any relapse. He sometimes has an occasional hack in the morning, but there are no evidences of disease other than diminished resonance over the outer

half of the supraclavicular space. Has not been confined a single day to his room during the whole winter.

CASE LIX.-Encouraged by her improvement at Aiken, this patient concluded to remove to Santa Fé, N. M., where she had relatives. Not liking the social aspects of that place, she went to Colorado Springs; but while there a valvular affection of the heart, of which symptoms had been observed at Aiken, became so aggravated by the altitude as to necessitate her return to her home in Washington.

January 14th.-Looks strong and healthy, but is harassed with almost incessant cough, the result of laryngeal catarrh, the vocal cords and surrounding parts being much congested. Pulse, 92; temperature, 99°. Still some dulness in the left side, between the clavicle and second rib, but the pulmonary disease is evidently at a standstill. She passed the winter without any material change in the lung disease, but, owing to the cardiac and laryngeal complications, she is much troubled with cough.

CASE LXIII.-Soon after her return to Aiken it was discovered that, in addition to the pulmonary affection, she was suffering with parenchymatous nephritis. She died of the latter affection a few weeks after her arrival.

CASE LXIV.-Passed the summer at Bethlehem, N. H., where he continued to improve.

November 26th.-Pulse, 94; temperature, 98.7°. Has a good color, weighs 124 pounds, walks four miles without being fatigued, coughs a little, bringing up a small quantity of muco-purulent expectoration. Over the right side the area of dulness extends in the front to the third rib, and behind over the supraspinous fossa. Expiratory murmur prolonged over the upper portion of the lung.

May 2d. Has been very imprudent, going out at all hours, and taking but little care of himself; but, notwithstanding this, he continued to improve. Pulse and temperature are normal. The cough, which for two weeks had disappeared entirely, has returned in consequence of imprudent exposure. The dulness in front is unchanged, but behind there is no trace of it. His appearance is that of a man in perfect health.

Ön looking over the above cases it will be seen that the improvement has been more or less permanent in the great majority of them, and that periods ranging from one to six years have passed without any relapse. Many others are doing well at their homes, but, as they did not return to Aiken, are omitted in this report.

CASE LXX.-Male, forty-six years of age, patient of Dr. A. B. Whitney and Jno. T. Metcalfe, of New York. Hereditary tendency, mother and one aunt having died of phthisis. Six years ago had diarrhoea for six months, and has had a similar attack every year since that period. In the autumn of 1879 he began to cough at night, but it was not until July of the following year that it became persistent. Hemorrhage on August 5th of the same year. Has had night-sweats, and has lost sixteen pounds in weight.

November 1st.-Pulse,92; temperature, 100; weight, 132. Color pale, digestion wretched, and can take but little in the way of food or medicine. Has tried malt and cod-liver oil, but has never been able to continue their use longer than a day or so at a time. Even the preparations of the hypophosphites have

disagreed with him. Expectorates eight ounces, but can lie on both sides. Right front dull from clavicle to third rib, with bronchial respiration and prolonged expirium, at one point cavernous in character. Marked bronchophony. Right back dull under upper half of scapula and over corresponding interscapular space. Respiration bronchial, with very distinct bronchophony. In addition to his pul monary disease the patient suffers with nervous prostration and is much depressed in spirits.

January 17th.-Pulse, 86; temperature, 98.6; weight, 138 pounds, a gain of 6 pounds. In addition to the area of dulness previously mentioned as extending in front to the third rib, there is diminished resonance lower down. Posteriorly there is now no evidence of dulness below the spine of the scapula.

March 1st.-Pulse, 104; temperature, 98.8°; weight, 140 pounds, an increase of 83 pounds since his first examination, of 9 pounds since his arrival in Aiken. The dyspepsia and diarrhoea, which had greatly improved, are again troublesome.

April 26th.-Pulse, 84; temperature, 98.7°; weight, 140 pounds. Physical symptoms have undergone no change since January 17th.

Result.-Marked improvement, diminution in the extent of the infiltration, and an increase in weight of 8 pounds since his first examination, and of 94 pounds since his arrival in Aiken.

CASE LXXI.-A young lady, nineteen years of age, patient of Dr. North, of Waterbury, Conn., consulted me at Bethlehem, N. H., in September, and by my advice came to Aiken. Her father died of consumption, and she herself has had repeated attacks of bronchial catarrh. Has also suffered with malarial poisoning. Has had cough for some time past, and has lost twenty pounds in weight, and her appearance is decidedly chlorotic.

November 9th.-Pulse, 96; temperature, 100.4°; weight, 139 pounds. Has some cough and expectorates two drachms of greenish yellow sputa, all of which floats. Right front dull from clavicle to the upper border of third rib.

Respiration bronchial, with prolonged expirium. Right back dull under supraspinous fossa. Respiration as in front. Bruit de diable over jugular vein. January 28th.-Pulse, 96; temperature, 98.6°; weight, 150 pounds, a gain of 11 pounds since her arrival in Aiken, and of 17 pounds since treatment was commenced. Cough reduced to a few hacks in the morning, without any expectoration. Color much improved. The area of dulness in front is reduced to a triangular space, with the clavicle as the base, and the junction of second rib and sternum as the apex. Respiratory murmur feeble, with audible expirium. Posteriorly the only evidence of disease is somewhat diminished resonance under the supraspinous fossa.

February 13th.--Weight, 153 pounds, a gain of 14 pounds in as many weeks.

May 9th.-With the warm weather of spring there has been a slight reduction in weight, but she still weighs 151 pounds. In every other respect the improvement above noted has been maintained.

Result.-General improvement, amounting to arrest of the process; diminution in the extent of the infiltration; cessation of the cough- the occasional hack in the morning scarcely deserving that nameand great increase in weight.

CASE LXXII.-Male, twenty-eight years of age, Dr. Wm. C. Ravenel, Charleston, S. C. Very pronounced hereditary predisposition, father, brother, and other relatives having died of consumption. Began to

cough in the winter of 1877-78; spent the following summer at Asheville, N. C., where he improved. Returned to Charleston, and there relapsed. Has lost from twenty to twenty-five pounds. Has had several slight hemorrhages. Has been in Aiken three weeks and has improved in strength, but has gained nothing in other respects. Had an attack of dengue a month ago, and was greatly prostrated.

November 5th.-Pulse, 128; temperature, 101.8°; present weight, 98 pounds; is greatly emaciated; looks wretchedly, and is evidently in the last stages of the disease. Extensive infiltration, involving the upper portion of the right lung and extending as low as the sixth rib in front, and to the angle of the scapula behind. Has no appetite for food, and suffers with severe colicky pains after eating. This case, evidently a hopeless one, declined steadily, and terminated fatally on January 2d.

CASE LXXIII.--A young colored man, twentythree years of age, of phthisical family and dissipated habits, began to cough last winter, but did not relinquish his occupation, that of a hotel-waiter, until the following spring. He lost flesh rapidly, but, instead of seeking medical advice, dosed himself with various quack medicines. Cough has been persistent, and has had profuse night-sweats.

October 27th.-Very pale; greatly emaciated; finger-nails clawed; cough very troublesome, with abundant expectoration, a large proportion of which sinks to the bottom when the vessel contains water. He is so weak as to be unable to cross the room without assistance. His general appearance seems to indicate a fatal termination within a week, or, at the utmost, a fortnight. The unfavorable outward aspect of the case was more than confirmed by physical examination. On left side, dulness from clavicle to third rib, with bruit de pot félé; respiration cavernous, with moist râles over the apex, and distinct metallic tinkling. Right side respiration harsh, with prolonged expirium. The case was so unpromising that I hesitated about subjecting him to any regular treatment, and it was only at the urgent request of his mother that something should be done, that I prescribed the usual remedies.

December 8th.-Has improved in color; has gained 10 pounds in weight, and is able to take long walks in the adjacent woods; coughs less, and with corresponding diminution in the amount expectorated. Lulled into security by his marked improvement, he soon began to grow careless and neglected himself. I did not see him again until April 3d. He was then very weak, and died within a few days after my visit. This case is worth noting as affording proof of the beneficial effects of treatment, even in seemingly desperate cases. member well his stating that he felt better from the time he took the first doses of the hypophosphite of lime. There is but little doubt that with more favorable surroundings his life might have been prolonged for several years.

I re

CASE LXXIV.-A young man, nineteen years of age. Dr. F. P. Porcher, Charleston, S. C. Father died of phthisis. Had in August, while residing in a malarial region, on the coast of South Carolina, what was supposed to be remittent fever, but which was attended with cough, sweats, and rapid emaciation. On his arrival in Charleston, was examined by Dr. Porcher, who is reported to have pronounced it to be a case of pulmonary infiltration, with pleural effusion. His temperature has ranged from 101° to 103', with occasional chills, without any regularity in their occurrence.

September 24th.-Pulse, 88; temperature, 102°. Has persistent cough, with muco-purulent sputa. On the right side there is dulness in front, extending from one inch below to mamma to the liver. The superior border of this area of dulness extends across the axilla to a point corresponding to the angle of the scapula. The percussion-sound is decidedly dull, but not flat as in pleuritic exudation, nor does change of posture cause any alteration in the character of the dulness. Intercostal spaces well defined, and without the bulging observed in fluid exudations. I accidentally omitted to note the character of the respiration, but remember that the respiratory murmur was distinctly audible, although more faintly so than on the left side. During October the fever gradually declined, and toward the middle of the month the cough abated, and finally ceased altogether. The area of dulness remained unchanged, but there was a marked improvement in his general health, his weight rapidly increasing from 119 pounds on the 19th to 131 pounds on the 28th, a gain of 12 pounds in nine days, or at the rate of over a pound a day.

November 19th.-Pulse, which has hitherto ranged from 104 to 112, is now only 88, and the temperature has declined to 99. He eats enormously, and his weight has steadily increased, being to-day 147 pounds, a gain of 28 pounds in one month. The dulness in front is unchanged, but behind it has dropped to a line one inch below the angle of the scapula. The respiratory murmur over the region of dulness is feebler than on the left side. From this time to the date of his departure there was but little change in his condition, except a gradual diminution in the extent of the dulness. When last examined (May), the upper border of dulness in front had receded to the seventh rib, while behind it had disappeared entirely.

Remarks. The rapid improvement of the patient and the rather unusual location of the dulness would at first sight lead one to suppose that the diagnosis of phthisis in this case was incorrect, and that it was either a pleuritic exudation or some disease of the liver. The fact that the dulness, although well marked, was by no means flat, and that the respiratory murmur, noted as feeble, was, nevertheless, audible over the whole of the base of the lung, are sufficient to exclude any fluid accumulation, or any great enlargement of the liver or tumor of that organ. Besides this, the location of the dulness was not influenced by change from the erect to the recumbent posture. There was no icterus or any other evidence of hepatic disease.

CASE LXXV.-Female, aged twenty-nine. Drs. Craig, of Manchester, O., and Murphy, of Cincinnati. Maternal heredity her grandfather, a brother, and a sister, having died of phthisis. Has had a persistent, hacking cough since last February, with little or no expectoration until two weeks ago. It has since then been once streaked with blood. Previous to the beginning of the cough she had been greatly reduced by nursing a sick sister.

November 5th.-Pulse, 82; temperature, 100.7; weight, 130 pounds; quite pale. Cough troublesome, with four ounces muco-purulent expectoration, all of which floats. On the right side there is dulness extending in front from the clavicle to third rib. Respiration bronchial, with prolonged expirium; conducted heart-sounds. Behind, the dulness is confined to the suprascapular region.

December 13th.-Pulse, 84; temperature, 98.7°;

weight, 140 pounds. Cough, which had nearly disappeared, has returned, but is not severe.

January 27, 1881.-Pulse, 84; temperature, 98.5°; weight, 141 pounds, a gain of 11 pounds. Walks two miles without experiencing fatigue. Has a fair appetite and good digestion. Cough reduced to an occasional hack, and without any expectoration. The dulness in front extends only to the upper border of the second rib. Over the back it is still evident over the suprascapular region. Respiration rough, with prolonged expirium. Up to this date she had improved steadily, had gained eleven pounds in weight, her color had returned, the cough had all but ceased, and there was every reason to hope that the disease had been arrested. During the month of February she imprudently exposed herself, brought on an attack of partial pleuritis, followed by increase of cough, fever, etc., and in the course of a few weeks lost all she had previously gained, and upon examination it was found that the disease had extended.

Result.--Marked improvement during first three months, with subsequent relapse and extension of the disease.

CASE LXXVI.-A recently married lady, aged twenty-one, patient of Dr. J. D. Kenyon, of Providence, R. I. Mother died of phthisis. Disease began in June, 1879, with sharp, pleuritic pain and loss of flesh to the extent of nine pounds. Hæmoptysis on July 28th, with return of pain and loss of flesh to the extent of nine pounds.

December 4th.-Pulse, 92; temperature, 98.5°. Of small stature and delicate appearance. Has never had cough. On the left side there is distinct dulness, extending from the clavicle to the fifth rib in front, and also in the axillary line to a point on a level with the angle of the scapula. Respiration bronchial, with distinctly audible expiratory murmur. Posteriorly the dulness reaches as low as the angle of the scapula. I did not have an opportunity of making another examination; but when she left, in the spring, she was much improved.

CASE LXXVII.-Married; thirty-two years of age. Dr. Fisher, of Hoboken, N. J. Has lost one brother and two sisters with consumption. When seventeen years of age she had typhoid fever, and ever since then has been subject to repeated attacks of cough. In August, 1880, the cough became persistent. Has lost fifteen pounds in weight.

November 17th.-Pulse, 100; temperature, 101.6°; weight, 104 pounds, three of which she has gained since her arrival in Aiken. Very anæmic; is excessively nervous, and suffers with dyspepsia; has cough, and expectorates one ounce, consisting chiefly of mucus, most of it being brought up in the morning. Dull on the right side from the collar-bone to third rib, with diminished resonance thence downward. Behind, there is a limited area of dulness in the interscapular space between the middle of the shoulder-blade and the vertebral column. The respiratory murmur is feeble over both front and back. Over the left lung a few sibilant râles are audible.

December 27th.-Patient has had an attack of articular rheumatism, lasting three weeks, with high temperature and loss of appetite, and is evidently much weaker and more emaciated. From this date there was some improvement in her general health, but no change in the character or condition of the local symptoms.

CASE LXXVIII.-Female; forty-one years. Dr. J. F. M. Geddings, of Charleston, S. C. Mother and husband died of phthisis. Has had more or less

laryngeal catarrh for several years, but no serious trouble until 1880, when she was attacked with influenza, which was then epidemic. Since that time the cough has been persistent, and has been accompanied with loss of weight (twelve pounds), nightsweats, and pleuritic pains. In the month of June she visited Bethlehem, where I examined her. Pulse, 100; temperature, 99.8°. There was dulness over the upper portion of the right lung, between the clavicle and third rib in front and under the supraspinous fossa behind. The respiration was bronchial, with prolonged expirium. Her weight at this time was 96 pounds. She improved rapidly, and at the time of her departure she had gained four and three-fourths pounds. Instead of going to some dry station in the interior, she remained a month in New York, gaining a little more weight at first, but soon losing it again. The cough became more troublesome, and the night-sweats returned.

November 20th.-Pulse, 96; temperature, 100°; weight, 102. Cough not very frequent, with a moderate amount of muco-purulent sputa, all of which floats. Voice is a little husky. The area of dulness is unchanged, but under the second rib the respiration is cavernous, with pectoriloquy.

April 8th.-Pulse, 96; temperature, 98.5°; weight, 108 pounds, a gain of 6 pounds since her arrival in Aiken, and of 12 pounds since she began treatment. Notwithstanding this improvement in her general health, there has been a slight extension of the disease downward, the lower border of the infiltration now extending to the fourth rib.

Result.-General health improved. Extension of the pulmonary affection.

CASE LXXIX.-A young lady, twenty-one years of age, a patient of Dr. Chapman, of New Haven. One brother and a sister have died of phthisis. Has had cough since August, 1880, during which time she has lost nine pounds in weight.

November 22d.-Pulse, 130; temperature not noted; weight, 110 pounds. Very fair complexion, with slender figure and delicate appearance. The appetite is good and the digestion fair. Walks two miles without becoming fatigued. Cough not troublesome; muco-purulent in character; about one ounce in twenty-four hours, all of which floats. Has night-sweats. Right side dull from clavicle to third rib. Respiration bronchial over the area of dulness, except below the clavicle, where it is cavern

ous.

Behind, there is dulness over suprascapular region, with diminished resonance lower down. In this situation the respiration is bronchial. The history of this case is one of slow, but uninterrupted decline. When she left Aiken, in the month of May, she had lost eleven and three-fourths pounds; cough and expectoration had increased; the dulness had extended over the greater portion of the front of the chest, while behind it reached to within an inch of the angle of the scapula.

Result.-Extension of the disease, with loss of weight to the extent of eleven and three-fourths pounds.

CASE LXXX.-Male, twenty-four years of age. Drs. Max Brock and Carl Heitzmann, of New York. No hereditary predisposition to consumption. Disease began with bronchitis, in June, 1877, but cough did not become persistent until September, 1880. Went to Sullivan Co., N. Y., and returned apparently well, but soon relapsed. Has had three attacks of hemoptysis, and has lost twenty pounds.

November 22d.-Pulse, 102; temperature, 100.2°; weight, 134 pounds. Slight exertion, such as ascend

ing stairs, causes dyspnoea. Appetite and digestion good. Cough slight, with four ounces of mucopurulent expectoration. Has night-sweats. On the right side there is dulness posteriorly over the suprascapular and over half of the scapular region. On that side, over both back and front, the respiration is bronchial. Over the upper portion of the left lung there is another area of dulness occupying the supraclavicular, the clavicular and mammary regions, as low as the third rib, with diminished resonance to the sixth. Respiration bronchial.

May 19th.-Pulse, 84; temperature, 98°. Patient's improvement has been almost uninterrupted. He has the ruddy hue of health, and his weight has increased to 140 pounds. Appetite and digestion are excellent. The cough has greatly improved, and the expectoration is reduced to one ounce, or to onefourth of what it was at his first examination. Walks five miles without being fatigued. On the right side the suprascapular and upper half of the scapular region have become resonant, the dulness being now confined to the lower half of the scapular and corresponding portion of the interscapular regions. The respiration has lost its bronchial character. On the left side the dulness has entirely disappeared, but the respiration is still bronchial. He remained at Aiken fourteen days longer without any further change other than the loss of a couple of pounds, caused by the increasing heat of spring.

Result.-Great improvement in the general as well as local symptoms, cessation of all activity in the disease, as evidenced by the absence of any rise in temperature above the normal during the last three months of his residence. Clearing up of the left lung and diminution in the extent of the disease in the right lung. A gain of six and one-half pounds of flesh, increased strength, and great improvement in cough, with corresponding reduction in the amount expectorated.

CASE LXXXI.-Male, twenty-nine years of age; single. Dr. H. O. Marcy, of Cambridge, Mass. Strong hereditary predisposition on both sidesgrandfather, father, two aunts on the father's side, and one maternal uncle, having died of phthisis. His brother also had the same disease and removed to Minnesota. Patient, who resembles his father, is slightly built, and presents a pale, unhealthy look. In October, 1879, he had an attack of pleuritis. The effusion was absorbed, but he continued to cough and lost flesh to the extent of twenty pounds.

December 13th.-Pulse, 108; temperature, 99.7°; weight, 114 pounds. He looks very ill, and the slightest exertion causes dyspnœa. Appetite poor and digestion not very good. Cough at times troublesome; expectoration one and one-half ounce in twenty-four hours. Extensive disease of the right | lung, the dulness in front extending to the third rib, and behind to the angle of the scapula. Respiration bronchial, with abundant moist râles. The left lung is also affected, but not so extensively as the right, the area of dulness being confined to the apex above the second rib. Mucous râles everywhere audible. The strong hereditary predisposition in this case, the great extent of the disease, and the poor general health of the patient, precluded all hopes of arresting the disease. On leaving for home, on April 21st, he had lost five pounds more. In addition to the

dulness observed over the anterior surface of the left lung, an area of diminished resonance had developed itself over the scapular region. On the right side the symptoms are unchanged.

CASE LXXXII.-A married lady, a patient of Dr.

Holcomb, of Lennox, Mass., twenty-four years of age, whose father died of consumption. Had diphtheria seven years ago, and ever since then has suffered with cough during the winter. Since last June the cough has been persistent, and has been attended with high temperature, night-sweats, and loss of flesh to the extent of twenty-five pounds.

November 21st.-Temperature in the forenoon,. 97.5°, but very high later in the day; pulse, 112. Is very pale and moves about with great difficulty, the slightest exertion causing shortness of breath. The thorax is very small, with prominent sternum (chicken-breasted). Both lungs extensively diseased. Her general appearance is that of a person in the very last stage of the disease. Notwithstanding her unfavorable symptoms, the change of air produced a marked improvement in her condition. The fever declined, the strength improved, and the cough became less troublesome. With the exception of occasional slight tinging of the expectoration, she did well until toward the close of January, when she began to decline, and died a few weeks later.

CASE LXXXIII.-Male, aged forty-eight. Dr. Raney. Family history not noted. Has had an occasional cough for twenty-seven years. Four years ago it became persistent. Had an attack of pleuropneumonia in January, 1879. Has at times observed a few specks of blood in his sputa. Has had night

sweats.

Over

November 29th.-Pulse, 108; temperature, 100°; weight, 147 pounds. Slight exertion causes dyspraa; appetite fair, and digestion good. Expectorates about four ounces of muco-purulent matter. the right lung there is dulness in front from the clavicle to second rib, with diminished resonance to fourth. Behind, the dulness is confined to the suprascapular region. Respiratory murmur feeble. This patient improved rapidly, but, after remaining in Aiken six weeks, thinking that he could do still better, went farther south. The move proved a most disastrous one. On his return in the month of March, his condition was most deplorable; his weight had declined to 143 lbs.; his pulse had risen to 116, and his temperature to 102.2°. His dyspnoea had increased, the cough had become more troublesome, and the expectoration more profuse. Physical examination showed that the disease had extended, and that a cavity had formed. He afterward rallied, but up to the time of his departure did not regain what he had lost by his ill-advised trip. Result. Improvement - relapse provement.

renewed im

CASE LXXXIV.-A married lady, aged forty-two. Dr. A. H. Nichols, of Boston. Hereditary predisposition. Last August she began to cough, had daily chills, followed by fever, and lost flesh rapidly. On examination, it was found that the apices of both lungs were affected. She visited Rye Beach, and while there improved rapidly, but lost ground again on her return to Boston.

December 2d. --Pulse, 124; temperature, 102°; weight, 110 pounds. Looks wretchedly; skin sallow and almost bloodless. Is excessively nervous, and so weak that the slightest exertion causes attacks of dyspnoea. Has daily exacerbations of fever, from which she is only free during a few hours in the morning. Cough troublesome, with profuse expectoration. Left side dull from above the clavicle to third rib in front, and under supraspinous fossa behind. Respiration bronchial, with prolonged expirium. Right side, diminished resonance in front and dulness over the scapular and interscapular space, with bronchial

breathing. This case, from the first a hopeless one, gradually grew weaker, and after a residence of ten weeks it was decided to take her home.

Result.-Gradual decline.

CASE LXXXV.-A naval officer, thirty-two years of age, from Norwich, Vt. Family history not noted. On the return of his ship from the tropics, he was exposed to rough, cold weather in New York harbor, which brought on an attack of broncho-pneumonia. He lost over ten pounds, and had several hemorrhages.

December 5th.-Pulse, 106; temperature, 101'; weight, 114 pounds. Is very thin, and presents the appearance of a very sick man. There is marked dulness over the whole right lung in front, and posteriorly over the upper two-thirds. In front the respiration is bronchial, except under the second rib, where it is distinctly cavernous. On the left side no dulness, but loud, sonorous ronchi, intermingled with moist râles. Cough very troublesome and almost incessant.

February 17th.-This unpromising case, after two months' confinement to his room, during which he suffered terribly with his cough, began to improve about the end of January. His pulse is now 98, and his temperature normal. His color is fresh and healthy; his strength is so much improved that he walks three miles in the course of the day without experiencing any fatigue, and mounts two flights of stairs without becoming short-breathed. Coughs but little, and then only in the early morning, at which time he raises only a few pellets of mucus. In front there is no change in the physical symptoms, but behind the upper portion of the lung has cleared up and is now resonant.

May 26th.-Pulse, 96; temperature, 98.5°. The improvement noted above has continued. Patient looks remarkably well, and is in excellent spirits. He now weighs 1254 pounds, a gain of 114 pounds; has gradually extended his promenades, and can now walk two miles consecutively. Coughs only a little in the morning, while dressing. The improvement in the case was all the more remarkable on account of its being due to climate alone, as he took neither oil, malt, hypophosphites, or any medicine other than such as was administered to allay his troublesome cough.

Result.-Great improvement in a case in which, from the extent of the disease and the unfavorable condition of the patient, there was no rational ground to expect anything other than a speedy decline.

CASE LXXXVI.-A young lady patient of Dr. Dearborn, of Nashua, N. H., and of Dr. F. I. Knight, of Boston; twenty-seven years of age, and of a consumptive family, her mother and sister having lately died of pulmonary phthisis. Commenced coughing last May; had fever, night-sweats, and lost six pounds in weight. She visited Bethlehem, N. H., and while there improved and gained ten pounds.

December 7th.-Pulse, 88; temperature, 99°; weight, 126 pounds. Has been losing ground since she left Bethlehem. Looks badly and is much depressed. Over the right front there is diminished resonance, and behind an area of dulness corresponding with the lower half of the scapula and extending toward the axillary line. Respiration feeble, with prolonged expirium; conducted heartsounds distinctly audible. Posteriorly, in addition to these symptoms, there are sibilant and moist râles. On the left side there is dulness over the suprascapular region, with mucous râles in front and feeble respiration behind.

December 23d.-Has improved in general appearance, and has gained four and one-half pounds.

April 2d.-Did well until the middle of January, at which time the digestive organs became deranged and she began to lose in weight. The pulse became more frequent, and the temperature higher. Since then she has continued to grow worse. Physical examination reveals extension of the disease in the right lung.

Result.-Extension of the disease and loss of

weight.

(To be continued.)

SPASMODIC NEURALGIA

OF NEARLY THREE YEARS' STANDING, RELIEVED BY CORRECTION OF SPASM OF THE CILIARY MUSCLES AND BY CIRCUMCISION.

BY FRANCIS H. RANKIN, M.D.,

NEWPORT, R. I.

THE importance of removing peripheral irritation is so markedly shown in a case which has recently been under my care, that I deem it of sufficient interest to present it to your readers.

The case about to be detailed is that of a little patient belonging to a very neurotic and highly cultivated family. His father died from apoplexy; his sister died suddenly, after suffering for several weeks from severe neuralgia about the head; a brother was at one time an inmate of an insane asylum; an uncle is at present in a similar institution; and other members of the family show strong neurotic tendency. With a knowledge of this diathesis in the family of our patient, we can readily comprehend the effect produced upon him by peripheral irritation.

He is twelve years of age, a bright, intelligent, handsome little fellow, with every appearance of being in the most robust health. A little more than three years ago he had typhoid fever, and. three months after recovering, he began to suffer from neuralgic headaches, which, four months subsequent, developed into neuralgia of very intense character, affecting at first the head, then extending to the back, through the diaphragm, stomach, and other parts of the body, accompanied by sharp lancinating pain in the eyeball, with marked congestion of the ocular conjunctiva. The little patient was confined to the house during the greater part of the winter of 1878-79, the neuralgia being of almost daily occurrence, and at times of the most agonizing and seemingly alarming form. He was

seen by several of our most prominent New York physicians, who pronounced the neuralgia to be of malarial origin, and, so far as I am informed, treated it as such, using, in addition to the anti-malarial treatment, galvanism.

The following eighteen months were spent in Europe, during which time he was rarely free for more than a day at a time from some neuralgic pain in his head or back, and while in Paris he had an alarming seizure.

In the fall of 1880 he returned to New York, and, shortly after his arrival, the neuralgia became of more frequent occurrence and much more severe in character. The eyes were markedly congested, and the little fellow was unable to read on account of the pain which it produced. For this condition, quinine in large doses was given. During the winter, notwithstanding frequent and severe attacks, the patient's general health was excellent; he was