REPORTS OF CASES. 
35 
These untoward symptoms continued without material 
change till his return, looking unthrifty, with staring coat, 
emaciation, debility, a temperature of 104.9 an< ^ pulse of 60. 
Exploration per rectum revealed no difficulty about the inguinal 
rings and the wounds made had healed. 
From the time of return until December 4 the patient showed 
a capricious, poor appetite, with a temperature vacillating be¬ 
tween 101 and 103.5 with progressing emaciation and weak¬ 
ness. 
On December 4, a cough appeared, with a thick, dark reddish 
foetid discharge from the mouth and nostrils ; the temperature 
dropped to 99.8 to rise shortly after to 104.8. 
Diagnosing a metastatic abscess of lungs, a trachea tube 
w r as inserted, after which a trocar was inserted through the chest 
wall into the right lung and about 10 liters of saline solution 
were injected into the suppurative area through the trocar can- 
ula and allowed to escape through the trachea and trachea tube, 
washing out much pus. The patient seemed for a time stronger, 
but the temperature quickly rose to 106.6. The injection of 
saline solution was repeated in a few hours. The patient died 
during the night of December 4. 
The autopsy on December 5 revealed right pleura somewhat 
inflamed, especially at border of diaphragm, some dark reddish 
flocculent exudate present. 
Right lung adherent to diaphragm throughout its posterior 
surface. Diaphragm much thickened. Between the liver and 
the posterior part of the diaphragm a large abscess existed of 
about 5 liters capacity. This had ruptured forward through the 
diaphragm into the right lung, inducing the symptoms of pul¬ 
monary abscess. The posterior and central portions of the right 
lung were largely necrotic, the other portions mostly hepatized. 
Small areas of hepatization occurred in the left lung. The 
capsule of the liver was intact and at the point of the abscess 
about 1 cm. thick. The abscess was between Glisson’s capsule 
and the diaphragmatic peritoneum. 
The infection had, it seems, entered the peritoneal cavity 
through the wound made into the peritoneal sheath of the sper¬ 
matic cord during the removal of the tumors, had become lo¬ 
cated and vegetated between the hepatic and diaphragmatic 
layers of peritoneum and opening in the direction of least resist¬ 
ance had penetrated the right lung, and opening into a large 
bronchus escaped through the trachea and nostrils. 
An error of judgment was probably made 111 removing the 
