to rely upon them exclusively. It is the same in acute diseases of the heart, in which Hufeland rebukes his contemporaries for no longer bleeding.*

I will not even except certain adynamic conditions which may equally demand blood-lettings, not subtractives, but derivatives, with the design of preventing hypostasis in the chief organs. Thus, cerebral, pneumonic, and abdominal. phenomena will be more certainly combated by the dynamic sedatives, after bleeding has been performed. For example, morphine is more efficacious after blood-letting than before. Stimulants and antiperiodics also act more surely when bloodletting has been seasonably performed. He is the true practitioner who is not exclusive.

Concerning the alkaloids, when and how must they be administered? Here there may be some doubt. Should they be given in the pyretic state, or must they rather be reserved for the apyrexia? I think that this depends upon circumstances; thus, when the danger is imminent, and when loss of time would be mortal, the defervescents must be given, even in the height of the fever; and there need be no fear of this increasing the reaction, since the alkaloids cause the pulse and heat to fall. The danger arises from the excess of caloric, which must, therefore, be conquered immediately.

NOTE. It is absolutely necessary in pyrexias and inflammations that the temperature be determined frequently. It is often very inconvenient, or even impossible, for the physician to take hourly records of the variations of temperature in cases of acute disease, with the ordinary clinical thermometer, to say nothing of the annoyance and irritation to which the patient is subjected from the constant application and withdrawal of that instrument. And yet how necessary it is to be acquainted with the condition of the temperature during the whole twenty-four hours of the day, say in a case of typhoid fever. Now the medical practitioner usually contents himself by observing the morning and evening temperatures.

*Bleeding, however, should be preceded and followed by the administration of strychnine (arseniate or sulphate).-H.A.A.

But what about all the other hours unobserved? Of such, he knows literally nothing. For want of this essential knowledge, the patient may die. If the hourly variations are known, medicaments can be employed with greater precision. It may then be ascertained with accuracy when to give aconitine or veratrine, strychnine, digitaline, or quinine, and when to cease the administration of these alkaloids. An instrument which will register all the variations of temperature during twenty-four hours, may be placed on the patient's body, and hourly observed by an intelligent nurse in the absence of the physician, and the needful medicaments administered, as indicated by the varying conditions of the temperature (of course, acting only on the practitioner's instructions, as previously given for her guidance).

Mr. W. D. Bowkett, late house-physician at the Leeds Fever Hospital, has invented and patented a " Clinical Thermograph." This apparatus determines and records on permanent diagrams, all variations of temperature occurring in any patient during twenty-four hours. The following description of this invaluable instrument is taken from Braithwaite's Retrospect:

"The principle involved in its construction is that of applying the pressure resulting from the expansion of a liquid in a closed chamber, under varying temperatures, for the purpose of recording these variations. The expansion produced in a given liquid by an increase of temperature is proportionate to that increase, and if its free expansion be restrained, the resulting pressure is also proportionate.

"The thermal portion of the instrument consists of a metallic vessel, rigid and unyielding, about three inches in diameter, and one-third of an inch in thickness. In connection with this is a curved hollow tube or spring, much smaller in size, but similar to that used in the Bourdon steam gauge. One end of this tube is fixed to the vessel, with the chamber of which it communicates; the other extremity is closed, and is in connection with a simple lever-movement, increasing a first motion some three or four times. The whole is filled with liquid, and hermetically sealed. Now any increase of temperature causes the contained liquid to expand. The vessel being unyielding, the expansive force influences the tube only, whose form renders it elastic, in such a manner as to cause the end in connection with the lever to recede from its position of rest, and the lever is thus moved upon the recording surface.

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'The recording surface consists of a dial or disc of cardboard, set in motion by watch-work, occupying the centre of the instrument.

"The dial makes one revolution in twenty-four hours, and is divided by concentric circles into degrees of temperature, and by twenty-four radial lines into spaces representing as many hours. The movement of the lever is from the centre towards the circumference; its extremity is armed with an arrangement for marking a legible ink line on the disc, upon which it

lightly bears; so that during its revolution, a line is drawn, whose position in reference to the concentric circles marks the temperatures; and in reference to the radial lines, the times of those temperatures.

"The lever permits of being lifted to allow of the disc being changed. The flat under-surface is applied to the body, the other portions being protected from injury by a suitable vulcanite case.

“It is usually applied to the abdomen, being held in situ by a broad band of non-conducting material, which also serves to protect the instrument and the skin from being unduly influenced by external temperature variations.

Being filled with a comparatively incompressible liquid, it is not to an appreciable extent affected by barometrical changes."

It is unfortunate that the price of this instrument is almost prohibitive (£5 5s.), as every practitioner should possess at least two or three for every-day use. It is to be hoped, therefore, that Messrs. Salt and Son, of Birmingham, who are the sole licensees, will see their way to produce this invaluable instrument at a reasonable price, so as to place it in the hands of physicians in every part of the world. To the dosimetric practitioner, this instrument is essential, and should always be used in severe cases of fever. Its indications will often enable him to jugulate fever, and thus prevent all dangerous pathological lesions.--H.A.A.

UROSCOPY.

In order to read a disease from the examination of the urine, the physician must be acquainted with that liquid in its normal or natural condition, as well as in its abnormal or pathological state.

The normal colour of the urine is yellow, more or less blended with red. This tint is due to a peculiar colouring matter, and indicates health, or in other words, that all the vegetative functions are performed naturally.

This coloration may be absent, as in the pale-coloured urine of chloro-anæmia. It is an indication which confirms the diagnosis, and which requires the administration of arseniate of strychnine and arseniate of iron :

Two or three granules of each, together, daily.

Dark, high-coloured urine, indicates a heated condition, which demands the employment of the Seidlitz salt and of digitaline :—

A granule every two hours.

A teaspoonful of the Seidlitz salt in a glass of water.

If the test-paper shows a very marked acid state of the urine, benzoic acid and benzoate of soda should be given:

A granule of each, together, three to four times a-day. In the morning, the Seidlitz salt.

If, on the contrary, the urine is alkaline, containing a considerable quantity of carbonate of ammonia,* phosphoric

* Blue and red litmus papers are generally used for testing the alkalinity or acidity of the urine. If the urine is acid, blue litmus paper turns red. On the other hand, red litmus paper turns blue if the urine is alkaline. If the alkalinity is caused by a volatile alkali (ammonia), it may be discriminated from that due to a fixed alkali (potash or soda), by gently heating the test-paper which has been turned blue by the urine, when, if the alkalinity is due to ammonia, the latter will be driven off (being volatile), and the red colour of the paper will be restored.-H.A.A.

acid and vegetable acid drinks should be given. If a typhoid condition exists, hypophosphite of strychnine will be required :

A granule every half-hour, until the urine has lost its ammoniacal odour.

Abnormal colorations of the urine (green, blue, violet) indicate an ammoniacal state. They are due to decompositions which take place in the bladder (uroglaucine, urrhodine). They must be treated as above, by the Seidlitz salt and the vegetable acids.

The urine may be of a red colour from admixture with blood (hæmaturia). In this case, the mineral acids must be given, the neutral perchloride in preference :—

Five to six drops in a wine-glass of water, morning, afternoon, and evening.

The urine may exhibit a deposit like coffee-grounds. This indicates decomposition of the red globules beyond the spleen, that is to say, in the renal parenchyma. If the deposit is very abundant, to the point of producing aglobulia of the blood, arseniate of iron and arseniate of strychnine must be given(Vide Diatheses.)

A granule of each, together, four to six times a-day. Lactescent or chylous urine (vide Diatheses) requires the bitters, such as quassine:

Two or three granules, before meals.

Albumen in the Urine.-1. When the presence of albumen in the urine is suspected, it must be tested for by means of nitric acid. If the quantity of albumen is very considerable, it forms an abundant white precipitate. If the quantity is but small, a test-tube must be filled two-thirds with the urine, and a little of the acid must be allowed to trickle down the inner side of the tube, in such a manner that the acid may reach the bottom of the tube without mixing with the urine. If albumen is present, a cloudy stratum is produced at the