faint systemic murmur over apex transmitted a short distance to left; second aortic accentuated. Lungs, negative. Liver, dulness to one-half inch below free border. Edge felt here. Spleen and abdomen negative. Suppurative glands slightly enlarged. One or two faint rose-colored spots on abdomen and back, disappearing on pressure. Right knee rather hot to the touch, slightly swollen, patella floats. Some tenderness and pain on motion, also slight pain on moving hip. Tongue thickly coated with white fur and slightly tremulous. Pulse, regular, full, soft. Urine acid, specific gravity, 1.130; five per cent. hyaline casts. Milk diet and calomel stat. November 14th.-Tincture of strophanthus, 5 minims, three times a day. Pain in knee and headache severe. Patient very restless. November 15th.-Salicylate of soda, ten grains every four hours. Leucocytes, 6,000; urine acid, specific gravity, 1.030; albumin, ten per cent.; hyaline and granular casts. Hot pack given. Local application to knee. November 16th.-Patient delirious during night and at times during day. Stop salicylate of soda. Hydrochlorate of quinine, three grains every three hours. Spleen percusses large. For sponges, see temperature chart. Bowels are constipated. November 17th. Urine acid, specific gravity, 1.030; albumin, twenty-five per cent., hyaline and granular casts. No Ehrlich. Right knee very much swolen; patella floats and distinct fluid were made out. Ice bag applied. Knee is very painful and patient is rest- November 18th.-Urine acid, specific gravity, 1.028; November 19th.-Patient wildly delirious during night. Marked strabismus of left eye. Pupils contracted, right the smaller. Conjunctivæ congested. Skin slightly cyanotic. Pulse irregular. Leucocytes, 145,000. Patient in alternating stupor and delirium all day. Pulse, very irregular. Right pupil smaller than left. Fluid in knee found to be purulent serum. No tubercle bacilli found. November 20th.-No change in condition. Distinct tenderness in back of neck, pain and rigidity on flexing head. Tache cerebrale present. Slight rigidity of limbs most marked on right side. Strabismus in left eye more marked. Bicarbonate of soda, ten grains, water, two drachms; lemon juice, one drachm with ice, every two hours; fluid extract of ergot, one-half ounce every four hours. Urine acid, specific gravity, 1.025; hyaline and granular casts. November 21st.-Patient still remains delirious, his condition is no better. Knee-joint more swollen. - Examination of eyes by Dr. C. S. Bull. Fundus normal in each eye. Strabismus thought to be due to irritation. of left sixth nerve. Patient transferred to surgical service, where the following notes were made : Suppurative Arthritis of Knee-Pyæmia-Acute Endocarditis Suppurative Pneumonitis - Suppurative Nephritis. November 21st.-Operation by Dr. Curtis. Two incisions were made, one on each side of patella, down to the joint; also two smaller incisions on posterior aspect of knee. A large quantity of pus was evacuated. The wounds were thoroughly irrigated with boro-salicylic solution. Drainage was provided for by three rubber drainage-tubes and several wicks of iodoform. gauze. Iodoform gauze and bichloride dressing applied. Whiskey, one-half ounce every two hours. November 22d.-Twitching of muscles of face and arms. Strabismus unchanged, little stiffness of neck. Entire dressing, packing, and drainage-tubes removed. Wound irrigated with boro-salicylic solution, one-half strength. Drainage-tubes cleaned and replaced. Packed with iodoform wicking; iodoform gauze and bichloride dressing applied. Urine acid, specific gravity, 1.020; albumin, five per cent.; no sugar; microscopic examination negative. Apply ice-cap. Patient extremely restless. November 23d.-Very restless and somewhat delirious. Dressed as before. Little discharge. Pulse increasing in rapidity and somewhat weaker. Sponge for fifteen minutes at 70°, if temperature is above 103° F. Pulse weaker, more rapid, and irregular. November 24th.-Patient has been restless and delirious most of night. Did not sleep at all. Whiskey one ounce every three hours. Fluid extract of digitalis five minims, hyp. stat. Trinity pill, No. 1, every hour. Stop when temperature is below 102° F. Lungs : Right, anteriorly resonance to sixth rib. Subcrepitant râles at end of inspiration, except in first two spaces. In axilla and posteriorly there is dulness beginning at angle of scapula and ending with flatness at last four inches at base. Here the breathing is feeble and there are crepitant and subcrepitant râles at the end of inspiration, with a few scattered areas of faint broncho-vesicular breathing. Lungs, left: Subcrepitant râles anterior and posterior. Posterior feeble breathing and subcrepitant râles with dulness at last three inches at base. Patient fairly rational. Vomited four ounces of undigested milk. Urine acid, specific. gravity, 1.015; albumin, trace; no sugar. Leucocytes. November 25th. Respiration labored. Sputum streaked with blood. Cough a little troublesome. 101 100° 99° PULSE 1 HR. LATER RESPIRATION PULSE RESPIRATION URINE MILK 3 MAGENDIC STOOLS 102 Cups applied to chest. Usual dressing. Free discharge of pus. November 26th.-Apex: Beat diffused over area of 2 by 2 inches. Here are heard inconstant rubbing and grazing sounds, synchronous with heart action. In left axilla there is good resonance, but many friction sounds. Otherwise signs in chest unchanged except that flatness in right posterior chest extends above angle. For past four days the abdomen has been moderately distended and tender. There is subsultus and occasional carphologia. To-day general hyperæsthesia. Strabismus unchanged. Moderate general rigidity. Usual dressing. Very slight discharge. November 27th.-Patient much weaker and pulse feebler. Takes nourishment with difficulty. Ice-coil stopped. few fresh adhesions in left lung and many on right lung. Many purulent foci in both lungs. Brain-pia congested and contains much serum. On section, some congestion. Gall-bladder contains pale yellow serous bile. Liver Four pounds two ounces. Rather pale, with faint nutmeg markings. Spleen Six ounces; rather soft. Left kidney: Ureter and adrenal normal, also pelvis; capsule free, surface smooth, color normal. Several purulent spots size of pin's head. On section cortex a little pale, markings fair. Right kidney the same. Meckel's diverticulum, three inches long, three feet above valve. Bladder, normal. No dictation on knee by Dr. Thacher. A large abscess ran up posterior aspect of knee-joint for about five inches. The temperature had been very irregular, ranging between 101° and 106° F., averaging about 104.5° F. 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 812 112 2 4 8 12 3 3 Sp. 15 m 70 20 4 8 12 124 November 28th.-Respiration labored and very shallow. Extremities considerably cyanosed. A.M. patient was very much cyanosed. Pulse almost imperceptible; and at 6.25 A.M. patient died quietly. Autopsy-Frame large; muscles well developed ; adipose fair. Heart weighed nine ounces; recent patch of fibrinous exudation on anterior surface. Section shows normal heart muscle; just above attachment of cusp of tricuspid valve is a pea-sized nodule containing pus, running down about an inch in the muscle of the septum; abundant small vegetations on under surface of tricuspid and mitral valves. Lungs Right, one pound; left, fifteen ounces. Left congested, especially lower lobe; Bradley & Poates, Engra, N. 1. Dr. Robinson said he had had such cases before, although not necessarily with joint suppuration; had found endocarditis at death, and had thought he would bear them in mind and make the diagnosis in subsequent cases, but the same experience had repeated itself. Replying to a question from Dr. Draper, he said there was no history of recent gonorrhoeal rheumatism. DR. DRAPER said the temperature chart in this case suggested to him a point which he had found of diagnostic value in endocarditis, namely, an up and down temperature several times a day. It was sometimes accompanied by chill, sometimes not. Some days there were three or four paroxysms of fever, a thing which was not usual in any infectious fever with which he was familiar. Grape Seeds in a Healthy Appendix.-DR. MCBURNEY presented a vermiform appendix containing two grape seeds, removed under the following circumstances: He was operating upon a patient for abdominal tumor; the healthy-looking appendix thrust itself into view, and on feeling of it he appreciated two concretions. Thinking it wise to act in time, he removed it, and the bodies which had been felt were found to be two grape seeds. The notion had been very prevalent that grape seeds were dangerous on account of their liability to lodge in the appendix and set up inflammation. Dr. McBurney had received letters regarding this matter from various parts of the country, a recent one being from a large horticulturist in the West, who said he would be greatly indebted to him if he could state that grapes were not dangerous. Dr. McBurney had always been able to reply that he thought grapes were harmless, since he had never seen a grape seed in the concretions contained within the appendix. It had so happened that the first exception to this experience was in a case in which he had incidentally removed the healthy appendix and found within it two grape seeds. DR. POLK remarked that he had seen grape seeds cause appendicitis in but one case. DR. BIGGS made some remarks upon the work of the Board of Health in producing diphtheria antitoxin for use in the city. NEW YORK ACADEMY OF MEDICINE. SECTION ON OBSTETRICS AND GYNECOLOGY. Stated Meeting, February 28, 1895. HENRY C. COE, M.D., CHAIRMAN. Hollow Cylindrical Uterine Dilator.-DR. A. M. LESSER presented a set of uterine dilators, made of steel, cylindrical in form, and differing from the ordinary dilator in being hollow, the object being the avoidance of forcing the uterine contents into the tubes. DR. S. MARX thought the instrument could have no place in obstetrics, whatever it might have in gynecology; that in obstetrics the hand was the best dilator. Improved Tarnier Basiotribe.-DR. E. A. TUCKER presented a modified Tarnier basiotribe, or combined perforator and cranioclast. The improvement related chiefly to doing away with some screw joints in the perforator, and in substituting a metallic for a wooden handle, thus aiding cleanliness. Without raising the question of craniotomy on the living child, it was well known that there were cases in which the operation had to be performed, and this he had found to be the ideal instrument for the purpose. Modified Ligature Carrier.-Such an instrument was presented by a gentleman who failed to give his name, the modification relating to the spring and catch at tachment. Puerperal Septicæmia; Abscess in Right Broad Ligament; Abdominal Section Followed by Recovery.-DR. ANDREW F. CURRIER related the case. The patient had had a normal and easy labor, and everything had gone well until the fourteenth day, when she was suddenly seized with pelvic pain which increased almost to collapse. The following day a tumor appeared in the right iliac fossa, and went on to extend over to the left side. The doctors who saw the patient diagnosed hæmatoma. She afterward suffered from violent chills, diarrhoea, loss of flesh, etc. About two months after the confinement Dr. Currier saw her, and made the diagnosis of hæmatoma of the right broad ligament degenerated into abscess. Notwithstanding the patient's extremely low condition, he ventured to open the abdomen, first in the median line, but finding the intestines firmly adherent over the tumor, he made a lateral incision above Poupart's ligament, introduced the finger, broke down material which was too thick to wash out, then irrigated and introduced two yards of iodoform gauze. By venous infusion of saline solution and stimulants the patient was saved. A hæmatoma in what appeared to be a sealed cavity undergoing purulent degeneration, was contrary to what was usually taught. It was not improbable the infection had entered it from the intestine to which it was adherent. Unintentional Induction of Abortion.-DR. A. E. GALLANT related a case in illustration of the difficulties attending the diagnosis of pregnancy. The case was one of cessation of menses for some weeks, then hemorrhage, the recognition of an enlarged uterus whose walls were flabby-circumstances leading to the diagnosis of abortion with retention of membranes. He introduced the sound, brought away fungosities, prepared for curettement next day, but found that soon after she had returned home a foetus had been expelled. Dr. Gallant presented Outerbridge's combined dilator and irrigator, which he had found very useful in opening the cervix and washing out the uterus after curettement. Ligature Carrier.-DR. A. GOELET presented a modified ligature carrier, so made that the ligature could not slip as it did in other instruments. Double-Current Uterine Irrigator.-Dr. Goelet also presented a double-current uterine irrigator, the important feature of which was its conical form, enlarging toward the end next the handle, and thus obviating tendency to become clogged by débris. DR. GARRIGUES had given up the use of doubleflowing catheters, finding them unnecessary. In obstetric cases there was plenty exit for the fluid, while in other cases one could dilate and retain the cervix open with a speculum or dilator while irrigating with a single-current catheter. Larger débris would thus escape than with a double-flowing catheter. Cœliotomy for Puerperal Septicemia and Peritonitis. DR. CHARLES P. NOBLE, of Philadelphia, read the paper. He divided cases of puerperal sepsis, or puerperal peritonitis, into two classes: 1. Those in which. some pathological condition existing in the pelvis before labor was the cause. 2. Those in which these organs were normal at the beginning of labor. In the first class sepsis might exist prior to labor, or be induced by bruising of the pathological tissue, or by causing rupture of pus-sac. In this class of cases operation was indicated, and if performed prior to labor promised a high percentage of recoveries. In a correspondence with a large number of operators, only three had stated that they had operated for peritonitis due to pus-tube which had been present before labor. The rarity of the complication was probably to be explained by the fact that few women with a pus-tube became pregnant. The second class, those in which there had been no preceding pathological condition, was subdivided into those in which the infection spread to the peritoneum, etc., through the lymphatics and veins, and those in which it spread through the tubes. The author knew of no positive way to determine between the two classes, but he believed that where the infection spread through the tubes, the inflammatory element was more marked, the septic element less marked, the reverse being true in the other class of cases. In the lymphatic form the peritonitis was of secondary importance to septicemia, and operation gave little encouragement. Simple cœliotomy with washing out the peritoneal cavity did not influence the principal seat of the trouble, which was in the uterus and pelvic lymphatics, and necessarily it could not influence the germs which had already entered the circulation. The more radical operation of hysterectomy offered but little, since by the time peritonitis had become a marked feature either the patient was so reduced that she could not with stand the serious shock of the operation, or was already suffering from well-marked septicæmia. If operated upon it should be at the early stage, before the occurrence of peritonitis or marked general septicæmia. Cases with less marked symptoms of general septicæmia gave better results. While cases of general peritonitis, so far as he knew, had died when operated upon, yet he thought that in localized peritonitis cœliotomy should be done the first few days, if there were not prompt improvement under other treatment. In cases presenting well-marked local lesions which could be made out on bimanual palpation, the indications for operation were more urgent than in those in which nothing could be determined by physical examination. In other words, he thought the operation should be done or rejected according to the conditions found rather than according to general rules. The prognosis from operation was most favorable in local peritonitis where the inflammatory process had become well localized, sepsis being absent, the case having resolved itself into one of pyosalpinx or pelvic abscess of some form. What should be done in cases of infection of the birth canal when, in spite of curettement, irrigation, and drainage, the disease went on from bad to worse? Cases in which septic infection or beginning septicemia were marked features of the absorption of ptomaïnes or micro-organisms taking place from the uterus or vagina, while cellulitis and lymphangitis were absent or in their incipiency? Some years ago treatment would have been continued by irrigation or internal medication. But in the great majority of the cases the issue was fatal. Abdominal hysterectomy had been performed by Kelly and Smith with success, while Montgomery had lost his patient, and pus was found in the uterine sinuses. Dr. Noble would defend the operation in this class of cases. Regarding the route to be chosen, he thought that in puerperal cases it was usually best to enter above the pubes. Prefers the Vaginal Method.-DR. H. J. BOLDT agreed with the author in the main, especially with regard to the hopelessness of operative procedure in puerperal general peritonitis and septicemia. In localized peritonitis of puerperal origin he thought no one would dispute the fact that operative interference was indicated, and for his own part he would choose the vaginal route as the one which caused least shock and offered the best drainage. Pathological conditions existing prior to labor belonged to ordinary gynecological work, and called for operation. Opposes Operative Interference.-DR. WILLIAM T. LUSK had seen three cases of tubal trouble present before confinement, complicating the puerperium, and when to-day he looked back upon the experience, which occurred some years ago, he wondered whether the patients could not have been saved by an operation. He thought it was very questionable whether, in the usual forms of puerperal infection, operative interference was ever justified before the tenth day. As the author had stated, in general septic peritonitis the patients died anyway. In other cases, where the disease was localized, he thought it would be better to treat them in the old way; many would get well, and if an operation should be called for it could be done with greater safety after five or six weeks than during the confinement period. There were a large number of cases of so-called septic endometritis in which the infection was limited to the mucous membrane, there was fever for about a week, and the patients recovered if let alone. If, however, the curette were used, and irrigation practised frequently, as had been done, the barrier offered to the entrance of micrococci by leucocytes in the infiltrated membrane would be broken down, and general infection would result. He, therefore, opposed the use of the curette in such cases. Pathological Distinctions Easier than Clinical.-DR. W. M. POLK thought the strongest criticism which could be offered against the classification was that it suggested distinctions which might be accepted in pathology, but which were not easily recognized at the bedside. In opposition to what Dr. Lusk had said, he felt very strongly the need of losing no time in reaching the interior of the uterus in cases of puerperal fever, cleansing it thoroughly either with the finger or curette, and providing for ample drainage by the introduction of gauze. Regarding further interference, it was difficult to decide clinically which cases called for hysterectomy, or at what stage. He presented the uterus removed four days ago for puerperal sepsis, but it was too late and the patient died. The treatment, then, was to attack the interior of the uterus first, and if the symptoms did not subside one was then at liberty to open the abdomen, but it should be remembered that this, as a last resort, did not promise a great deal. He had saved one patient by cœliotomy without hysterectomy, operating not later than the seventh day. In pus accumulations existing before labor operation was indicated. DR. H. J. GARRIGUES thought laparotomy would have an extremely limited field in puerperal affections. He would hardly care to take the responsibility of opening the abdomen the first two or three days, as suggested in a certain class of cases by the author. It was known that many patients with bad forms of puerperal peritonitis recovered without operative interference, and he doubted whether the surgeon could secure a better result. Some years ago he had saved seven out of thirteen cases of general peritonitis by enormous doses of opium. He believed in cleaning out the uterus, preferably by hand in fever after labor at term, by instrument after abortion and cleansing with antiseptic injections. DR. W. E. PORTER thought a large percentage of cases of puerperal fever could be saved by early removal of septic matter from the interior of the uterus, but unfortunately the specialist was not usually called until the disease was advanced. If cœliotomy were done at all it should be limited to irrigation and drainage. Hysterectomy would cause shock out of proportion to the amount of sepsis removed with the uterus. DR. RALPH WALDO thought very bad cases, mentioned in the paper, would die whether the abdomen were opened or not, while others treated in time by emptying the uterus, irrigating, and draining, could be saved without laparotomy. Of course an operation was sometimes called for to remove local accumulations of pus. DR. FORD, of Philadelphia, impressed the fact that the source of infection varied in different cases, being, in some from a laceration of the vagina, in some from a laceration of the cervix or perineum, in others from absorption within the uterus, and it was not easy to decide when operative interference was called for. He related a case of extra-peritoneal pus collection similar to Dr. Currier's, treated successfully by incision over Poupart's ligament. DR. BROOKS H. WELLS related a case seen by him fifteen months ago. The attending physician had delivered the patient with forceps; sepsis followed; he curetted four or five times, at intervals of five or six hours, without antiseptic precautions; the patient grew steadily worse, the temperature went up to 106° F., and Dr. Wells was sent for when she was in collapse. A mass was felt in the right side of the abdomen, and although the patient was almost moribund he decided to operate, which he did in a tenement-house. On opening the abdomen he found that the uterus had been perforated anteriorly. The vermiform appendix being unusually long, had become adherent across this perforation, thus proving a life-saver instead of a lifedestroyer, in this instance. He cleansed out a collection of pus with the sponge and introduced gauze, to his surprise the patient recovered. The right tube, which had lain over the abscess, was perfectly normal. and DR. E. A. TUCKER said that his experience had shown the wisdom of Dr. Lusk's remarks. Out of about four thousand cases of labor which had passed under his observation, there had been puerperal fever in 150 or 200, and he could recall not more than one in which laparotomy might possibly have been done with benefit. Later operations for pus collections, say a month after labor, should not be spoken of as cœliotomy for puerperal sepsis. DR. CURRIER remarked that most cases seen by gynecologists had previously been treated by the general practitioner, and were not very recent, yet he thought they should not be excluded from consideration as puerperal cases. There was such a variety of conditions that it was not easy to make exact classifications, yet he thought three main types might be recognized 1, Cases in which the infection was limited practically to the uterus; 2, those in which it had extended into some neighboring structure, but was limited; 3, those in which there was diffuse peritonitis. Laparotomy was excluded in the first variety, was to be considered in the second, was hopeless in the third. Local pus collections should be removed. The Chairman, DR. COE, did not think the author had intended to raise the question of curettage and irrigation. Of course, Dr. Coe said, everybody resorted to those measures. He had not arrived at the stage where he would remove the uterus, although he had been tempted to do it twice. There were a good many cases of pus collection the first week after childbirth, and he would not exclude them from consideration as puerperal cases, as he had understood Dr. Tucker to suggest. In one instance he had emptied a pus collection which had extended up to the umbilicus the first week, and in another instance where he had found it under the lower rib. He supposed the author had not intended to limit the term cœliotomy in this discussion to median incision. DR. NOBLE, in some concluding remarks, said that if after curettage, douching, and putting in gauze, the patient went on to get worse for twelve or twenty-four hours, the septic symptoms becoming more marked, he thought all would acknowledge that the case would terminate fatally unless something more were done, and it was under those circumstances that he would perform hysterectomy. Peritonitis and general septicamia had not yet become marked. The chances for the surgeon to win laurels were not great, but operation gave the patient about the only chance. Clinical Department. REPORT OF A CASE OF SEPTIC POISON- BY EDWARD J. WARE, M.D., NEW YORK. IN the MEDICAL RECORD of January 19, 1895, an article by Dr. A. Seibert, gives an account of the toxic effects of antitoxin treatment which are so very similar to those occurring in a case of my own, and yet having some points of marked contrast, that I deem it of interest to note them. The patient, Elizabeth B, aged three years and four months, had not been well for two weeks previous to the present illness-having had a persistent cold and so-called "bilious condition," with clay-colored stools, loss of appetite, and general malaise. On December 21st, the child was constipated and had fever. She was first seen by me December 22d. Temperature, 103° F. (groin). Child peevish and somnolent; tongue coated; some pallor and loss of appetite. No swelling of the glands, and the throat abso lutely clear and hardly injected; some coryza; no fetor to breath. December 23d.-In the morning slight deposit on left tonsil. Glands of neck slightly swollen. Temperature, 1021⁄2° F. (groin); afternoon temperature, 1032° F. Child restless and depression marked. Ordered tincture of chloride of iron and whiskey in full doses. December 24th.-Deposit decidedly more marked on both tonsils, and decidedly diphtheritic in appearance. Some albumin in urine. Temperature, 1021⁄2° F. At 8 P.M., II C.C. Pasteur's serum were injected in loin. December 25th, 8.30 A.M.-An injection of 10 c.c. serum was given. In afternoon, temperature (axilla) 98° F. The throat gradually cleared. Temperature was uniform at 98° from December 25th to 30th. Swelling of glands diminished-albumin was disappearing. December 31st.-Throat was practically clear and convalescence appeared to be established. Pulse ranged from 96 to 106. ranged from 96 to 106. Iron and whiskey were continued throughout. January 5th.-In afternoon, temperature was 99.6° F., and there was slight swelling of glands on left side of neck behind sterno-mastoid muscle. January 6th (thirteen days after injection).-Glands were swollen on both sides of neck in corresponding location. Temperature, 101.4° F.; pulse, 112. A discrete eruption of raised, flat papules appeared on buttocks. They were of rather dusky-red color, closely resembling the eruption caused by antipyrine. There was no rigor; there was, however, some stupor, somnolence, depression, and loss of appetite. Child complained that eruption hurt, which probably would be better described as itching or burning. There was, also, a general hyperæsthesia of the whole surface; but no distinct joint swelling or pain as in Dr. Seibert's case. The temperature ran to 102.2° F. (its highest point), with pulse of 145 and respirations of 33. January 7th.-Temperature ranged from 99.9° to 101.8° F. Pulse, 118 to 130; respirations, 28 to 32. The rash next extended to thighs, legs, and feet; then attacked the hands and arms, face and neck; lastly extending from buttocks on to the back, abdomen, and chest. It was more marked on back and chest, and was generally discrete in distribution, although there was coalescence at times, with large, white, clear areas, such as we see in measles. The general appearance varied but little. The papules were large-flat and raisedvarying in size from that of end of slate pencil to the size of a silver three-cent piece or larger. The color was dusky-red. There were no vesicles or pustules. The hands, forehead, arms, and face showed considerable œdema. During all this time the throat remained perfectly clear, and there was never a suspicion of return of the exudate. The urine was almost completely suppressed and the amount of albumin much increased. This was relieved by cupping the loins and the use of the hot pack. January 8th.-The temperature ranged from 99.8° to 102° F.; pulse, 104 to 122. January 9th.-Temperature from 101.2° to 102.2° F.; pulse, 118 to 130. The rash lasted from three to four days. The first papules appeared on January 6th, and the skin was practically clear on the 10th. As each new crop appeared there was a rise of temperature. January 10th.-Temperature at 1.50 A.M. was 101.2° F.; at 8.45 A.M., 98.2° F.; at 1 P.M., 98° F.; at 7.40 P.M., 96.2°. At this time (7.40 P.M.) pulse was 100, fair in quality. Second sound of heart very indistinct; feet and hands cool; ordered whiskey, ammonia, and hot beef extract. January 11th.-Temperature ranged from 97° to 97.6° F.; pulse from 96 to 106. Ordered tinct. nux vomica one drop every four hours; increased to two drops at 2 P.M. Pulse somewhat better and sounds clearer. |