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unavoidably mixed up with it.

with it. At morning visit, on 27th, the splenic dulness was almost an inch further away from the middle line than it was before and was decidedly less.

On this day the expectoration was very small in quantity, but early in the morning of the 28th it again became copious and again tinged with blood. On the 29th, it was found that the cardiac dulness had increased and there was a distinct pericardial rub, and it was feared that the splenic abscess had also burst into the pericardium.

During these days quinine had again been given in large doses hypodermically. During the 30th, the expectoration contained a considerable quantity of blood. On August 2nd, the following note shows that matters were improving-" Lungs clearing up very much, dulness at left base very slight and crepitations limited to a small space in posterior axillary line. Heart sounds again clear." Up till the 8th August, improvement was slow, the temperature going up every day to 103° or 104°. After that, however, improvement was more rapid, the 13th of August seeing the temperature remaining normal all day.

The splenic dulness had considerably decreased. After this he had slight out-bursts of fever very frequently, and it was not till the 21st of October, that the fever was got under control. He was dis- charged from Hospital in March on home leave.

When he entered hospital he was 178 lbs, in weight, on the 15th August, he was 115 lbs., a mass of skin and bone. On March 1st, he weighed 152 lbs. When he left Hospital the anterior border of the spleen could be felt well in front of the ribs, but it must have been a thin enlargement, as on medium percussion there was very slight impairment of the stomach note.

Details as to tonsillitis, dysenteric diarrhoea, fistula-in-ano, bedsores, &c. need not be given. The only ill effect left was the stiffness of limbs consequent on so much hypodermic injection of quinine. There was never any inflammation following. If the patient had not been one of the finest and most complacent men in the Police Force, it is difficult to see how he could have held out and reco- vered so well. Attached is the chart of his temperature during the week when the fever was at its height.

J. A. LowsON.

Appendix B.

CASE OF REMITTENT FEVER; HIGH TEMPERATURE; RECOVERY.

JAMES L

Æt. 35.

Admitted to the Hospital 18th June, 1890, at 8.30 a.m.

On admission patient stated the fever had commenced the day previous (17th instant,) about 10 A.M.; from his account the attack was a typically 'aguish' one. His temperature, on admission, was 99° F.; he was placed on low diet with two pints of milk daily, soda and ice, and was ordered ten grains of quinine every half hour. Notwithstanding this, his temperature gradually rose, and, at 6.20 P.M., registered 103.4° F.; two minims of tincture of aconite were now ordered every ten minutes; at 8.40 P.M. his temperature had risen to 104° F., and thirty grains of antipyrin were given; at 10.10 P.M. his temperature had fallen to 102.8° F., and ten more grains of antipyrin were now ordered, but as this made him vomit, the aconite was recommenced; at 12 midnight his temperature was 105° F., thirty grains of antipyrin were again given and this brought his temperature down to 103° in half an hour.

The aconite was continued during the night when he was awake.

19th instant, 7 A.M. temperature 103.6° F.; as the temperature at 10 A.M. was still 103° F., twenty grains of antipyrin were given; 11.30 A.M. temperature 105.4° F., the patient was now placed in a bath, temperature of water being 96° F.; he was kept in for an hour, the temperature of the water in the meantime being reduced to 80° F.; at 12.30 P.M. his temperature was 102.2° F., and at 12.40 P.M. 100.8°; he was kept in the bath until 1 P.M., by which time his temperature had fallen to 98.6° F. After being taken out of the bath he slept for an hour. At 2 P.M., ten grains of quinine were given hypo- dermically; he now slept until 3.40 P.M. when his temperature was found to be 101° F., as his skin was now dry, the following mixture was ordered:~

Re Tr. Aconiti

Mixt. Diaphoretic Aquam ad.....

.........

.m. ii. .3ii.

3ss.

To be given every 15 minutes, notwithstanding this his temperature gradually rose as will be seen from the following observations:-

4.30 P.M.,

6.00 P.M.,

7.00 P.M.,

8.00 P.M.,

9.00 P.M.,

9.40 P.M., 10.25 P.M., 11.00 P.M.,

.102° F. ..103° F.

........104°

F.

.....105,6° F. ....105.6° F.

.106° F. .107° F. ..108° F.