Pustular eruption appeared on the face. The cough became less frequent, and the expectoration more scanty. Eruption became more extensive, but disappeared before discharge. Signs of consolidation of lung gradually disappeared. The pain on breathing, which was present February 2, lasted only two days, and a similar pain was felt February 13. Was able to be up and dressed part of the day February 13. Improvement was constant from the first. Hepar sulph. 3x was given internally. Discharged February 16th, cured.

Peculiarities. The attention of the internes and a few students was called to this case; and they were asked to examine it carefully. Signs of hepatization of the lower lobe of the right lung were marked, and the differences between the two lungs were distinct and easily demonstrated; and yet the temperature was but slightly elevated. Pulse was not very rapid, and "rusty sputa" were absent.

SUPPURATIVE OTITIS MEDIA, WITH MASTOID PERIOSTITIS.

No. 135. Female; aged, 28. Admitted February 16, 1892. History. There has been some discharge from right ear since January 1, 1892. Discharge was bloody for first few days, then became of a purulent nature; has been deaf in the same ear since discharge commenced. Very little pain has been present until the last three or four days, during which pain has been quite severe.

Present Condition. Now there is considerable swelling and much tenderness in mastoid region; integument, over mastoid process, of a dark-red color; some shooting pains over right side of head and in mastoid region; slight purulent discharge from external meatus; watch not heard upon pressure. Dr. H. P. Bellows was called in consultation, and it was decided, in spite of the indications for operation, that syringing the ear with hot water ten minutes every hour, day and night, keeping an ice-water coil constantly applied to the mastoid region, and giving capsicum 3x internally, might still abort the impending mastoid abscess. Trial of these measures for twelve hours (or longer if indications were favorable) was determined upon, the temperature and pulse, as well as the local condition, to be carefully watched.

February 19th. Temperature and pulse show steady improvement, but locally not much change is noted; discharge from external meatus rather diminishing. Dr. Bellows made a free incision in the tympanic membrane, and in the superior wall of the external canal. The above measures to be continued for twenty-four hours longer, and, unless more decided local improvement, should resort to operative measures.

February 20th. Improving; after inflating ear with Politzer bag could hear watch three inches from ear; meatus swollen and red. Bell on small pledget of cotton kept in ear to allay pain.

February 22nd. Water, of the temperature of the room, was used in the coil during the day, to be discontinued at night; ear syringed with hot water every two hours. Rapid improvement, yet much swelling of lower part of auricle and walls of external meatus. Milk and gruel diet.

February 26th. Much improved; some itching in meatus; very slight pain, and no discharge. Discontinue syringing and cold coil. Full diet. Merc. dulcis 3x.

March 2nd. Improving, yet rather weak. Hoff's malt t. i. d, After February 22nd Dr. Bellows inflated the ear by catheterizing, or by the Politzer bag. The catheter had to be carried through left nostril, on account of a deviated septum.

was carefully inspected and cleansed daily by Dr. Bellows.

March 8th. Feeling well; can hear watch twelve inches from ear after inflation. Discharged, cured.

SCARLATINA.

No. 149. Female; aged, 10. Admitted February 24, 1892. Has been sick four days. Tonsils large; deglutition not painful; herpetic eruption about lips, and on left cheek; fine, elevated eruption over entire body; very little redness; strawberry tongue. Says she feels very well. Pulse, 128; temperature, 100.4° F.

She was given a milk diet, and bell. Ix, 10 gtt. in half glass water two teaspoonfuls every hour.

Temperature never was higher than 100.6° F. during entire illness. There was considerable photophobia during first four days. Eruption disappeared on 28th.

The correctness of the diagnosis was doubted by several who saw the case, on account of the mildness of all symptoms. The doubt was definitely removed, however, when there was complete desquamation of ends of fingers on March 8th. Bran-like desquamation commenced March 2nd, and continued, more or less, while in hospital; after which date she was given full diet, excepting meats, which were not allowed. No albumin in urine at any time. She made a very satisfactory recovery, and was discharged March 9th, cured. A few doses of sulph. having been given during the last few days.

No. 180.

PNEUMONΙΑ.

Female; aged, 25; chambermaid. Admitted

March 15, 1892. II A. M.

History. Had diphtheria eight years ago. The present sickness commenced three days ago with severe chills, lasting half a day, followed by sweating, vomiting, and intense headache.

At time of admittance. Lips parched; tongue coated brown; pale and anæmic; pupils dilated; right cheek flushed; skin dry and hot; pulse, 120; temperature, 105.8°; respiration, 30; respiration labored and interrupted; entire right side of chest moves together, and differently from left; a few sonorous and sibilant râles over the chest; cough painful; glairy expectoration, scanty; broncho-vesicular breathing near apex of right lung, in front; diminished respiration in central and lower lobes, especially in central. Percussion, negative. Treatment, milk diet; sponge bath every two honrs; cold compresses changed every hour; iodine IX, 10 gtt., in half glass water-two teaspoonfuls every half hour.

At II P. M. Pulse, 106; temperature, 102.8°; respiration quiet. March 16th. Face pale and yellow; eyes sunken; feels very little pain; pain on pressure in umbilical and ileo-cæcal regions; scanty expectoration of glairy mucus. Five fæcal evacuations within twenty-four hours, of a thin pea-soup consistency. Vomits. her food, and marked prostration. Treatment, wet pack, night and morning, and cold compress, and sponge bath to be continued until temperature falls below 102° F. Arsenicum 3x, one tablet night and morning; bryonia Ix, in water, two teaspoonfuls every hour.

March 17th. Pulse soft and almost dicrotic; tongue coated yellow; stomach retains milk; considerable pain in umbilical and ileo-cæcal regions, from pressure. Six fæcal evacuations in twenty-four hours. Treatment above continued.

March 19th. Sleeping a great deal-has to be aroused to take medicine and food; red miliary eruption in epigastric and right. hypochondriac regions; two rose-color spots in epigastric region; breathing shallow, interrupted, and painful; expectoration scanty, and of glairy mucus; pain in right scapular region while coughing; pulse soft and compressible. Four fæcal evacuations, and urine voided once involuntarily. Treatment continued.

March 20th. Some improvement; lying with knees elevated in bed; eruption almost gone; not so stupid; coughing causes pain in abdomen and right scapular region. Above treatment continued.

March 21. A marked drop of the temperature, to normal in twenty-four hours. Cold-pack, compress, and sponge bath discontinued. Hot-water bags to feet.

March 23. Sulph. 3x.

Suffers no pain; constipated; urinalysis negative.

March 27. Ant. tart. 3x. March 31.

Some rattling in chest; is anæmic; improving.
Soup and crackers added to diet.

Some pain deep in extremities, like bone pains;

The peculiarities were the apparent coexistence of an enteric and pneumonic fever. This idea was abandoned on the abrupt termination of the fever. The typhoid condition was, however, marked for a few days. The negative results of percussion would indicate that the diseased portion of the lung was centrally located and separated from the thoracic wall by a stratum of non-hepatized tissue. The violent chill, high fever, rapid and labored respiration, flushed cheek, cough, and pain in right lung, with the abrupt resolution, establish the diagnosis.

CROUPOUS PNEUMONIA.

No. 108. Female; aged, 40.

History. February 10th, Alexander's operation was performed, and about four inches of each round ligament removed, to correct an obstinate retroversion. She bore the operation well, and was improving nicely until March 5th, when she felt an acute pain in left side of chest, low down, aggravated by motion or deep breathing. Slight cough, but no expectoration. Bryonia was given with marked improvement until March 17th, when she had a slight chill, faintness, and nausea. Exaggerated breathing in left infra-clavicular region, with diminished respiration, and dulness in lower left lobe. Pulse, 140; temperature, 101° F.

March 18th. Transferred to the medical side. Cheeks flushed; skin dry and hot; tongue coated dark yellow, with red stripe in centre; pupils dilated; respiration painful, rapid and interrupted; dulness over inferior lobe of right lung; crepitant râles; bronchial respiration on affected side; can lie only on right side. Pulse, 140; temperature, 102°; respiration, 40.

Milk diet. Cold compress around chest, below axillæ, until temperature falls below 102° F. Phos. 4 gtt. in half glass water— two teaspoonfuls every hour.

March 19th. Rusty sputa abundant; cough painful; crepitant râles; labored and bronchial respiration; percussion shows dulness of lower lobe of right lung, almost amounting to flatness; pectoriloquy. Pulse, 128; temperature, 101.4°; respiration, 35. Treatment continued.

March 20th. Feeling much better; rusty sputa abundant; only a few crepitant râles; marked dulness; any attempt to change position provokes a very painful cough; bronchophony, and whispering bronchophony. Substitute myro-petroleum for cold compress.

March 21st. Sputa glairy and scanty, with a few bright spots of blood; whispering bronchophony not so marked; no crepitant râles. Pulse, 98; temperature, 101.4°. Treatment continued. March 22nd. A chill last night and two to-day, followed by fever and sweat; severe pain in infra-axillary region; lies on back; bronchophony not so marked. Pulse, 100; temperature, 100.8°.

After March 22nd there was continuous improvement, and gradual disappearance of all the pneumonic symptoms. There seemed to be a very abundant deposit of plastic material in the inferior lobe of right lung, however, which disappeared very slowly. Pulse and temperature became normal March 29th, and full diet allowed.

March 31st. No pain whatever; sits up some; gaining strength rapidly; appetite good; still signs of abundant deposit on right side, which disappeared slowly. Discharged April 16, cured.

Peculiarities. A patient in hospital convalescing from a surgical operation suffers from an attack of what was considered pleurisy in left lung, and later passed through a typical pneumonia of the lower lobe of the right lung. Query. What caused the pneumonia?

DILATATION OF THE HEART.

No. 98. Female; aged, 46. Admitted January 28, 1892. History. Came into the hospital for operation. Has had interstitial fibroid of uterus and albuminuria for about two years. Has been troubled with bloating of abdomen. Climacteric not completed.

Present condition. Examination showed great increase (laterally) in the area of cardiac dulness; no definite valvular disorder; broncho-vesicular respiration, and jerking respiration of left side; nasal ducts occluded; vision blurred; anæmia and serous effu