produced by slight distention as well as by contraction of the
bladder. The albuminuria was the well known infectio-toxic 'febrile'
form; indicanuria was in proportion to tile fecal stasis.

"In the course of the next few days a new symptom was added to this
group: Exudation, which was demonstrable both by palpation and
percussion. It was the natural consequence of inflammation of the
peritoneum, and was both of diagnostic value as indicating general
peritonitis and of special value in that, more definitely than the
pain, it pointed to the original seat of the affection, which,
according to present indications, could only have been an internal
incarceration following right-sided inguinal hernia, or femoral
hernia, or appendicitis. As neither the history nor the general
status (normal condition of the hernial rings) furnished any points
of support for the first view, only the diagnosis of appendicitis,
that is, of perforation of the appendix, could be made with that
degree of certainty attainable in diseases of the abdominal cavity
in general.

"After the appearance of these symptoms, a more or less firmly
adherent but limited perityphlitic abscess, and a less intense
although well developed peritonitis in this region, were assumed;
the latter, notwithstanding the painful meteorism, was not
necessarily diffuse in the strict sense of the term; the omentum
often protects the upper abdominal cavity from infection, as was
proven in this case at the autopsy. It is possible that this diffuse
peritonitis, which did not in the early period of the affection
extend beyond the limited local focus, was not due to the intestinal
contents and to bacteria, but chiefly to bacterial toxins which
arose from the circumscribed original focus. This fact is pointed