advised aspiration, both to relieve distension and as an aid in the diagnosis. This being acceded to, it was done the following day, in presence of Drs. Baird and Hoge, of Wheeling, who assisted me. The needle was introduced three inches below the umbilicus, and eighteen pounds of sero-purulent matter removed, with immediate relief. It was now found that the tumor had no connection with the liver, and the history of the case forbade the idea of its being ovarian. Still there was doubt as to whether it was nephritic or an enormous psoas abscess; the urinary signs failed to indicate the former, and muscular action the latter. Tonics and stimulants were prescribed, and morphine to allay pain. For several days afterward she felt much better, the stomach was less irritable; she rested better at night, and sat up most of the day. It was evident, however, that the sac was refilling. February 15th she was found to be distended almost as much as at first aspiration, and the operation was repeated, removing fourteen pounds of purulent fluid. At this time and subsequently she complained of great pain, which was almost constant under the floating ribs on the left side near the spine. The urine was scanty and bowels constipated, which was attributed to morphia. This was the last time she was aspirated. The general treatment, however, was continued until near the close of the case. She died March 29th, three months nearly after my first connection with the case. Autopsy-March 30, 1881. Body very much emaciated and sallow, the abdomen enlarged greatly, the right leg had become swelled and edematous a few days before death. Dr. Hoge made the examination, exposing a tumor extending from the under surface of the liver, with which it was in contact, but not adherent, downward toward the left into the cavity of the pelvis. The small intestines were pushed to the left, while the lower end of the ileum ran across the tumor to the ileo-cæcal valve, producing the constriction before mentioned in the tumor. After removal from the body the sac was found to be fifteen inches in length, twelve inches wide, and by estimation six inches through. from before backward. It was not weighed for lack of facili ties. On opening the sac about ten pounds of purulent fluid escaped, and now her symptoms were clearly accounted for. The tumor was formed by the remains of the right kidney, the pelvis, and infundibula, together with the upper portion of the ureter, all of which were enormously distended, while the pyramidal and cortical portions of the kidney were almost entirely obliterated. The pressure of the tumor had occluded the ureter, and prevented any discharge of its contents into the bladder, during the time the patient was under my observation. The primary cause was found to be an enormous renal concretion, imbedded in the remains of the kidney, which with many smaller ones, after carefully washing them, were found to weigh 416 grains. They are probably mostly phosphatic, but this will be determined hereafter. The remaining contents of the abdomen were healthy, except the left kidney, which was congested from having to do the work of both. P. S. I should have stated that at no time were there any symptoms of uræmic poisoning. AN EXPERIMENTAL AND CLINICAL INQUIRY INTO THE ETIOLOGY AND DISTINCTIVE PECULIARITIES OF TRAUMATIC FEVER. By B. A. WATSON, M.D., NEW JERSEY. PROF. BILLROTH says: "I am firmly of the opinion that wound fever, and inflammatory fever generally, chiefly depend upon a poisoned condition of the blood, and that they can be produced by different materials which escape from an inflamed part into the blood." This distinguished author, as if to render more emphatic the same. idea, employs, on another page, the following language: "If a wounded man gets fever I conclude, whether the wound stink or not, that a phlogistic tissue-decomposition is taking place, and its products have entered his blood." The idea here expressed is a deduction drawn principally from experiments made on animals by Billroth, which consisted in introducing into the cellular tissue beneath the integument, or directly into the veins, pus, ichor, and various putrefying organic fluids, which invariably excited local inflammation, fever, and other constitutional disturbances. A similar series of experiments were made on animals by C. O. Weber with like results. These experiments were made with fluids taken from inflamed and suppurating wounds, which freely communicated with the air, and in which, according to our present opinion, there was already going on decomposition, and which, therefore, contained septic germs. Prof. Ernst Wagner merely reiterates the opinion expressed by both Billroth and Weber when he says:3 "It is absolutely established that the mode of injury and its immediate consequences, as far as effects upon the tissues are concerned, do not by themselves constitute factors capable of explaining the states of the temperature referred to above. All the remaining phenomena of traumatic fever in man are best explained by the hy 1 Lectures on Surgical Pathology and Therapeutics, vol. i. p. 125. 2 Ibid., 3 General Pathology, p. 672. New York, 1876. VOL. XXXII.-27 pothesis, that it is dependent upon inflammations set up, not by the injury itself, but by septic processes taking their start in the wound. It is most probable that the fever is caused only by spores which enter the blood through the wound, and that SEPSIS is the result of vibrionic putrefaction." The idea so concisely expressed in the above has already been the subject of much initial thought and dissention among surgeons more than one hundred years. During this period many surgeons have earnestly contended that the cause of inflammation and suppuration in wounds was due to atmospheric influences, while a very ancient idea attributed nearly all the evils arising in connection with a traumatism to the pseudo-demon cold. The numerous and everchanging views of the etiology of traumatic fever, which have been promulgated in the different centuries, beginning with Hippocrates and coming down to our time, reflect for each age the true condition of the medical and other allied sciences; but it is sufficient for our purpose to state, that nearly all these theories may be classified as the septic, nervous, and nervo-septic. The question, however, here entitled to priority is, what do we understand by traumatic fever? Richmond says: "Traumatic fever is an inseparable companion from all wounds of a certain extent healing by suppuration." Dupuytren says: "Traumatic fever is a diseased condition following the receipt of a more or less severe wound, which has for its object the preparation of the wound for healing." C. O. Weber defines traumatic fever as a general increase of metamorphosis of the various substances of the body, accompanied by an elevation of temperature, which is caused by poisoning the blood with the products of the decomposed tissues, which act as a ferment and produce a rapid loss of body-weight. M. Verneuil declares that traumatic fever is a constitutional disease, accidentally caused by the introduction of traumatic virus, and he designates it "traumatic septicemia. He adds that, in consequence of the small quantity of virus absorbed and the rapid elimination of the same, in some cases the disease is very slight and fugitive. This is what happens in simple traumatic fevers; it is a diminutive characteristic manifestation of septicemia. The definitions already cited form only a minor part of those which have been published, but the others differ from these principally in the language chosen to express the author's views rather than in the subject matter. A majority of these definitions are in |