HOSPITAL MEDICINE AND SURGERY. 409 th.-Patient very irritable. Spots fewer, but larger and tion of "ringing in the ears." There was a faint systolic anae raised. Temperature 1024°. Diarrhoea still continues. murmur in the mitral area. No evidence of pericarditis, (th.—Temperature at 9 A.M. 101°. Patient more com- and the pulmonary sounds were healthy. About 2 P.M. she forable. Bowels open six times. complained of severe headache, but fell asleep shortly after, Vith the exception of a slight rise on the 8th, the tem- and slept till between 3 and 4 P.M., when she woke up sud- peature remained about one degree below normal in the denly in a great fright and said she had had a dreadful morning, and one degree above in the evening until the 18th, dream. She talked in a strange, excited manner, and wlen a relapse took place. attempted several times to leave her bed. About 5 P.M. the 14th.-Took bread-and-butter; on the 15th still two or nurse thought the girl was " going off her head." She was tlree spots on abdomen and chest, complains of deafness, restless and excited ; answered questions correctly, but had bowels open once, motion thick. a delusion she home. The pulse was rapid and 18th. -Temperature at 9.30 A.M. 97°; 9.35 P.M., 103-4"; the breathing accelerated.was going . Temperature in axilla 106 ’2°; pjse weak and rapid, great pain in lumbar region. An enema perspiring freely. She was given ten grains of quinine, and was given at 10 P.M., consisting of castor oil and soap and cold cloths were applied to the head, after which she was wter. Twenty drops of sedative solution of opium were quiet and rested. At 6.45 P, M. she started up, talking in a by mouth. Pains relieved at 11 P.M.; temperature loud, excited manner, imagining she saw things on the wall, given-2°. and was with difficulty persuaded to lay down in the bed. 19th.-Pulse somewhat stronger, still rapid; bowels open Temperature 106.4°. Her head was ordered to be shaved, tvice, motion dark and watery. Temperature at 9 A.M. 101°; and her body sponged all over with cold water. About half 230 P.M., 1042°; 7.30 P.M., 101°. an hour later she became wildly delirious, could not be 20th.-Patient much better, but had rise of temperature reasoned with, and was so violent that she had to be fn the evening. strapped in bed. The thermometer rose to 106 6° in 24th. - Temperature still high, spots all disappeared, the axilla, but could not be properly retained, owing to aowels opened twice; no pain in abdomen. Patient began her struggles. The clothes were now removed from the bed, to mend rapidly, though the temperature did not reach and she was wrapped in sheets wrung out of iced water. Ilormal till July 7th. She was discharged July 22nd, fairly I, She became much quieter, and soon lapsed into a semi- strong, temperature normal. comatose condition. The sheets were changed frequently. At 8.15 P,M. the had risen to 109° in the axilla. Remarks.-In this case the patient experienced great relief temperature She was on her back with her mouth from each ice packing, and each time it was performed ex- lying open, quite pressed comfort both and after the unconscious. Pulse rapid and feeble, respiration stertorous, great during application. much contracted and insensible. One drachm of sul. It seems to be much more efficacious than sponging or the pupils wet packing; it is quicker than the former, and less trouble- phuric ether was given hypodermically. 8.30 P.M. : Tem. some to both nurse and than the latter. In this perature in rectum 109’2° ; pulse 140, barely perceptible;; patient and death seemed imminent. .nstance a waterproof was passed next to the bed with a respiration irregular gasping ; blanket between it and the patient. A large quantity of ice Ice was packed over and round the body, in the axilla and and half a drachm of P.M. : was then packed next to the skin along the trunk only, and hands, ether injected. 9 Tem. in rectum freer. Still uncon- the mackintosh and blanket folded over. The patient ex- perature 106’6° ; breathing scious and insensible to 9.15 perienced no shock from the ice, but seemed to like the stimuli. P.M. : Temperature Dontact. At the end of the packing, the ice removed, in rectum 103 6°; pulse 140, fuller ; decided improvement in being and the blanket was drawn over the body, the moisture absorbed condition ; pupils dilating slightly sensible; feeble and the mackintosh and blanket both withdrawn. The re- attempts to cough and occasional twitchings of hands. Half a drachm of 9.30 lapse in the case is difficult to account for, but the fact that etherinjected. P.M. : Temperaturein rectum much the temperature came down at once after the use of an 100’6°; pulse 132 ; breathing freer. Pinching the skin caused her to move rolled her head from ?nema might lead one to suspect that it might be caused by slightly. She the retention of effete matter in the bowel. side to side, and tried to open her eyes. The cold pack was now removed. She was wiped dry, and placed on another bed between blankets. 10 P. M : Temperature in rectum 98.4°; pulse LEITH HOSPITAL. 120, of fair volume; surface of body very cold. Hot bottles ap- CASE OF RHEUMATIC FEVER WITH HYPERPYREXIA (109·2°F.) plied to sides and feet. Swallowed a little brandy-and-water FOLLOWING ACUTE TONSILLITIS ; ICE PACK ; TEMPO- withdifficulty. 10.30 P. M.: Temperature in rectum 98° ; pulse RARY RELIEF; DEATH; NECROPSY; REMARKS. 112; respiration slower and less embarrassed. More sensible (Under the care of Dr. GARLAND.) to external impressions. Pupils acting freely. No return of consciousness. Half-drachm of ether injected. 11.15 P.M. : FOR the notes we are indebted to Mr. Herbert following Condition much the same. Twitching of muscles of mouth C.Male, M.B., house-surgeon. and attempts to expectorate. Moving about more in bed. Margaret R-, a servant girl, aged twenty-four, was 11.45 P.M.: She started as if suddenly awakened, uttering extreme terror. admitted about midday on May 25th, suffering from pain unearthly screams, expression indicating The touch or of in the and She had been under slightest approach light produced general joints pyrexia. previously convulsive tremors and appeared to excite the greatest alarm. treatment for acute tonsillitis, which had developed on Temperature in rectum 101°; pulse could not be counted May 13th, and for which quinine in three-grain doses had owing to spasms of hands when touched. Breathing laboured, been prescribed. She had always been a healthy girl, but long inspirations with peculiar hiccoughy catch at fall inspi- ration. Saliva collected in mouth and was of a nervous, excitable temperament, and had recently spasmodic attempts of dilated. to but joined the Salvation Army. She recovered from the ton- expulsion. Pupils Ice-bag applied head, had to be discontinued as it produced spasms. Ward was but of in all her on the sillitis, complained pain joints darkened, after which she was quieter. evening of May 24th, and was sent to the hospital on the 27th.-12.15 A.M.: Temperature 102.40; respiration 40. following morning. Lay quietly in bed, if left alone, with wild vacant stare, but On admission she was flushed and feverish, complained of screamed and shrank from anyone who approached or headache, pain in the knees, ankles, and hands, the ankles touched her. 1 A.M.: Temperature 104’8°; respiration 44, being considerably swollen; copious perspiration. Tem- more laboured. A lighted candle produced violent convul- perature 100.8°. She was placed between blankets, ordered sions and caused great agitation. Spasmodic contractions a milk diet, and to be given fifteen grains of salicylate of of muscles of mouth, with rolling of eyes and blinking; soda with two grains of carbonate of ammonia in camphor- mouth firmly shut and attempts to spit saliva out of closed water every four hours. The affected joints were wrapped lips. Pupils widely dilated. The patient died somewhat in cotton-wool. The evening temperature was 103°. She suddenly at 1.20 A.M. with frothing at the mouth and passed a very restless night, did not sleep at all, and com- symptoms of asphyxia. Temperature immediately after plained much of thirst. death 105 4°, and fifteen minutes after death 104 2°. May 26th.-The pain in the joints much relieved. Tem- Necropsy, eighteen hours after death. -Post-mortem perature (8 A.M.) 102°. The patient was seen about noon lividity very slight ; rigor mortis present only in lower by Dr. Garland and by Dr. Struthers, who had previously extremities. Dura mater congested and about two ounces attended her. She was cheerful, but appeared to be very of blood-stained serum escaped on its incision. Brain sub- nervous. Respiration was noticed to be rather rapid, and stance firm, vessels on surface distended; on section white she complained of some shortness of breath and of a sensa- matter presented a mottled injected appearance, the puncta 410 REVIEWS AND NOTICES OF BOOKS. vasculosa being more numerous than usual; the brain sweat. Costiveness gave place to diarrhoea. Thoracic rhls appeared otherwise normal. Heart soft and flabby; right indicated cedema of the lungs, and he sank on June 2ct, auricle and pulmonary artery contained firm decolourised consciousness to the last.