third stage commences, in most cases, slows the heart's action without depression; dilates the capillaries, thus relieving the venous tension and the right heart-relieves dyspnoea-conserves the vital forces-reduces temperature and lessens the inflammatory process.

If there is dicrotic pulse, and especially from the use of digitalis, veratria, morphia and atropia will relieve, as I have witnessed in multitudes of

cases.

They should neither be pushed to their unpleasant consequences, since the desired results can usually be obtained without.

THE REPORT OF A CASE OF FATTY

URINE ACCOMPANYING AN AB-
SCESS IN THE RIGHT ILIAC
FOSSA-RECOVERY.

BY J. P. CONNELLY, M.D.,

OF WILLIAMSPORT, PA.

Mrs. W., colored, aged 27, born in Pennsylvania, and never resided outside the borders of the State. Gave birth to a living child at 16; has never been pregnant since. Had good health for the first five years following the birth of her child, During the last six years, has had irregular chills followed by fever lasting from two to five days. No disturbance of the menstrual functions, Bowels have always been regular, and she never had pain in the region of the cæcum. On Thursday, January 9, 1890, she was taken with headache and backache, and then a severe rigor followed by high fever. I saw her on Saturday, January II. She had then temperature 104°, pulse 120, a heavy white coat on tongue, and in addition to the general symptoms accompanying fever, complained of a pain in the right iliac region, where a deeply seated tumor, giving an obscure sense of fluctuation, could be felt. It was about the size of a croquet ball, slightly ovoidal in shape, and

dipped down into the pelvis, displacing the uterus to the left.

She stated that since Tuesday, January 7, two days before the rigor, she had noticed fat in her urine, and showed me some which contained large broken pieces resembling tallow.

To avoid a possible error, the patient was requested to pass urine in my presence, which was done. Floating upon the surface of the warm urine, could be seen large quantities of fat, resembling castor or olive oil. It rapidly solidified upon cooling, to the consistency of beef tallow, and was of a yellowish white color.

The amount of urine passed in twenty-four hours was 24 fluid ozs. In this the fat, when collected and warmed, measured 41⁄2 fluid ozs., and weighed, when moulded into a cake, 31⁄2 ozs. avoirdupois.

No

The urine was clear, without sediment, color amber, reaction acid, specific gravity 1020. albumen, tests used were heat and nitric acid and Heller's test. No sugar.

Fat was passed in about the same quantity for eight days, when a large amount of pus was suddenly discharged with the urine. The fat then immediately and entirely disappeared.

Pus was passed in gradually diminishing amounts for about three months.

The patient slowly improved and in about five months was apparently restored to health, and has remained so to the present.

No cod-liver or other oil had been taken before or during this period.

The blood was frequently examined for falaria, but always with negative results.

So far as my knowledge goes the case is unique, in the amount of fat passed, the time at which it was passed, and in the subsequent recovery of the patient.

In the previously recorded cases, the fat seems to have been passed in small amounts, except in the cases of Dr. Johnson and of Dr. Cushing. Dr. Geo. W. Johnson's case was one of calcareous disease of the pancreas, published in the American Journal of the Medical Sciences, October, 1883, p. 427, where the fat is said to have passed in such quantities as to float when cool in greasy flakes on the surface."

Dr. E. W. Cushing published in the Boston Medical and Surgical Journal, February, 1881, p. 242, the report of a case of abscess in the left iliac region, in which, several days after the appearance of foul pus in the urine, "at the end of catheterization pure, clear oil ran out, in volume about one-fifteenth of the urine." This continued, with occasional intermissions, for three days. One week after its first appearance, death ensued. "On opening the abdomen a large, foul collection of pus, containing an abundance of pure oil and large strings and pieces of sloughing fat, was encountered in the left abdominal and iliac region. Near the exit of the left ureter was a small opening communicating with the abscess."