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the case of which he gives an abstract, as some of myobservations, in which the ’mercury certainly rose, by what-ever means, to 108° or over, were taken in the mouth, thethermometer being watched all the time, and several axillatemperatures were taken when the instrument was eitherseen or held by the observer. I make these remarks on thefriction theory in view of the obvious plausibility of its adduce-ment, and to show that whatever other fraudulent means ofraising the index of the thermometer were employed, andwhich may have escaped my observation and that of manyothers, this at least is out of the question. For a furtherconsideration of the question of fraud in my case, I mustagain refer to my first report of it. In the case of Dr.Ormerod’s, to the account of which, in THE LANCET, thereader is referred, no obvious cause was detected for pyrexia.There was great pain complained of, but not explained, inthe right hypochondrium. It will be seen on reference tothis case that, unlike mine, there was a considerable rise ofthe pulse-rate, though not always in proportion to the tem-perature. The patient, moreover, was obviously hysterical.

It may be noted here that three of the above quoted fourcases showed disturbance of the menstrual functions; threeshowed more or less obvious hysterical symptoms ; all fourowned the common fact of female sex; and none evincedsufficient organic disturbance to account in any recognisedway for the high degrees of temperature recorded by thethermometer.

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While urging that in the above cases a sufficient amountof probability as to genuineness of facts is made out toarrest attention on the matter, I do not lose sight of theweighty à priori arguments against such allegations. Argu-ments of this kind are, in a scientific investigation, of im-portance in exact proportion as the data, founded on observa-tion and experience, which go to make up the d priorldictum are sufficiently numerous and well ordered to

comply with the necessities of a scientific induction. Inthe investigations of some subjects previous knowledge oithe matter is sufficiently ample to satisfy these conditions,and so to justify the use of an d priori argument againstany apparently contradictory facts. But the questionnaturally arises here, Are we in possession of knowledgeregarding animal temperature under all conditions-of itsproduction and modification-in a sufficiently large quantityand accurate form to warrant us in denying ia, toto the pos-sibility of the phenomena which have been above related,and which appear so difficult to explain away ? In otherwords, are the following assumptions, which are made withregard to reported cases of paradoxical temperature, scien-tifically infallible ?-l. That temperatures such as have beenrecorded in these cases are, some of them, incompatiblewith the degree of health alleged, and others with the con-tinuance of life. 2. That it is impossible for cooling to takeplace so rapidly as alleged-e. g., for the blood to cool downseven or eight degrees at least in a few minutes.One or both of these objections are almost universally made

in some form to the allegations of paradoxical high tempera-tures. It is taken for granted, firstly, in all clinical ther-mometric observations, that the temperature registered inthe axilla, mouth, or rectum (due precautions being takento exclude the thermometer from the action of the externalair, &c.), and making allowance for certain other conditions,is approximately the temperature of the whole mass of cir-culating blood ; a registration of 104° in fever, for example,meaning that the whole mass of blood is about that tem-perature or somewhat higher. The impossibility of this massof blood cooling down to normal in a few minutes is assumed,no obvious mode of disengagement of body-heat being de-tectable, and therefore the allegation of such facts is set asidewithout discussion. With respect to the first of these objec-tions, it may fairly be said that the subject of animal ther.mometry has not been so worn out that it is impossible tcbelieve in the existence of very high temperature withoulthe concomitance of other well-known symptoms. As regardsthe second objection, I wish to raise no counter-theory as tcthe occurrence of these paradoxical temperatures, but wouldmerely suggest (1) that rapid cooling of circulating blood irthe human organism, considering the systemic complexityof that organism, may be connected with conditions aj

present not understood, and not be a simple question oi

accepted physics ; or (2) that the temperature taken on ski!or mucous membrane may possibly represent surface-heatinfonly, comparable, though generally diffused as to surface, t(the blush and rise of temperature in certain parts aftedivision of the sympathetic. Might there not be some obscur(

parallelism between such cases as I have quoted andothers showing an obvious connexion of high temperaturewith lesions of the nervous system-as, ior instance, acase related by Sir Benjamin Brodie (and quoted by Dr.Carpenter in his "Human Physiology "), in which, the spinalcord having been so seriously injured in the lower part ofthe cervical region that the whole of the nerves passingoff below were completely paralysed, the heat of thebody, as shown by a thermometer placed on the in.side of the groin, was not less than 111° Fahrenheit,and this, notwithstanding that the respiratory functionwas very imperfectly performed, the number of inspira-tions being considerably reduced, and the countenancebeing livid ? May there not be some temporary modificationof the nerve-centres, due to some necessarily obscure, becausevital, cause, working temporary results in some such similarfashion ? In this connexion a possible relationship might behinted at between these thermometric phenomena and thosenow well-known changes of sensation which own, at least,as an important link in the chain of their causation, amental impression. I allude to the clinical accounts of

hysterical ansesthesia, &c., recently brought into prominenceby Professor Charcot and others. For in these cases physicaleffects, presumably as objective as a rise of temperature,and apparently reducible to tests, do confessedly follow,though in some inexplicable way, on certain nervous

changes which are only evidenced boy mental impressions;the phenomena of sensation returning to an anaestheticpart, and anaesthesia induced in a healthy part, being as in-disputably a sequence of the application of certain miscel-laneous articles to the skin, as the variety of such articleswhich minister to this effect is great, and their natureimmaterial to the end in view. As one further possiblelink between such phenomena and the paradoxical tempera-tures to which I have made reference, pointing to nervousorigin, it may be noted that variations in temperature areobserved in parts subject to the above-quoted remarkableand unaccountable disappearances and reappearances ofsensation, the temperature rising as the sensation returns.The question, however, of the explanation of these ab.

normal facts, if facts they be, must depend on extendedobservation subject to strict criticism. My wish in publish.ing these notes is to place on record what I have found andcollected with regard to the possible occurrence of abnormallyhigh temperatures, in order that either it may be shownthat an error of observation respecting the alleged facts hasbeen committed, or that some line of explanation may besuggested.Note.-Since writing the above, I have learnt from Dr.

Cheadle, of St. Mary’s Hospital, that a case of a girl agedeighteen, convalescent from enteric fever, showed a series ofrapidly fluctuating temperatures, beginning about one monthafter the fever had apparently disappeared. The highestdegree registered was 111°. One of 1086° was taken, withevery precaution, by Dr. Cheadle himself; on one occasion105° was registered simultaneously in the two axitlse andunder the tongue; and on another, 103°, 102°, and 103° weresuccessively noted during the course of one quarter of anhour. The case will be published by Dr. Cheadle, who ha?kindly allowed me to quote the above facts.

CASE OF LITHOTOMY, BY DR. BUCHANAN’SMETHOD, WITH THE TRIANGULAR STAFF;SEVEN LARGE STONES; RECOVERY.

BY J. O’DWYER CREAGHE, L.K.Q.C.P., L.R.C.S.I,

THE following report of a case of lithotomy may proveinteresting to the readers of THE LANCET.Juan B-, a strongly-built countryman, of dark com-

plexion, fifty years of age, came under my care in January,1878. He had all the subjective symptoms of stone, andwas suffering fearfully from the bladder irritation; but Iwas unable to touch the stone with an ordinary sound.However, after two weeks’ perfect rest, on a diet strictlylimited to milk, and washing out the bladder every day, heimproved very much; and then, as I still was unable totouch the stone with an ordinary sound, I asked Dr.

Colbourne, of the British Hospital in Buenos Ayres, to see

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him with me, and he kindly brought with him a case oishort-beaked sounds, and with one of them we at once werEable to feel the stone.On the 26th of February, assisted by Dr. Colbourne, whc

held the staff, and Dr. Domingo Fernandez, of this place, 1

operated after Dr. Buchanan’s method, and removed, one byone, seven good-sized stones. The largest has a widestcircumference of seven centimetres, and the smallest of fivecentimetres. They are nearly quite round. As soon asconcluded I had him placed in bed and a piece of full-sizedelastic catheter passed in through the wound. On comingto himself he complained of very little pain. The urine ina couple of hours began to run freely and clear through thewound. The haemorrhage during the operation was trifling,and it had quite ceased by the time we had finished. Nextday (27th) his pulse in the evening was 95, and the tem-perature 1022° F. On the 28th the pulse was 95 in themorning and 100 in the evening, and the temperatura was99° in the morning and 100° in the evening. On March 1sthis temperature and pulse were normal, and he continued toimprove from day to day until, on March 15th (the seven-teenth day from the date of the operation), the wound wasquite healed, and he was able to get up quite well.

I wish to call attention to the fact that I and two othermedical men who attended him before I did were unable tofeel the stone with an ordinary sound. The long-beakedsound cannot be made to turn in a contracted bladder so asto get into the pouch behind the prostate.The only difficulty I experienced in performing this opera-

tion was in keeping my knife in the groove of the staffafter entering it, and I have to confess that though I was inno way hurried, and delayed considerably so as to feel surethat all was right, I was still unable to prevent it fromleaving the groove and cutting for a short way wide of thetrack. I think this was owing to two circumstances-first,that the staff I had made here was not thick enough, andconsequently the groove was not so deep as usual; andsecondly, as I now think, because I did not have the hori-zontal arm of the staff inclined a little to the right, withoutwhich, as anyone will see by putting it to the proof, it isextremely difficult to guide the knife along, unless yougive it an inclination at such an angle to the staff thatyou are liable to make the incision in the superficialstructures much too wide. However, as soon as I foundwhat I had done, I withdrew the knife until its point was atthe angle of the staff, and from there I made the incisionoutwards and then backwards, as recommended. I thentook a probe-pointed bistoury, and easily passed that intothe bladder, and incised the prostate, and continued theincision outwards to join the first.

I think that in case I have again to perform the operationI would do it in this way, which is certainly easier. In anycase, I think that by lateralising the staff a very little thereis no great difficulty; and I desire to record this case as atestimony to the great value of Dr. Buchanan’s operation.It is easily performed, is free from risk of haemorrhage, ad-mits of great dilatation, and, for my part, I cannot conceivehow there is any possibility of wounding the rectum.Analysis of one of the stones showed it to be composed of

a uric-acid nucleus, and the rest mixed urate of ammoniawith carbonates of magnesia and lime.Lujan, Province of Buenos Ayres.

NOTES ON TREATMENT OF DIPHTHERIA.

BY T. M. LOWNDS, M.D.,LATE PROFESSOR OF ANATOMY AND PHYSIOLOGY, GRANT MEDICAL

COLLEGE, BOMBAY.

As diphtheria has lately occupied considerable attention,I may be permitted to narrate the treatment I have pursuedfor the last eleven years with almost unbroken success.

Looking, with the late Dr. James Begbie, on the disease asallied to erysipelas, I have treated it with one of the persaltsof iron, and I may say that, however successful the tinctureof perchloride of iron has been in erysipelas, I believe theform of the persalt that I have used is quite as efficacious indiphtheria. My cases of the disease have occurred at allages, from under one year up to seventy-six, the last beingthat of my oldest patient. The fatal case (seen in consulta-

tion) was one immediately following scarlatina, and it provedfatal in two days.A large number naturally comprises a vast proportion of

cases of slight severity, some of which would probably havedone well under any treatment which did not lessen the

powers of life; but upwards of twenty were cases verysevere, if judged by the great depression of the vital powers,the dusky hue of the countenance, the deep redness of thefauces where the exudation did not conceal it, and, lastly,the appearance of the characteristic of the disease-thethroat exudation.The general form of prescription, which I have used in-

variably, modifying dose and frequency of administrationaccording to the age of the patient and the severity of thedisease, is as follows : Tincture of perchloride of iron, threeto four drachms; solution of acetate of ammonia, an ounceand a half to two ounces; chlorate of potash, one drachm toa drachm and a half; water to eight ounces. It must beobserved that in this mixture the perchloride of iron is con-verted into the peracetate, and there is also contained aportion of muriate of ammonia. There is also chlorineliberated, at least it is so when the tincture or solution isadded to chlorate of potass ; but as these notes have referencesolely to treatment, I need not refer further to the changeswhich take place. This mixture I have used as frequentlyin the worst cases as a tablespoonful every hour, during thefirst day or days of treatment. I have never interferedwith the sloughing exudation in any way, only prescribing agargle or wash containing half a grain of permanganate ofpotass in an ounce of distilled water, to be used frequently.This may be applied with a sponge or a brush, or inhaledas atomised vapour. I have always tried to get one evacua-tion daily from the bowels, and have supported the powersof life by wine, soup, milk, &c., as each case seemed todemand. How free such support has occasionally been, oneof the cases outlined will show. Lastly, I have always in-sisted on perfect ventilation of the bedroom by a windowopened at the top, so as to ensure fresh and pure air to

diphtheritic sufferers.I now append outlines of a few cases.Miss A-, aged about twenty-one, " sent for me June

25th, 1872, having for three days felt very ill, shivering,aching all over the body; had headache, and for the last twodays she had kept her bed with, as she expressed it, a verybad sore-throat. She had used the permanganate gargle,which a former patient had recommended. I saw her at2 P.M. In addition to what I have said, she could scarceraise or turn her head to the window for my inspection ofthe throat, and she could not raise herself in bed withoutfeeling very faint. Both tonsils, especially the left, coveredwith ragged dirty-whitish patches. Pulse 118, very smalland compressible ; bowels opened; skin dry, 1038° ; coun-

tenance oppressed, and very dusky; her tongue was brownfrom the use of the gargle. In addition to the gargle, Iordered half an ounce of peracetate mixture every two h011 rq ;.wine and soup. On June 25th, at 9 P.M., the temperai-nrawas 101’4°; pulse 106. On the 26th, at 8 A.M., the tempera-ture had fallen to 996°, and the pulse to 94. There had.been profuse perspiration in the latter part of the night.The heat of the skin never returned in this case, and thoughshe was very weak, the throat was quite clear from sloughsby the fourth day (June 29th), and she made a perfectthough tedious recovery. She had taken eight ounces ofthe mixture in the first eighteen hours. There was never

any albumen found when I examined the urine. In thelodgings where this young lady resided there was a veryfoul smell from the drain in the back kitchen.A girl, aged about thirteen, slept over a stable. In the

corner of her room was a sink, which communicated withouta trap with the main drain. At times this smelt exceedinglybad. On June 1st, 1872, I was called to see her. Shehad all the usual symptoms, and her throat, tonsils, uvula,and pharynx, were all covered, except one deep-red patch,as large as the point of the little finger, on the pharynx.Pulse 114; temperature 1028°. Ordered hourly doses ofthe mixture, with the gargle as frequently, and to havehourly doses of wine and beef-tea in small quantity. Aftertwo days, the exudation began to curl up at the edges, andshe gradually improved until, on the 8th, the throat wasfree from any speck. Her convalescence was slow, as shefrequently suffered from fainting fits, which, I was told, lasted