88 ^ 1 he Philippine Journal of Science 1920 
perienced in its use, but may be easily overlooked by the inex- 
perienced. A diverticulum opening is sometimes so very small 
that it looks like a dark speck in the field. This apparently insig- 
nificant speck, however, may be the opening into a very large sac. 
The cystoscopic examination may be verified and the size and 
exact location of the diverticulum determined by the injection 
of collargol or other silver preparation, followed by an X-ray 
of the bladder region. 
A CASE OF LEFT RENAL CALCULUS COMPLICATED BY PYELITIS 
CAUSED BY BACILLUS PYOCYANEUS 
Case. — H. G. E., wagon master, age 42. 
Personal history. — For the past three years has had pains 
in left kidney region. These attacks occurred on an average 
of opce a month and would last from a half hour to twenty- 
four hours. Attacks were severe and would radiate down to 
left groin; urination and hematuria frequent during an attack. 
During the past ten months has been observing urine at in- 
tervals of two weeks. After an attack of pain would pass, 
he would notice eight or ten small calculi; the urine would be 
dark-colored at this time. 
Past history. — Two weeks before admission had chills and 
fever, and slight pain in left renal region. Complains of loss 
of appetite, nausea, and vomiting. No frequency of urination, 
no burning pain. Urine was dark-colored and very turbid. 
Cystoscopy showed mild degree of cystitis involving the entire 
bladder wall, the ureteral orifices apparently normal. Ureteral 
catheters, passed to both kidney levels, met no obstructions. 
X-ray of genitourinary tract, with X-ray catheters in situ, was 
negative for calculi. Examination of urine from left kidney 
showed many pus cells and the presence of Bacillus pyocyaneus. 
Repeated examinations verified these findings and showed that 
the finding of Bacillus pyocyaneus was not due to contamination. 
An autogenous vaccine was made from the pus obtained from 
the left kidney, and eight injections of this vaccine were given at 
intervals of four days ; previous to the giving of the autogenous 
vaccine the patient ran a very septic course, the temperature 
varying from 97° F. to 105° F. The autogenous vaccine was 
given after this septic temperature had continued for three 
weeks. On the day of administering the first injection the tem- 
perature was 103.2° F. ; with each succeeding injection of the 
vaccine the temperature declined toward normal until the end 
