653 43 ounces of urine from 6 P.M. on the 4th to 6 P M. on the 56h. The urine was now not nearly so bright as before; it contained less deposit and no clots. From the 6th onwards he passed plenty of urine, the blood in which steadily diminished. He remained in bed and on low diet until the evening of the 9th when his temperature rose to 99' 6° and his pulse-rate to 100. His face, trunk, and extremities were thickly covered with a most pronounced urticarial rash, the wheals being exceedingly

more »

... e. The dermatitis caused oedema of the eyelids and face, so that it might at first sight have been taken for the onset of an acute attack of Bright's disease. I could not trace this attack to any error in diet ; it lasted two days and then entirely disappeared. On the 13th there was no albumin in the urine. On the 15th the urine was alkaline, with no deposit, no phosphates on heating, and no albumin. The patient was then discharged to duty and as some anæmia was present an organic salt of quinine and iron was given. On the 21st the urine was alkaline and of a bright amber colour; it deposited phosphates on heating but there was no albumin. The treatment consisted of rest in bed and milk diet without solid food. Barley water was also given and ice was applied to the perineum. It is difficult to say whether this was a case of renal hæmaturia or what is called "strangury" (haemorrhage from the neck of the bladder). As the blood was uniformly mixed with the urine and as the urine was of a bright red colour and contained clots I think that the hemorrhage was from the kidneys. The pain at the neck of the bladder might have been due to irritation from the urine. The drug which produced these effects was clear in colour with a taste of turpentine but scented and of a syrupy consistence. It was purchased at Brompton, near Chatham, and was labeled I pure terebene. " The dose to be taken was not mentioned on the label. There was no return of the symptoms during at least the ensuing three months. H.M.S. Alacrity, China Station. (Under the care of Dr. W. B. CHEADLE.) Nulla autem est alia pro certo noscendi via, nisi quamplurima8 et morborum et dissectionum historias, tum aliorum tum proprias oollectas habere, et inter se comparare.—MORGANI De Sed. et Caus. MA4,h--lib. iv. Prnmminm-FOR the notes of the case we are indebted to Mr. F. Dering Nicholson, house physician. A woman, aged 36 years, was admitted to St. Mary's Hospital on Dec. 6th, 1903 under the care of Dr. Cheadle. Six weeks previously she had been confined, the labour being easy ; she had had a good deal of pain in the abdomen afterwards, which was regarded as after-pains, and she got up on the tenth day. Bleeding from the uterus began and four days after became so severe that a medical man was called in who removed some clots, and three days later a piece of retained placenta which did not smell offensively. The haemorrhage stopped, but about a week later thrombosis of the right femoral vein took place and the patient had a "white leg." " She had several rigors since the removal of the retained secundines. Her past history showed that she had always been a healthy woman except for a cough of some months' duration; she had had eleven confinements, the labours being usually difficult and instrumental. Five of the births had been premature. On admission she was seen to be very thin and aneemic the nose was pinched, the extremities were cold, the temperature was subnormal (96 4° F.), and she looked extremely ill. The pulse was 124, small and of low tension but regular. There was no morbus cordis. Cough was frequent, loose, and harassing ; the lungs showed signs of general ,bronchitis with congestion of the bases, but there were no pneumonic crepitations. Nothing abnormal was found in connexion with the alimentary system and a vaginal examination showed the uterus to be well contracted and freely moveable, there being no signs of old or recent inflammation in the surrounding tissues. The urine had a specific gravity of 1012, was acid in reaction, and contained no trace of albumin. She was given a mixture containing iron, digitalis, and magnesium sulphate three times a day. For the next fortnight she continued to be desperately ill ; the pulse was about 120 and the temperature chart showed excursions from 97° to 103°, the variations occurring at all hours ; rigors were frequent and severe, leaving her prostrate and bathed in sweat. The bases of the luugs showed no improvement but the thrombosed leg cleared up rapidly. The patient was obviously in a septicaemia condition and was given a mixture containing quinine every four hours. On Dec. 20th she developed a severe pleurisy in the right axilla which did not go on to effusion; an icebag relieved the local distress but en the next morning it had to be discontinued as large petechial spots appeared at the points of contact which eventually ulcerated and slowly healed. Intense pain was felt in the hypochondrium but the gall-bladder could not be felt and there was no jaundice. In the evening she became much worse, was cyanosed, and had to be propped up in bed ; she was too weak to cough and a low muttering delirium set in. The pulse was 140. There were distinct signs of double basal pneumonia and larger quantities of alcohol with hypodermic injections of strychnine were resorted to. Examination of the blood revealed a staphylococcic infection and accordingly ten cubic centimetres of anti-stapbyloccccic serDm were injected subcutaneously. On the next day she was better and continued to improve for four days; the lungs became freer of crepitations, the pleuritic rub disappeared, cough diminished, and she had no further rigors. The temperature gradually fell to 99°. A second and similar injection was made on the 28th, but her respirations rose to 40, the temperature to 102°, and she had another rigor. A third and last injection of ten cubic centimetres was given on Dec. 31st; no marked improvement followed and she had three rigors in the next two days. On Jan. 4th, 1904, she complained of aching pain in the right knee with some oedema of the leg and foot. The temperature ro-e e to 1030 and remained high for the next four days. Rapidly each extremity, and finally the neck, became implicated, the pain being intense and the tenderness so exquisite that she could not bear the lightest touch or movement. There were no sign of phlebitis and no further oedema and the complication was diagnosed as influenzal neuritis.