SURGICAL COMPLICATIONS AND SEQUELS OF FEVERS. 51 



nil. Indeed, of 47 cases, I find 10 were wholly unsnspccted 

 until revealed at the post-mortem. The position of the tumor 

 accounts in part for this. Both in the thigh and in the 

 abdominal wall they are almost alwaj's in the posterior part of 

 the muscle — a position due probably, to the effect of gravit}^ 

 in the recumbent posture. Often, indeed, they are so deep as 

 to extend to the pelvic and iliac muscles, and in two cases, 

 under the serous coat of the bladder. Hence there is usually 

 little or no discoloration of the skin, though Foucault reports 

 a case with ecchymosis in the h3q30gastrium, extending later 

 to the scrotum, thighs, and buttocks Swelling is only 

 reported 13 times, and fluctuation but 10 times. Suppuration 

 and softening are but rarely attended with any special fever. 

 Pain is mentioned in 14 cases, j^'lexion of the legs to relax 

 the abdominal wall, which we would suppose to be frequent, is 

 named but once. Tlie size of these blood tumors varies from 

 that of a bean to that of an orange. If small, they may be 

 obscured by mcteorism ; the symptoms then being so indeci- 

 sive, as in many of these surgical sequels, the necessity for 

 frequent and rigid physical examinations is at once apparent. 

 If a sudden and fixed pain exist in the recti below the navel, 

 or even if movements be onl}^ hindered or uneas}^ and painful, 

 a close examination should be made, and if a tumor or onl}^ 

 hardness be found, it should be carefully scrutinized, from 

 day to day, especially for the pasty feel and other signs of 

 oedema, and of fluctuation. The differential diagnosis is not 

 usually very dilTicult. The most likely error, if in tlie rectus, 

 is that of mistaking it for a distended bladder, but the 

 catheter will at once unmask this error. If in the right iliac 

 region, it may be mistaken for perityphlitis ; or in the adduc- 

 tors, for a simple abscess ; but, as in point of practice, the 

 treatment of all three would be more or less similar, the error 

 is of less moment than might be supposed. From aneurism, 

 an abdominal tumor, and peritonitis, the differential diagnosis 

 is sufficiently easy. 



