Pneumaturia.

During the last two centuries observations of the passage of gas with the urine have been made from time to time by various authors, and lately a number of very detailed accounts of this phenomenon have appeared.Brierre de Boismont in 1825 mentioned the spontaneous production of gas in the bladder and considered it due to a sort of flatulence or secretion of gas by the bladder mucosa.Roche confirmed this and Chomel added to the suggestion of gaseous secre- tion from the membrane, the idea that the gas might be due to fermentation.But up to 1860 practically all the instances were in cases of fistulous communi- cation between the bladder and intestine, and when in that year Raciborski was called to treat a man who passed bubbles of gas from the urethra he first satis- fied himself that there was no vesico-enteric fistula, before describing the case as one of spontaneous development of gas in the bladder.The cases of pneumaturia may be roughly divided into three groups:1.Those in which air is mechanically introduced into the bladder from without.2. Those in which gas develops in the urinary tract through the agency of some fermenting organism.3. Those in which there is a communication between the bladder and an air-holding viscus.The first group is of little practical importance, as the discomfort is transient and the phenomenon has no pathologic significance.The introduction of air may occur during irrigation of the bladder if the appar- atus used is not emptied of air before the fluid is allowed to flow.More commonly is the condition brought about by the knee-breast position occupied by the patient during the cytoscopic examination as practiced by Dr. Kelly, when it forms the basis of the