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were signs of extreme anæmia, the lips being livid, the gums blanched, and the tongue pale. The whole uncovered surface of the skin had a dusky hue, as if from greenish pigment; but the discoloration was not of uniform shade, and was most evident upon the forehead, temples and sides and back of neck. On the sides of the face and neck, and on both arms, were several almost black spots, with well-defined margins, resembling nævi, but which the patient assured me had appeared within the last three months. The discoloration of the body was less deep, and, with the exception of some dark patches in the dorsal region, more uniform in shade than that on the face and neck. There was an ill-defined, dark-brown line along the red portion of the lower lip, near the margin of the skin; the buccal mucous membrane on both sides had a sallow hue, with several distinct light-brown stains; the conjunctivæ were clear and pearly. The hair had a strikingly dull, dusky appearance, and was said to have become much darker during the few preceding months. She complained of smarting in the darker portions of the face and neck when warm. Was very wakeful at night.
From this time she continued to suffer from occasional sickness, vertigo, and pains in the loins; the anæmia and coldness of surface increased; the pulse soon became too feeble to count; palpitation, breathlessness and a tendency to syncope supervened, and she sank in about two months from the time I had first seen her. For several days before death she was unable to sit up, and had palpitations and retchings on the least movement. A disagreeable fetid odour was observed about her person during the last two days of life. She was conscious to the end.
At the post-mortem examination, the whole body was of a dusky mulatto colour, but the hue was darkest on the abdomen, and next to this on the face, neck, insides of the elbows and margins of the axillæ. There was little or no emaciation in any part, and there was a thick layer of fat under the thoracic and abdominal integuments. The muscular tissue was normal in appearance. The lungs were perfectly healthy, with the exception of a few small yellow tubercles in the apices. The heart contained a large fibrinous clot in the right cavities, extending into the pulmonary artery. The under surface of the omentum, the peritoneal lining of the diaphragm and abdominal parietes, and the peritoneal covering of the liver, were studded with small opaque, yellowish, irregularly stellate bodies, which could be readily scraped off the serous surface with the back of a scalpel, leaving the subjacent membrane apparently intact, but slightly opaque. The peritoneal covering