Sept. 8th-Patient passed a much more comfortable night; the application of poultices was ordered to be continued, and the chloral hydrat to be given at night. This treatment was continued without much interruption for three consecutive days, the patient also taking the quinine and iron as before.

Sept. 12th. The slough seemed to be coming away so slowly, that Dr. MacCallum thought it advisable to apply caustic potash to the part; and the patient being placed partly under the influence of chloroform, the caustic was thoroughly applied and large poultices of linseed meal were ordered to be frequently applied, and the part to be well cleansed with warm water.

On the 14th, a great deal of the slough had come away, but patient was suffering severe pain, and the pulse at the wrist was small and quick; a draught of chloral hydrat xx grs. was given to him at bed time, and as extra he had a pint and a half of ale with full diet and his allowance of whiskey; a local application of carbolic ointment spread on the poultice was applied the patient gradually got better; the sloughs came away, and the wound was soon studded with healthy granulations.

On the 20th September, he was discharged nearly well, and was ordered to come as an out door patient, to have his neck dressed. I saw the patient sometime after in the out-door room, the wound on back of the neck was quite healed, and the patient only complained of stiffness in the muscles of his neck.

Case 25.-Typhoid Fever with Bronchitic complication, Delirium, &c. Reported by Mr. Wм. G. Ross.

James G., aged 14, emigrant, admitted 20th August, 1870.

Previous History--Has been ill two weeks; during the first he had severe and continuous diarrhoea; during the second his bowels were constipated; he was hot and feverish, and felt very giddy when he attempted to walk.

Symptoms on admission. Skin very hot and dry; cheeks flushed; pupils dilated; seven or eight bright rose spots on the chest and abdomen; tongue thickly furred; complains of great thirst. Dr. MacCallum ordered mist. potas. chlor. (M. G. H.) 3 ij. every four hours; milk diet and one pint of milk extra. Morning. Temperature 103; pulse 114. Evening: temperature 104; pulse 112.

August 21st. The abdominal walls have become tense; the bowels are confined and give out a tympanitic note on percussion, and there are well marked gurgling and tenderness on pressure in the right iliac fossa;

the tongue is covered with a thick, yellowish fur; in addition to the chlorate of potash mixture he was given the following: R spts, terebinth 3j. ov. vitell. j. spts. æther chlor. 3 jss. aquæ. ad- 3 viij. a tablespoonful three times a day. Morning: temperature 103, pulse 106. August 22nd.-Complains of a slight dry cough; the inspiration is wheezing, the chest everywhere resonant. On applying the ear, inspiration whistling, expiration has a prolonged sonorous ronchus; vesicular murmur nowhere heard; no expectoration. A turpentine stupe was ordered to be applied to the chest once a day. Morning temperature 103; pulse 106; respirations 45; evening temperature 104; pulse 106.

August 23rd, 24th, 25th.-General condition the same as on the 22nd; the bowels are constipated, there having been two small and hard motions; large eruption of spots on the back; the temperature has gradu ally risen half a degree morning and evening, so that on the night of the 25th it was 1041, the pulse 104, and the respirations 50. Examination of the urine cloudy appearance cleared by a drop of nitric acid; acidreaction; chlorides deficient; no albumen or uro-hematine.

August 26th-A few moist râles heard in different situations; tongue thickly furred in the centre; tip and edges red; bowels very tympanitic; gurgling plainly heard. Morning temperature 104; pulse 108; respirations 44; evening temperature 105; pulse 114; respiration 44.

August 27th.-Cough very troublesome with expectoration of frothy mucus; moist râles heard all over the chest; a few fresh spots on the abdomen; lips dry; sordes on the teeth and centre of the tongue, the tip and edges of which are red, the papillæ appearing larger; sleeps a great deal; tossing about and muttering; when awake is quite delirious; a pint of chicken broth was added to his diet. Morning: temperature 103; pulse 112; respiration 54. Evening temperature 104; pulse 120.

28th, 29th, 30th.-During these three days the râles became moister; the expectoration greater; the delirium was constantly present, also the muttering and restlessness during sleep; the tongue was dry, with a thick brown fur in the centre; the lips brown and fissured; the bowels constipated, one hard stool having been passed after the lapse of a week; tympanitis, gurgling and tenderness on pressure always marked; the pupils continue dilated; a few fresh spots appeared. To mist. potas. chlor. was added spts. æth. chlor. and ipecac; he was ordered 4 ozs. of claret daily. The morning temperature ranged between 103 and 103; the evening between 104 and 103; the pulse from 116 to 102, and the respirations from 42 to 60.

31 Aug., 1st and 2nd Sept.-The râles are very moist; the tongue is dry but gradually clearing off; the bowels confined; the face appears a little

brighter; he is still delirious; the morning temperature was between 102 and 1023; the evening between 102 and 103; the pulse from 92 to 106 and the respirations from 44 to 50. Examination of urine clear, normal colour, acid reaction; chlorides deficient; uro-hematine in small quantity; no albumen, sp. gr. 101i.

From 3rd to 9th Sept.-During this week the râles rapidly decreased, so that on the 9th none could anywhere be detected; the vesicular murmur re-appeared, the inspiration being harsh: the stupes discontinued; the tongue became cleaner every day, but was sometimes dry, sometimes moist, and fissures began to appear in it extending obliquely outwards from the centre; it finally became of a deep red colour; he had two stools of a clay colour, natural in consistence and quantity; no fresh spots; skin desquamating in very small scales; the delirium is quieter and he sleeps well, without muttering and moving about; tympanitis, gurgling and tenderness on pressure being no longer perceptible, the mist. terebinth. is stopped. The morning temperature was from 99 to 102; the evening from 103 to 1042, 1041 being the degree for the last two nights; the pulse varied greatly being between 80 and 106; the respirations between 28 and 50.

From 10th to 28th, the day of his discharge, the boy kept improving, without the slightest tendency to relapse. On the night of the 10th he had a rigor followed by profuse sweating, being the first time the skin had acted sensibly since his admission; it afterwards became dry and continued so; the tongue was usually moist and clean, but sometimes slightly furred; less frequently dry; his bowels were moved every three days, the motion being of natural form and consistence, and at last of a normal colour; on the 12th the chlorate of potash mixture was stopped and he was put on quinine sulph gr. j. three times a day. His diet was changed as he improved, rice pudding, eggs and mutton chop being added; the variation in the temperature was slight, although the heat kept up to 100; the pulse remained very quick, being usually 112; the respirations dwindled from 50 to 20; the pupils were dilated throughout. He became coherent by degrees and walked about the hospital five days before his discharge, although his understanding was by no means clear.

Case 26.-Typhoid Fever, with Bronchitic complication, Epistaxis, restless delirium, &c. Reported by Mr. HENRY WRight.

Mrs. C., æt. 22, admitted into the Montreal General Hospital, on Sunday, August 28th, 1870. Ill three weeks previous to admittance, and during that time, has been under proper medical treatment. At the

215

commencement of the attack suffered from headache, and has been up to this time unable long to retain anything on her stomach.

Sunday, 11 a.m.-Countenance flushed; pupils dilated; skin hot and dry; tongue parched and cracked in the centre, moist at the edges typhoid spots distinct on the back, chest and abdomen: tenderness in the iliac region of the abdomen: has had diarrhoea for some time; stools watery and rather dark. Is also suffering from slight attack of bronchitis; rales heard over the upper part of the chest; the lower and back part of the right lung is congested; temperature 103; pulse 128; respiration 38. Dr. MacCallum ordered turpentine stupes to the chest, and prescribed R, potas. chlor. grs. v.; acid hydrochl. dil. m x.: æther chlor. m x. vin. ipecac. m v., to be taken every four hours; milk diet with arrowroot and barley water. 6 p.m. Temperature 102; pulse 128; respiration 38; bowels moved twice through the day.

August 29th, 10.30 a.m.-Temprature 104; pulse 128; respiration 38; tongue cleaner and moister; had three motions through the night; can distinguish no râles this morning; breathing simply exaggerated. 7.30 p.m. Temperature 102; pulse 136; respiration 38; two motions to day.

August 30th, 10.30 a:m.-Temperature 103; pulse 136; respirafound tion 38; 7.30 p. m., temperature 103: pulse 126; respiration 34; her quite delirious this evening, restless and attempting to get out of bed; skin slightly moist: respiration same as yesterday.

August 31st, 10.30.-Temperature 103; pulse 132; respiration 42; had severe epistaxis yesterday and this morning; delirium through the night: tongue and skin moist: one motion from the bowels this morning.

August 31st, 6 p.m.-Temperature 102; pulse 130; respiration 42 : delirious through the day; slight epistaxis; no motion from the bowels; face pale; pulse weak and fluttering; heart sounds rapid, almost the 1st as short as the 2nd: grs. iij. of plmub. acet. in solution were ordered to be taken every four hours; other medicine stopped; beef tea and claret

as extras.

Sept. 1st, 10 a.m.-Temperature 99; pulse 140 and very feeble; respiration 38; still delirious; walked about the room during the night; pupils dilated, and her appearance is wild and restless; had another attack of epistaxis through the night; skin cooler and moister; ordered

iv. of sherry instead of claret. Examined her urine to day and found it scanty and high colored, sp. gr. 1030, contained a considerable amount of albumen; chlorides normal. 7-30 p.m. Temperature 103; pulse 144; had a short sleep this afternoon and seems a little better this evening: tongue moist and cleaner: skin also moist.

Sept. 2nd, 10 a.m.-Temperature 102; pulse 148 and flickering; respiration 44; delirious through the night, walked about the ward; face pale; tongue glazed; skin moist. This morning, is very restless and picks the bed clothes; stopped the plumb. acet. and prescribed R. acid. sulph. arom. m. x. tinct valer. ammon. 3 ss. to be taken every fourth hour. 7 p.m. Being asleep was not disturbed.

Sept. 3rd, 11 a.m.-Temperature 103; pulse 140 and fuller; respiration 44; looks a little better this morning, slept well through the night; pupils not so much dilated; tongue glazed and fissured; abdomen tympanitic; ordered turpentine stupes: 7:30 p.m. Temperature 103 pulse 140; respiration 42; skin very hot and dry: is taking sherry vi. and claret iv. daily.

Sept. 4th, 10 a.m.-Temperature 103; pulse 130; respiration 38; tongue dry, not so much glazed as yesterday; slept pretty well through the night; still delirious: 7 p.m. Temperature 103; pulse 130; respiration 42; bowels moved six times during the day.

Sept. 5th, 10 a.m.-Temperature 102; pulse 136; respiration 42; tongue dry and fissured at the tip, glazed at the back; surface cool and moist; was very restless through the night, making frequent attempts to get up. 7 p.m. Temperature 1023; pulse 134; respiration 48.

Sept 6th, 10 a.m.-Temperature 103; pulse 140 and full; respiration 44; rested a little last night; tongue has lost its glazed appearance and is moist at the tip and edges; still delirious: bowels moved once this morning; face pale, and skin moist, brandy ordered instead of wine. 7.30 p.m. Temperature 100; pulse 144; respiration 50; surface warm and moist.

Sept. 7th, 10 a.m.-Temperature 103; pulse 144; respiration 35; slept about two hours last night, poultices applied to the abdomen. 8 p.m. Temperature 101; pulse 130 and weak; respiration 40; slept a good deal through the day; tongue and skin dry.

Sept. 8th, 10 a.m.-Temperature 101; pulse 138, stronger and fuller; respiration 32; better this morning; passed a pretty good night; tongue moist at the edge, general appearance improved. 7.30 p.m. Temperature 100; pulse 134; respiration 34; looks better, tongue moister.

Sept. 9th, 10 a.m.-Temperature 100; pulse 125; respiration 34;. slept about four hours last night; tongue cleaner and moister. 6 p.m. Temperature 100; pulse 125; respiration 34.

Sept. 10th, 11 a.m.-Temperature 100; pulse 126; respiration 38; one motion from her bowels this morning; coughs a little this morning; bronchial râles can again be heard over the chest. 6 p.m. Temperature 102, pulse 136, respiration 40; slept through the day.