the time of the attack, and the typhoid condition
which followed, as also the low grade of inflammation bordering on the
scrofulous, made such a thing probable.

CASE FOURTH.--On Jan. 31st, 1879, Mr. R----, Italian, aged 35 yrs., while
chopping wood near Almaden mines, was injured by a falling tree. The lower
part of the body was very much bruised, both posteriorly and anteriorly.
The only place where the skin was broken was a smooth cut about four
inches long and nearly half an inch deep, following the fold or crease
between the right testicle and thigh, and extending from the anterior part
of the testicle to the perineum in a straight line just where the scrotal
integument joins that of the thigh.

The main injury was in the lumbar region over the upper lumbar vertebrae.
The spinous process of the lower dorsal vertebra seemed to be unusually
prominent, leading to the supposition that the spinous process of the
upper lumbar vertebra might be fractured and depressed. However, I was
unable to detect mobility or crepitus in any of the processes, spinous or
transverse, either of the dorsal or lumbar vertebrae.

There was considerable tenderness over the lumbar region. I would here
state that the examination was made about twenty hours after the receipt
of the injury. There was but little discoloration of the skin, not very
much pain, no paralysis of any part, the bladder evacuating itself
naturally, and a cathartic producing its ordinary effect in the usual
time.

The patient did well; complained of but little pain; did not use opiates.
On Wednesday and Thursday following, the patient felt well enough to walk
about the wards, eating well and having no constitutional disturbance,
pulse never higher than eighty per minute, and the temperature not above
99 degrees F.

On Friday morning the nurse remarked that this patient had complained of
pain in the back during the previous night, and that there seemed to be a
soft spot on his rump. By examining, I found below the bandage which I had
put around the patient, a fluctuating mass, immediately beneath the skin
and superficial fascia, extending from the tenth dorsal vertebra above, to
the coccyx below, and from the crest of the right ilium to that of the
left.

I was at a loss to know how to account for this fluid, for there was at
least a quart. I removed the bandage and examined more carefully. There
was no inflammation to amount to anything, nor had there been. Here it