the most skilful use of the bronchoscope for two hours the attempt was given up, as it seemed wise not to produce too much irritation. On the 5th of November it was again attempted, and this time with success; the young lady made an uneventful recovery, the irritation of the bronchial tubes entirely subsided, and I have no one on my list who has been more free from cough or cold during the past winter. On July 24, 1915, I was hurriedly summoned to attend a patient at a neighboring hotel. I found Mrs. K. in bed, suffering excruciating pain, and with persistent vomiting and purging. The patient was a young woman, 28 years of age. She had two children, the younger child ten months old. She gave a history of having been usually well the previous day, but a rather hearty lunch, quite an elaborate dinner, apparently, according to her story, were the cause of her undoing. The nausea came soon after the pain, severe, causing her to double up, and with much tenderness; the movements were mucus and some blood. My first thought was that I had to do with a sharp, acute attack of gastro-enteritis. In the night, later on, I was hurriedly summoned because the patient was apparently worse, and when I arrived I found her with increased pain, stools composed almost wholly of blood, and a peculiar pinched look about the face. The attack of pain at this time was of a spasmodic nature, coming in paroxysms. Colocynth seemed to be clearly indicated on the first visit and was prescribed, and its failure seemed to me difficult of explanation. A more careful inquiry into the history of this attack revealed two or three things of interest. The first that her menstruation was overdue and, more important yet, that she had taken means to bring it on, and I was shown the remains of a bitter apple which she had taken the previous day. Then the explanation of the pain, vomiting, and the intestinal disturbance was made clear, and under the influence of opium, which I was obliged to use, white of egg, large quantities of tepid milk, and brandy, the condition cleared up. Strange to say that with all this suffering the purpose for which the apple had been taken was not accomplished. It would be impossible to have a more perfect picture of colocynth than this case presented. It is one of the authorized drugs, and, if you accept tradition, this is supposed to be the fruit which the servant of Elisha secured in the fields near Gilgal during the famine. After it had been gathered and boiled and the men began to eat it they cried out "Oh thou man of God, there is death in the pot," which may explain one common name for it, - Mors in Alla. It may be of interest to recount two other cases and I give them to you for that reason. ACTION OF LARGE DOSES OF COLOCYNTH "A woman, aged forty years, had a chronic rheumatic pain in the left thigh and left shoulder. A kind friend advised her to infuse half a pound of colocynth in a half pint of red wine, to drink the fluid before going to bed. By good fortune she took only half of the infusion. Scarcely had she swallowed this, when she was seized with fearful pains in the region of the stomach, great anxiety, vertigo, faintness and cramps. She vomited several times without relief; then evacuated copious stools, at first watery and fæculent, then consisting of pure blood, with distressing tenesmus; with the stools came large pieces of the inner membrane of the intestine. The pain then concentrated in the stomach and in the lower part of the rectum; the abdomen became collapsed; at last the tenesmus ceased, and the patient gradually fell asleep. Great exhaustion followed, but she finally recovered." In another case of the kind, which proved fatal, the autopsy revealed that the intestines were red, with black spots, glued together by false membrane. A white fluid had exuded into the cavity of the abdomen and in it flocculi were floating. On the coat of stomach, here and there an ulcerated spot could be seen. There was no trace of inflammation in liver, kidney or bladder. Two things are of interest, first, that it is a hydragogue cathartic and has always been avoided in pregnant women for fear of its abortifacient property. The first case tends to prove that this theory is groundless. The second lesson is that the homœopathic use of the drug in gastro-intestinal disturbances can only be explained on the ground of the law of similars. MERCURIC CHLORID POISONING On June 9th I was called to a Boston hotel to see a patient who, over the telephone, was described as being desperately ill. The patient was Miss a nurse, age 45, who had been constantly in my employ for many years, and at this time was caring for a patient with whom she had been for some weeks. When I arrived I found her in a most serious condition. She was vomiting almost continuously, the vomitus was streaked with blood, and at times was clear blood. The bowels had moved quite freely, and at this time the bowel movements were attended with a good deal of tenesmus. Careful questioning failed to reveal any reason for this sudden and violent illness; but a friend who was with her said that she had had a great mental and nervous shock, and that for some days she had been wretchedly unhappy, and on the afternoon of that day she had consulted her lawyer and made her will, and expressed a desire for death. There was nothing to be found about the room which might offer any clue to the mystery, but I felt perfectly confident that it was a case of poisoning, possibly mercurial, and this was confirmed by the finding in her room of a partially emptied bottle of corrosive sublimate tablets. The only thing possible was removal to the hospital where she could have immediate care and attention. The hospital records are as follows: Admitted June 9th. Vomiting at this time was persistent, and it would seem that whatever was in her stomach must have been entirely cleared. Stomach washing was discussed and dismissed because of violent hæmorrhages and the fear of causing perforation. White of egg was administered every fifteen minutes, and mouth. washed with chlorid of potassium. 10th. Vomited brown fluid and some clear blood; dejections black in color. Milk, Vichy and white of egg was advised, as much as possible, at short intervals. 11th. Vomiting continued, very thirsty, oatmeal tea was suggested. Severe pain in the stomach, hiccough, urine had been suppressed for twenty-four hours. 12th. Still no urine; hot saline baths, hot pack. Had a very restless night, constant desire to vomit, and raised a thick, yellowish substance almost continuously; was able to retain no, or very little, nourishment. Mouth very sore. Small amount of urine obtained by catheterization showed trace of albumin, a few red blood discs, no casts. 15th. Dejections light brown, of exceedingly bad odor and containing a good deal of blood. Menstruation began on this day. The mind up to this time had been exceedingly clear. 16th. Vomited continuously; frequent stools, at times involuntary; great tenesmus. Morphin was then advised both by suppository and by mouth. 17th. Had vomited pretty continuously since ten o'clock the previous night, blood, mostly in large clots which seemed to cause a choking sensation; a few minutes before this had a good deal of pain in the abdomen. 18th. Saline enema water came away with thick grayish material of offensive odor. Cannot swallow liquids for fear of choking. Very restless, mind wandering. 19th. Restless sleep, mind wandering, patient was unconscious for some time and, after some convulsive seizures, died. The urine which was obtained on the morning of this day showed a specific gravity of 1013; a trace of albumin; total solids, 3 per cent.; urea, 1 per cent. Many granular casts, leukocytes, renal cells, old red blood discs, many squamous cells. The following typical symptoms correspond closely to the ones I have narrated. Blythe says if the poison has been swallowed symptoms come on almost immediately, within the first half-hour. In thirty-six cases collected by Folck eleven died on the first or the second day, eleven on the fifth, and the remainder from the sixth to the twenty-sixth day. The symptoms in the order of their appearance were as follows: Painful constriction of the throat; burning heat in the throat extending down to the stomach; all mucous membranes with which saline comes in contact shrivelled and whitened, back of throat looks as if nitrate of soda had been applied; local changes may be so intense as to cause œdema of glottis and death through asphyxia; nausea; vomitus blood streaked or of clear blood; purging, frequently bloody; body temperature becomes lowered; respiration difficult; pulse small, frequent and irregular; urine scanty and sometimes completely suppressed. In regard to this symptom, Soers reports two cases which confirm the view that when anuria is present the patient always dies. Sometimes when there are profuse hæmorrhages from bowel, stomach and other mucous membranes, the patient dies in a state of collapse or insensibility, and death is often preceded by convulsions. The symptoms in cases of poisoning from external use are practically identical:- vomiting at first; on the third day, diarrhoea, tenesmus, diminution of renal secretion; on the fourth day, fœtid breath, stomatitis, hyperæsthesia, feeling of pins and needles in hands and feet; and death in about the same time as when taken by mouth. Can you wonder that we prize mercury as a remedy in disturbances of so wide and varying natures? Its use in sore throats, in disturbances of the mouth and gums, in dysentery, in nephritis and in the varied manifestations of syphilis are among the choicest specimens of precisionizing in drug application. Confirmed in our faith, confident of honorable effort to discern the truth and to practice it, we must remember that saying of Date: "It is better to have our medical pictures written on a blackboard with chalk so as to be readily modified to suit the revelations of increasing light than to have them engraven on tablets of stone never to be changed.” SYDENHAM'S CHOREA By WINFRED Overholser, A.B., M.B., M.D. Resident Physician, Evans Memorial Hospital, Boston, Mass. The object in writing the present paper is not to present the results of any original work, nor yet to make a compendious survey of all the manifold aspects of this common disease. It is, rather, to offer to the general practitioner as comprehensive a review as is possible in these few pages of the more important phases of chorea minor, especially diagnosis, prognosis and treatment, together with such historical notes and debatable points as may seem to be of profit or interest. Chorea is a generic term, derived from the Greek word meaning "dance," applied to a large number of more or less distinct pathological entities. In all these conditions there are at least two outstanding features: spontaneous movements and disturbance of coördination. It is upon the basis of the relative prominence of these symptoms, as well as the course of the disease, age of the patient, etc., that the classification is made. To those not inclined to be too meticulous in their use of words, "chorea" calls to mind invariably the clinical picture known under the various names of Sydenham's chorea, chorea minor, and St. Vitus' Dance. Sydenham's description1 of this species of |