During the last week the pulse ranged from 84 to 112; the respirations from 16 to 20; the temperature has for the most part been rather subnormal. Has been free from sickness, and able to take food. Her aspect this morning is rather more depressed; colour darker; has return of vomiting, retching, and hiccup. The mammary areolæ are darker; breath very offensive.
February 17.- Pulse 124; Temperature 98.6°; vomiting; very apathetic. Complains of pain in the sacrum and aching in the legs. Refuses food.
February 19.- Pulse 140, almost imperceptible; temperature 99.6°; respirations 12. Is very drowsy; urine sp. gr. 1015, normal. Tenderness over sacrum. Vomiting and retching continue. An offensive odour about patient.
February 22.- Pulse 128; temperature 97.8°; respirations 16. Is very prostrate. Answers questions slowly and reluctantly. Frequent sickness and hiccup. Voice faint. Colour of skin darker; mole-like spots on face appear larger and darker, being almost black.
March 1.- Pulse almost imperceptible, about 140; temperature 99.6°; respirations 16; free from vomiting and retching, but has frequent and violent hiccup.
March 3.- Pulse quite imperceptible; temperature 98.5°; lies in a semi-torpid state with the eyes half-closed. Sordes on teeth. Answers when addressed. Complains of general soreness of the surface of the body.
Died at 8 P.M. of March 4th.
Post-mortem Examination.- Slight general duskiness of surface; skin of face, axillæ, abdomen, groins, and knees of a pale dusky brown tint. Nipples ill-developed. Areolæ not very markedly pigmented. Besides the more diffuse pigmentation of the surface, minute dark brown specks of pigment were scattered sparsely over the face and limbs. Subcutaneous fat of a rich yellow colour and very abundant, forming a layer ranging from three-quarters of an inch to two inches in thickness, in the walls of the thorax and abdomen.
Thorax.- Heart small, valves healthy, muscular tissue pale coloured. Auricles filled with tolerably firm decolorized clot. Both lungs slightly adherent by a few bands at the apex. Right lung healthy; scattered throughout the upper and contiguous part of the lower lobe of the left lung were some caseous nodules, varying in size from a pea to a walnut. They were wedge-shaped, and situated immediately beneath the pleura. Some of them had softened down into small cavities containing puriform fluid, each cavity having a distinct lining membrane.
Abdomen.- Numerous bands of adhesion existed between the liver and diaphragm, spleen and stomach, and also between the omentum and parietal peritoneum. The gastric mucous surface presented numerous points of injection and ecchymosis; the intestinal mucous membrane was natural, with the exception of marked vascularity and slight prominence of the solitary glands.
The supra-renal capsules were firmly adherent to the surrounding tissues, much fat being intermingled with the cellular tissue, so that it was impossible to dissect out the nerves with any great exactness. Both capsules were enlarged, hard, and nodulated. The right capsule was of an irregular quadrilateral shape, and measured two inches vertically by one inch and a half wide. The vena cava was firmly adherent to its anterior surface, concealing the lower half of the organ. The left capsule was triangular in shape; it measured two and a half inches vertically by one inch in width at its base. On section it presented numerous opaque, firm yellowish nodules, averaging a split pea in size, besides two much larger masses of the same character, situated in the lower part of the organ. These nodules were all separated from one another by bands