had become more severe, and again she suffered from sickness and was unable to take her food.
State on Admission.- Pulse 104, small and compressible; temperature 99.0°; extremities cold; tongue clean; lungs and heart normal. Urine sp. gr. 1027, normal. Tenderness on pressure at the epigastrium and also over the sacrum. Bowels confined. There is slight duskiness of the skin, especially over the face and arms; on the face are several mole-like specks; there is also very slight darkness of the mammary areolæ, and a band of dark pigmentation round the waist, corresponding to the situation of the strings of the dress. Conjunctivæ markedly white and clear. Ordered simple effervescing medicine, milk diet, and two ounces of brandy daily.
There was no vomiting from the day of admission until December 14, from which date it recurred frequently until the 18th. The pulse during this period ranged from 104 to 124, and the temperature from 97.2° to 99.9°. On December 18, when the vomiting had greatly subsided, tincture of perchloride of iron, combined with glycerine, was prescribed; and, the appetite being very capricious, the diet was ordered to be varied from day to day to meet the wishes of the patient.
Vomiting still recurred from time to time, but not frequently, and on January 7 she was so comfortable that she was permitted to sit up in the ward. This exertion, however, brought on vertigo, sickness and return of pain and tenderness in the epigastrium and over the sacrum. Pulse 130, very small and compressible. Temperature rather below the normal standard. Patient very feeble, the mere exertion of being examined having caused hiccup and vomiting. Considerable tenderness was now discovered, on pressure, in the left hypochondrium and the complexion was observed to have become darker since admission.
A microscopical examination of the blood made this day revealed nothing abnormal; it was perhaps a little poor in red corpuscles, but there was no excess of white ones.
From this time she appeared for a few days to be improving, and on January 16 the general discolouration seemed less marked, but the mammary areolæ had become darker. Vomiting and hiccup continued to occur almost daily, and sometimes several times a day, usually after some exertion, and she complained of much pain in the epigastrium and both hypochondria.
January 19.- Pulse 120, almost imperceptible; temperature 98.6°. Complains of severe pain in the region of the sacrum.
Next day she was found lying in a torpid state; she disliked being disturbed and answered questions with evident reluctance; refused food and retched on the slightest movement, but did not actually vomit. Complained of severe pain in the loins. It was now observed that small patches of discoloration resembling moles had become developed upon the lower extremities.
Ordered nutritive enemata, consisting of beef-tea, egg, and brandy, every four hours.
The enemata were retained, and on January 22 she appeared brighter, but still retched on being moved. A few days later she seemed still better and was able to eat some solid food. On January 28, the blood was again examined microscopically, and found to be normal.
February 4.- Has varied much during the last few days. Pulse 84. Distinct and of better volume. Discoloration of skin rather less. General aspect improved. Tongue clean. Still has occasional retching and vomiting, but is nevertheless able to take food and a small quantity of port wine. The nutritive enemata are still continued daily, but less frequently.
Feb 13.- Pulse 120, thready and feeble; temperature 99.0°; respirations 24.