the quality of the urine evolved in phthisis, but as an American observer* has made the unaccountable obser vation, that "in phthisis, as a general thing, its specific gravity does not exceed 1010," we think it right to cite the specific gravity in the cases of phthisis now referred to. The specific gravity was determined with great care, by means of an instrument with a large bulb, and graduated to a quarter of a degree, and at the same time the exact temperature of the urine was determined. The inquiry was made in the day and night urine separately, and as the whole returns are too voluminous, we insert in the following table a copy of the record in the first eight cases. It will be observed that there was much diversity in the returns of the specific gravity, so that on one occasion it was so low as 1007, and in several others as high as 1030. Usually that of the night urine (9 P.M. to 8 A.M.) was less than that of the day. We cannot determine the true average specific gravity in these cases without the laborious process of multiplying each return by the number of ounces of urine of the day and night separately, and adding the totals, but it will suffice if we represent the number of occasions on which certain specific gravities were found. Thus, A specific gravity of 1030 and upwards was found in 4.3 per cent. * Extracted from the "Phil. Med. Reporter," Sept. 21, by "Dublin Med. Press," Nov. 13, 1861. G TABLE No. 5. SHOWING THE SPECIFIC GRAVITY + 1000 IN THE DAY AND NIGHT URINE IN EIGHT CASES OF PHTHISIS DAILY DURING ONE MONTH. 12. 14.5 20 14 16 22 19 26 6 28.5 14.8 17.5 15 20 27 26.5 16.5 15.5 31 21 25 27 14.5 17 28 22 22.7 29.5 12.6 13.3 26.3 23 11. 14. 18 28 14 5 24 16 30.3 17. 16.5 15 30. 25. 29. 20. 12. 25. 26. 26 18 13.7 16.3 12.6 25 23.6 17.6 29.5 18.5 15. 7 27.5 23 25 8 28 2 14 8 20.4 25. 22. 21. 17.5 27. 14.7 21.8 25.8 29. 25 16.8 25.5 11. 12. 25. 15. 23.5 27.5 23.8 15. 26 24 27.5 10.7 11. 25. 28. 16.5 13.5 22 27 14 19.3 15.2 26. 27 27.5 25. 9. 11.5 28 29.5 20.5 23 27 3 26.5 14.2 15.4 22.3 24.5 11.5 26.5 29. 18.8 24.6 24. 29. 18. 17. 24.5 28.5 8.5 11.5 23. 29. 17.5 23. 28. 26. No. 77. 25. 24. 9.5 11. 19. 27.5 16.5 22 29 37. 18.722.3 12 25.5 9.611-6 23.5 27 17 20.2 25.5 33.5 20.5 24 12.2 26.5 9.5 9.5 16.5 27 21.5 16. 24. 26.8 25. 24. 21.5 27-5 9.8 7.5 24.3 17. 25. 26.5 34. 18.6 22.6 23 25. 12.5 27.5 25.8 22.5 25 24.5 18.6 22.5 20 3 23.5 22 29 22.3 25 12.9 27 16 24 20.5 26. 15.8 27 17.5 10.6 14 30 15.5 20.5 22.4 24. 17.8 31 3 12.5 19.7 14.8 27.3 10 23. 22. 27. 18.5 22 22.3 24.6 16.6 25.7 20.3 24. 20. 25• 12.6 27.5 25. 19. 16.5 31. 20.5 23.5 24 18.6 22. 17.4 20 26.5 25 28.5 20 26 20. 21.8 34. 32. 20. 23. 23.8 23. 17.8 26.2 11.5 21 14.8 13.8 18.2 20 21.6 25.2 and hence it is quite clear that the specific gravity was certainly not less than in health. As we intend on a future occasion to analyse the returns of two large series of inquiries which we have made, into the chemical and other qualities of the urine in phthisis, we shall not enter more fully into this question on the present occasion. PERSPIRATION. Perspirations are common in the early, as in the later stages of phthisis, and oftentimes have a sour odour. In Of 177 cases of phthisis we found 40.1 per cent. had constitutionally a tendency to perspire much, 46.7 per cent. perspired as is usual, and 27.3 per cent. were believed to perspire less than others in health. cases of debility and bronchitis there was a somewhat greater tendency to perspire. In a comprehensive inquiry, including one thousand phthisical persons, we recorded that 25'4 per cent. had been ascertained to perspire with unusual freedom in health. It is common to regard the occurrence of considerable perspiration as a mark of the advanced stage of the disease; but in this we think there is an error. It cannot be doubted that profuse perspirations occur in the exhaustion of the later stage, and more commonly than at any other period; but it is equally true that they are met with, in a less degree, in a majority of cases in the early stage. This may be inferred from the remarks already made (p. 74), but they occur in an intermitting manner, and chiefly in the evening and in the early morning, whilst the patient sleeps. They also are observed whenever the heat is suddenly increased, as also with the sudden occurrence of cold weather in the autumn, upon any unusual exertion, and on the occasion of sudden surprise. The cause of this occurrence is to be found in the preternatural action of the skin, and particularly with that low state of the vital powers, which we have shown to occur at night, both in health and in disease. We are unable to explain the precise mode by which the degree of activity of the skin is regulated; but in reference to the latter, we have ascertained the rate of pulsation and respiration, and the amount of carbonic acid evolved at each hour of the day and night, and have proved that the vital actions are reduced during the night to a point not higher than from one-half to two-thirds of that which is found during the day. Whether, therefore, a state of atonicity occurs in the night, which leads to the more rapid elimination of fluid by the skin, we perhaps cannot prove, but the correlation of the two facts quite corresponds with other observations both in health and disease, viz., that with debility, or a diminished degree of vital power, there is commonly increased tendency to perspire. We have also noticed that perspirations occur in feeble persons who sleep when lying upon the back, and in whom the tongue, falling back into the pharynx, induces increased dyspnoea. In such instances the patient sleeps uneasily, and wakes bathed in perspiration; but on awaking, the respirations become more natural, and the perspirations gradually cease. We have also observed two conditions of the perspiration which must have a significance both in reference to the condition of the system and as an indication for treatment. Normally, the perspiration is slightly acid, -a condition due, we believe, not to secondary changes, as some chemists are inclined to think, but to the fixed and volatile acids which have been detected in that fluid. The amount of acid varies at different periods of the day, so that before breakfast it is the least, and if much exertion be then made, it will be found that the perspiration is perfectly neutral, whilst after meals, and particularly in the afternoon, the degree of acidity is increased. We have noticed that in numerous cases of phthisis the acidity of the perspiration is so increased, that the odour has attracted the attention of the patient, and particularly in the more marked perspirations which occur in the early morning. In some it is so pungent as to be perceptible, and sometimes very offensive, in every part of the room, whilst in other cases there is no acid odour, however profuse may be the perspiration. In the former case, we have constantly taken pains to prove that it occurs in cleanly persons, and after daily washing of the whole body, and when using clean linen, and is therefore not resulting from the circumstances too commonly found in the working classes. Of 177 cases of phthisis, 564 per cent. had a constitutional tendency to acid perspirations; whilst of those who perspired much, 70·7 per cent. had sour perspiration, and of those who perspired less than is usual, 54.2 per cent. had remarked the acidity of the excretion. Hence phthisical persons appear to be constitutionally predisposed to an acid state of the perspiration. We do not attempt any sufficient explanation of these conditions, but that which most readily occurs is the deficiency of alkali in the blood, whereby the final transformation into carbonic acid is prevented, and |