fluid in the pleural sac. with serum. Ovaries and bowels healthy, except that they, with all the other organs, were blanched. Right kidney about half the usual size; left, a quarter or a third larger than normal, and soft. The uterus was about double the natural size, and ulcerated internally. A considerable quantity of pus flowed out. The surface of the cavity was studded with rather large granulations. In the body of the uterus there was a tuberculous tumor about the size of a hazel-nut.

The connective tissue was infiltrated

The uterus and tumor, at my request, were examined by a microscopist, who pronounced the tumor tuberculous.

Case Third. This will be detailed-principally in the words of Dr. Hofmann.

Mrs. M. S., aged forty-nine, mother of four children. Dark hair, spare habit, nervo-sanguine temperament. Always looked pale and sickly. Have known her twelve years. Although never seriously ill, she was troubled with a nervous headache. About four years ago she noticed an enlargement of the abdomen. I examined her, and diagnosed dropsy of the left ovary. She had not much pain, and, although excessively weak, was able to walk about. I prescribed for her, at different times, Sepia, Apis mel. and Apocyn. cann., under which her general health improved, but without diminishing the swelling. For about two years I lost sight of her, but was told that she had tried an electric physician, who said, that if she was tapped, he could cure her. She called in a physician, who tapped her and drew off about twenty-two pounds of liquid, and on the next day about eight pounds.

May 21, 1865. About three weeks before her death, I was again called to see her. Found a hard tumor in her left side, in the hypogastric region, extending towards the median line, not very painful, but sensitive. Her skin was of a pale, yellowish tint; she was much emaciated. Her appetite was gone; tongue coated, white, not dry; no fever; she was very restless;

had to get up frequently, on account of a pain in the sciatic nerve. I found ascites.

My diagnosis was retro-peritoneal cancer. Prognosis unfavorable. The only thing which could be done was to relieve the sciatic pain, and improve the tone of her stomach. Colocynth did the first very well. For the gastric symptoms I prescribed Nux vomica and Arsenic. She commenced to eat again, and had great hope of recovering. During the last four or five days of her life she was very restless, for which I gave her one-sixthgrain doses of morphine till she slept. She was very grateful for this relief. During the last twenty-four hours she vomited a dark, blackish mass like charcoal mixed with water, which prostrated her exceedingly.

Autopsy. -Very much emaciated. Skin very sallow, as during life. Abdomen distended with gas and serum. From an opening in the region of right ovary, drew off twelve pounds of a dark, offensive serum. Section made from scrobiculus cordis to symphysis pubis, along the linea alba. Peritoneum was attached to the abdominal walls, uterus, bladder, and small intestines. Peritoneum at lower third thickened to about eight or nine lines by a deposit of thick, hard, yellowish bodies between its layers. Where they were sparse they were as small as a split pea; but, where compact and numerous, as large as a hazel-nut, and attached to each other. There were deposits in the whole of the peritoneum,-sparse in the folds of the epiploon, omentum, and diaphragmatic portion. In the left hypogastrium a portion was softened and infiltrated with blood (apoplexy). In the region of bladder and ovaries, deep-red congestion, and cavities filled with dark blood. Stomach half full of black, fluid matter, which, when poured out, looked like powdered charcoal in solution.

Section was then made along the sternum, exposing the heart and lungs. Lungs black, dotted, rather soft, emphysematous externally, with infiltrations of minute bodies, about the size of a

pin-head; very few in number. Some infiltration at root of left lung. It may be stated here, that these changes were so slight that it would have been impossible to have detected them during life. Right kidney normal; left, soft; upper portion had two cysts, each about size of a hazel-nut, probably enlarged calices. Heart normal in every respect. Fat scanty in all portions of the body, very yellow.

Portions of the diseased tissues in this case were examined under the microscope, and presented all the characteristics of tubercle. The small bodies in the lungs, which might be considered by some tuberculous, were not so, unless they were retrograding, but they showed no sign of shrivelling.

These cases are presented to give emphasis to the clearlydeclared opinion of our best pathologists, that, though tubercu losis commonly invades the lungs first, it is not invariably the case; and to warn the practitioner against undue haste in denying the existence of tubercles elsewhere, because the lungs seem to be free from them.

XI.

THERMOMETRICAL PHENOMENA IN DISEASE.

BY JOHN J. MITCHELL, M.D., NEW YORK.

AMONG the many mechanical contrivances having for their object accuracy in diagnosis and certainty in prognosticating the result of diseases, perhaps none promises to be of more general application, or of greater usefulness, than the thermometer. Although it has been employed for years by the physiologist, and its indications noted in many conditions of the body, yet nothing like systematic observations on this subject have been, till recently, undertaken.

For our present knowledge of the thermometrical indications in disease, we are principally indebted to Wunderlich, of Germany; Ringer and Aitken, of England; Compton, of Dublin; and Flint and Da Costa, of our own country. In presenting to the Institute an abstract of the experience of the profession upon this subject, I shall be obliged to avail myself of the investigations of these careful observers, being able to add the personal observations of a few months only.

It has long been well known that the temperature of the body varies quite sensibly in disease. But it is only recently that the fact has been revealed that the amount of this variation is a more constant and reliable indication as to the character of the disease, and the progress it is making, than the pulse of the patient; and, with the general symptoms, giving us data upon which to found a prognosis, far more accurate than it would be

possible for us to form without it. It frequently enables us to decide upon the existence or non-existence of a particular disease, hours before the rational symptoms and the physical signs would enable us to do so.

A thermometer for clinical observation should have its stem bent to an obtuse angle, so that the bulb may be conveniently placed within the axilla (the situation best adapted to the purpose), with the face of the ivory index directed forward. A self-registering instrument is convenient for the physician, but not when it is to be intrusted to the care of the nurse for observations during his absence. The range of the thermometer should be taken twice daily, between the hours of seven and nine, A.M., and about seven, P.M. It will be necessary for it to remain in situ for about five minutes, or until the mercury ceases to ascend.

Beginning our investigations with the study of the normal temperature of the body, we find that it varies according to the age. It is but very slightly affected by the thermal condition of the atmosphere. It is lowered by sleep, a full meal, or the use of alcohol; but it is slightly elevated by the completion of the digestive process. At birth it will usually be about 100° F. It falls rapidly to 95.5°, but, during the course of the first twenty-four hours rises to about 99.5° Between the ages of four and six, it ranges about 99°, and, from six to fourteen, about 99.2°. In the adult it varies from 97.6° to 98.4°. In general terms, for the purpose of our investigations, it will be safe to put the normal temperature of the child before ten years of age at 99°, and the temperature of the adult at 98°.

The variation of a single degree, either above or below this normal standard, is, in the vast majority of cases, indicative of disease, and this more or less acute, according to the amount of the variation and the characteristics of the attack.

It has been asserted that an increase of ten, in the number of the cardiac pulsations, will correspond to an increase of one