some hours with increasing rather than abating pain, her physician wisely thought it best to remove the pessary. Imagine his astonishment and fright when the most diligent vaginal examination failed to discover it! In this emergency the practitioner first referred to was sent for in hot haste; and he too was for a time baffled in his search-the rectum and vagina were vainly explored; but finally he discovered the offending body in the bladder, and removed it by the vesico-vaginal operation. These are the essential facts as received from a medical friend, who had them directly from the operator, and of their truth we have no doubt.

This history shows the exceeding dilatability of the female urethra. and that a doctor is not always infallible.

T. P.

An Essay upon Digitalis and its Mode of Action, by Dr. LEGROUX Translated from the Gazette des Hopitaux by L. J. FRAZEE, M. D., Professor of Materia Medica and Therapeutics, Kentucky School of Medicine.

Dr. Legroux makes the following resume in his inaugural Thesis:

1. Digitalis, of which the active principle is digitalin, exercises in all doses a special action upon the circulation;

2. If in poisonous doses, digitalis acts directly upon the heart; it seems that in therapeutic doses it primarily excites the contractility of the capil lary vessels, and only influences secondarily the circulatory centre by reestablishing the equilibrium of the circulation;

3. If we adopt this theory, digitalis is a sedative to the circulation, in this sense, that it quiets derangements of this function; but this is done by an excitant and tonic, and not by a sedative action ;

4. The influence of digitalis upon the temperature, the secretions, nutrition, uterine contractions, and hemorrhages, can only be explained by its excitant action upon the terminal filaments of the great sympathetic

nerve;

5. This theory fully accounts for the favorable results obtained from the use of digitalis in fevers, cerebral affections, hemorrhages, dysmenorrhoea, congestions, dropsies, and derangements of the circulation connected with cardiac lesions."

Some Remarks upon the Practical Value of Isolated Records of the Temperature Characteristic of Diseases, by C. A. WUNDERLICH. Translated for the Western Journal of Medicine by Dr. WM. CARSON, of Cincinnati, O.

He commences by forming a scale of temperatures corresponding with the degree of the febrile state: *

A. Non-febrile temperature, below 38 to 38.1 centigrade.

1o Temperature of collapse below 36.

2° Normal or nearly normal temperatures

a Temperature sub-normal,

b Temperature normal,

e Temperature sub-febrile,

B. Febrile temperatures exceeding

1° Trifling fever

2° Moderate fever

3o Intense fever

4° Notable fever, (considerable,) rarely higher than

C. Hyper-febrile temperatures, 40 and beyond.

100.4

36 to 36.5

36.6 to 37.5

37.5 to 38.1

38.1

38.1 to 38.5

38.5 to 39.2

39.5 to 40.5

40.5 to 41.5

1° Temperature of a paroxysm of infection, (malaria,) 41 to 41.6. 2o Temperature of pernicious infection, without limit below, can rise

to 42.5.

3° Temperature of neuro-paralytic (agonie); mostly it rises rapidly above 41.2, and can even reach 45.

The extreme limits of temperature compatible with life are, according to his researches, 33.5 and 42.1. These two extremes have been observed with "typhiques."

With children, temperature in disease has the same significance as in adults; only there is much more of variability. It is the same with adults of certain nervous natures, with the so-called hysterical constitution. Old men, on the contrary, have usually a degree and a half below the mean. The hour of the day has a great influence; in general, the morning temperature is lower (about half a degree) than after mid-day, or in the evening. The term of digestion brings an increase of temperature which, in case of difficult digestion, can go to even one or two degrees and more. Temperature rises usually some tenths of a degree when a sanguineous

Multiply by 9, divide by 5, and add 32, will give the Fahrenheit equivalent.

flow is imminent; it falls after the flow. Menstruation, pregnancy, accouchement, heighten the temperature.

PRACTICAL VALUE OF TEMPERATURES.

1. Significance of Temperatures for a Man in a Healthy State. A sub-normal temperature appears nearly without importance. The sub-febrile temperature is more frequent with men in health; it indicates that all is not right, that there is a morbid sensibility, and it is nearly right to suspect a latent change if it is observed at several observations. Then the organs, and chiefly the intestines and the lungs, should be carefully examined.

Febrile temperatures are sometimes found in men apparently healthy. They are the certain indication of a lesion, or of the beginning of an acute affection, without other apparent evidence, or of a chronic affection. 2. Significance of Temperature in Convalescence.

One observes sufficiently often in convalescence and of a transitory form the temperatures of collapse. When this temperature happens a short time after the end of the fever, after serious diseases, or after light attacks in very susceptible subjects, and does not reach too low a degree. there is no danger. But the danger augments in proportion as this tem perature of collapse is more removed from the antecedent febrile period; and it is necessary then to inquire if there be not some serious accident, internal hemorrhage, perforation of the intestine, etc.

Sub-normal temperatures are shown in convalescence; they have no dangerous significance-only they indicate that convalescence is not entirely assured.

A sub-febrile temperature denotes always that convalescence is incomplete; if it occurs in the morning, there is reason to fear some lesion.

A temperature really febrile is always of the greatest importance. It can depend, however, upon regimen, the premature use of meat or spirits, an overloading of the stomach, from the overtaxing of the patient, and from constipation; in all these cases it is of brief duration-all of them slackening the progress of the cure. But can also result from lesions, as only showing themselves by the temperature, (incomplete cure of morbid processes which re-appear, new intercurrent affection, latent chronic affection, ignored before and during the principal disease, and which at its termination has received an active propulsion); in these cases the increase of temperature may be for a long time the only apparent phenom

enon.

3.

Value of the Temperature in an Indisposition Apparently Simple.

The febrile temperature can exhibit itself in an ephemeral manner; but if it continue, there is a probability of another affection than a simple indisposition. But it is necessary to recollect that children, women, impressionable subjects, men affected with chronic and especially tuberculous disease, have the febrile temperature in the simplest indispositions.

4. Of the Temperature in the Beginning of an Acute Affection, not yet, even to the Fourth Day, Diagnosed.

The sub-normal temperature is only seen in diarrhoea, cholera, loss of blood, and perforation of intestines.

A normal temperature excludes completely the idea of typhus, of acute exanthemata before the period of eruption, of croupal pneumonia, and makes less probable the developement of acute and intense inflammation of

any organ.

The sub-febrile temperature has nearly the same significance; however one can meet it in the acute exanthems, very feeble before eruption, or in acute inflammation with slow developement; finally in abdominal typhus, but only on the first day or on the morning of the second.

The temperatures which characterize a trifling febrile movement or a Inoderate fever have rather a negative than a positive significance. In abdominal typhus, the temperature of the "trifling fever" is shown on the evening of the first or morning of the second day; that of the "moderate feuer," the evening of the second, and the morning of the third, and sometimes of the fourth day.

A temperature strongly febrile on the first or second day, excludes .typhus abdominal, or proves that it had begun sooner than the other symptoms indicated.

If on the first day a temperature of about forty-one degrees is observed, and if there be no symptoms of pyæmia, there is reason to expect an intermittent fever.

5. Of the Temperature in the Second Half of the First Week.

If the temperature of the evening is normal, sub-febrile or moderately febrile, the prodromial exanthematic fever, typhus, and croupal pneumonia can be excluded.

If the temperature be hyper-pyretic, we must infer an intermittent or an infectious disease.

6. Of Temperature in the Exanthematic Fever.

When an exanthema is produced, in the beginning there may be doubt as to its nature; the temperature falls at the beginning of variola or varioloid; it. persists on the contrary in rubeola, 'scarlatina and exanthematic typus.-Gazette Medicale, Feb. 16, 1867, by Dr. H. Beaunis, Professeur, etc., at Strasburg.

[TO BE CONTINUED.]

On Jaundice and Biliousness.*

Perhaps there is no disease that is more intelligible than mechanical jaundice, or mechanical obstruction (for example, by a gall-stone), in the common duct.

Some slight error of chemistry, as extreme diminution of alkalescence, or perhaps slight acidity of the bile for a few minutes, may lead to the formation of cholesterin crystals, or to the precipitation of bile-acids, and thus the nucleus of a gall-stone would be produced. When this stone passes into the common duct, it stops the flow of bile; and by increasing the pressure of the bile in the bladder and in the ducts, it causes an increase of diffusion of the bile into the blood. The different ingredients of the bile diffuse at different rates; and according to their properties, they are more or less acted on by the oxygen in the blood, and being more or less changed they diffuse into the texture and excreting glands, in which they are still further oxidised.

The relative diffusibility of the different substances in the bile has yet to be determined by accurate experiments, and their relative resistance to the action of oxygen under different circumstances, is not known; but it is probable that the bile acids are more oxidisable than the coloring matter and cholesterin, and that the rate of oxidation of the bile acids will vary with the quantity of the bile acids present, with the amount of alkali, and with the active condition of the oxygen in the blood.

The unaltered bile acids possess highly energetic chemical properties, which do not at all belong to the cholesterin or coloring matter of the bile. For example, when appled directly to the heart, they greatly diminish the frequency and force of contraction. This is caused by a direct paralysing action on the striped muscular fibre of the heart, and also by by a paralysing action on the ganglionic nerves in the heart. On the nervous centers the unaltered bile acids also have a strong poisonous action, causing sopor and ultimately coma.

But the most decided action of the unaltered bile acids is on the blood globules. These are dissolved and destroyed by the chemical action; so that they are deprived of their power of carrying on oxidation in any part. Direct experiments have shown that unaltered bile acids can rapidly produce fatty degeneration of the liver, the kidneys and the heart; and if ever the destruction of blood globules takes place in any part of the brain, the action of oxygen there will be stopped, and from this convulsions will be produced.

When we turn from such cases of jaundice to the multitude of other cases in which no mechanical obstruction exists our pathology and reasons for treatment are still very uncertain and very unsatisfactory; and if, instead of taking an extreme case of non-mechanical jaundice, we take that daily condition which is summed up in the word bilious, no clear view of the state of the patient, nor of the reason why relief is obtained by aperient medicine, mercury, or emetics, exists.

*By Dr. H. Bence Jones, St. George's Hospital Reports, Vol. 1, 1866.