Dr. G. W. POOLE: The patient (Case No. 180995; P.M. No. 10546) was born on 21 January 1921 and was 42 years old when he died. He was single and a maintenance fitter. There was no history of serious illness as a child ; vaccination was uneventful. In 1937 he developed acute appendicitis. The original section of his appendix is available and will be discussed later. His parents reached old age. There were 10 siblings, two of whom died in infancy of measles and one of a respiratory infection as a young man. One sibling has been traced. In 1940 the patient was normally well and was accepted A.1 for the Army. In 1942 he had an acute respiratory illness. Recovery was slow and there were exacerbations, so that in 1943 he was invalided out of the Army. A bronchogram in 1946 is said to have shown left lower lobe bronchiectasis and the tuberculin test was only positive using 100 units O.T. In 1955, at the age of 34, he was first admitted to Hammersmith Hospital with a middle lobe pneumonia, which responded promptly to treatment. Clubbing of the fingers was noted and there was also anaemia, described as iron deficiency in type: haemoglobin was 11.9 g./100 ml., P.C.V. 41%, and M.C.H.C. 29%. The total serum protein was 5.8 g./100 ml. (albumin 3.2 g./100 ml., globulin 2.6 g./100 ml.). There was no proteinuria. Already the patient was disabled by recurrent pulmonary infections, sinusitis, and persistent sputum. In 1958 he contracted a pleural effusion which was thought to be post-pneumonic. Haemoglobin was 10.1 g./100 ml. The

Dr. C. T. DOLLERY: The patient was a law student who died at the age of 22 (Case No. 143012; P.M. No. 10,000). He had had poliomyelitis at the age of 31 and was left with weakness and shortening of the right leg. In 1952 he was first admitted to Hammersmith Hospital complaining of pain in the right iliac fossa for 18 months, which had grown much worse during the preceding four days. He had had frequency of micturition for three days. Several urine examinations showed orthostatic proteinuria. His bloodpressure was 160/100 mm. Hg on admission, and later went down to 140/90 mm. Hg. One urine specimen showed scanty red cells and pus cells, two others were normal. Intravenous pyelogram was normal. No treatment was instituted. In 1956 he was admitted to West Middlesex Hospital with fever, haematuria, and infected urine. His blood-pressure was 150/100 mm. Hg. He was treated for a urinary infection. In 1961 he was admitted to Hammersmith Hospital with one week's history of malaise, nausea and vomiting, and frequency of micturition. He was pale, ill, and slightly jaundiced, with a blood-pressure of 230/170 mm. Hg. His venous pressure was normal. The heart was not enlarged but an atrial gallop could be heard. His retinae showed bilateral haemorrhages, exudates, and papilloedema. The right kidney was just palpable, but there was no bruit. The muscles of the right leg were wasted and the leg was shorter than the left. The urine contained 3.5-7 g. of protein in 24 hours. There were no cells. Four specimens were sterile and three grew E. coli sensitive to sulphonamide. Haemoglobin was 13 g./100 ml. W.B.C. was 8,000, with 3.6% reticulocytes. E.S.R. was 16 mm./hr. and serum bilirubin 3.2 mg./100 ml. Blood urea was 60 mg./100 ml. Serum sodium was 130 mN, potassium 2.9 mN, and bicarbonate 31 mN. Chest x-ray showed no cardiac enlargement. Intravenous pyelogram showed poor excretion of contrast bilaterally. An aortogram showed normal main renal arteries, with both kidneys 12 cm. long. Electrocardiogram showed severe left ventricular hypertrophy. He was treated with subcutaneous pentolinium and oral guanethidine, and his papilloedema and retinopathy slowly improved. The serum bilirubin fell to normal but the reticulocyte count remained at 2-3 %. He was discharged on guanethidine 80 mg. daily, pempidine 10 mg. in the afternoon, and sulphadimidine. He was fairly well for three months and the bloodpressure was controlled, but he was then readmitted with severe breathlessness and a haemoptysis; he coughed up half a cup of bright blood. Blood-pressure was 190/135 mm. Hg, and the venous pressure was normal. The left ventricle was moderately enlarged with an atrial gallop. His retinae showed fresh soft exudates. The E.S.R. was 90 mm./hr., haemoglobin 9.5 g./100 ml., and M.C.H.C. 33.5 %. Reticulocytes were 7.8 %, with some burr cells, and the Coomb's test was negative. The urine was sterile, with 3.6 g. protein in 24 hr. Blood urea was 320 mg./100 ml. Serum sodium was 130 mN and potassium 4 mN. Chest x-ray showed severe interstitial pulmonary oedema. He did not improve and died two weeks later. Clinical Diagnosis

4 she was admitted to the Luton and Dunstable Hospital with what was diagnosed as lupus vulgaris of the right calf -and an abscess underlying it from which tubercle bacilli were isolated. This healed up satisfactorily, but the following year contractures of the right elbow and of the wrists were noticed, without either pain or swelling. Left adrenalectomy was performed by Mr. Broster in 1944 because of excessive pubic hair and marked clitoral enlargement. 17-Ketosteroid excretion was then 9.8 mg./day. Following the operation, increasing deformities