finding—The whole mucosa of the bladder was 
pale and covered by a thin layer of mucus. There were tra- 
beculz in certain areas at the bottom. Blood vessels scarcely 
visible. The trigonum vesicze was a little darker than the rest 
of the bladder mucosa. The left ureteral meatus was hardly 
found on account of a rather thick sheet of mucus and pus cover- 
ing the opening, which was situated in a slightly elevated area 
in that region. The meatus of the right ureter, on the contrary, 
was relatively free of such mucus and pus covering and was 
immediately found. 
In view of this finding, my impression was that in the upper 
part of the left meatus uretericus there was some pathological 
condition which was not present in the right side. I, therefore, 
passed the ureteral catheter through the opening of the left 
