It appears from the above table that 96 deaths out of 202 (i.e., 47 per cent.) occurred within six hours of admission and 151 deaths (i.e., 75 per cent.) within 24 hours. For all practical purposes the former were moribund patients whose life could only be prolonged for a few hours and the treatment had no fair chance among them. It could not, in fact, be carried out in most of these cases ; they have had, however, to be included with the rest, as their exclusion would have unduly favoured the

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... esults. The virulence of the disease and the condition of the patients treated are thus well brought out by the above figures. Considering the comparatively low mortality-rate of 51 per cent. from the treatment above described it is to be hoped that it will have a more extended trial. Bombay. SENIOR PHYSICIAN TO THE WESTMINSTER HOSPITAL. ON Feb. 21st I was called to Croydon by Mr. A. J. Owen to see a patient in consultation with him. Mr. Owen gave the following history of the case. " On Dec. 20th, 1906, I was called to --, whom I found suffering from headache, backache, nasal and bronchial catarrh (slight) ; he had a temperature of 102°, and vomited twice. I treated the case as one of influenza. In five days the above symptoms cleared up, leaving him very weak, and after a week he returned to work. On Feb. 19th I was sent for again and found the patient suffering from severe dyspnoea. He told me that a fortnight after returning to work his breathing had become difficult and he had been treated by a doctor for bronchitis and asthma for six weeks. As he had been getting worse all the time he sent for me. He had lost a great deal of weight since I saw him at Chriatmas. His condition was so serious that I came to the conclusion that his dyspnaea was not due to asthma, but probably due to a growth pressing on the bronchi." When I saw the patient on the afternoon of Feb. 21st he was suffering from urgent dyspnoea and was propped up in bed. He was somewhat cyanosed and was sweating freely. His pulse was about 140 and very feeble. On making a laryngoscopic examination I found the vocal cords slightly congested but moving freely. There were no respiratory excursions of the larynx. The chest was resonant all over; there was hardly any sign of air entering the lungs, but a few rhonchi were audible'. The heart sounds were normal. The patient had had no sleep for the past 48 hours and was much exhausted. The physical signs on examining the chest clearly showed that there was some obstacle to the entry of air into the lungs. This, of course, might be due to obstruction at the glottis, to pressure on the trachea or main bronchi, or to spasm of the smaller bronchi as in asthma. The first of these conditions was negatived by the result of the laryngoscopic examination and by the absence of respiratory excursions of the larynx ; the last condition was excluded by the almost entire absence of any kind of respiratory murmur and by the long persistence of the symptoms. In asthma there is always from time to time some amelioration of the dyspnoea and return of breath sounds over some part of the lungs. By a process of exclusion one came to the conclusion that the cause of the, patient's distress was due to direct pressure on the trachea or main bronchi. As both lungs were equally affected the probability was in favour of tracheal stenosis. The problem then arose as to what had brought about this stenosis. The diagnosis rested mainly between pressure of an aneurysm or of a, new growth. In the absence of any physical signs suggestive of an aneurysm, and bearing in mind that new growths are much more liable to bring about stenosis of the trachea, the diagnosis of pressure on the trachea by a new growth was arrived at. As the patient was in a state of awful distress a subcutaneous injection of a quarter of a grain of morphine with I' 1--ith grain of atropine was at once administered with almost immediate relief to the worst symptoms, and he was ordered to take a combination of iodide of potassium and chloride of ammonium every four hours. The patient passed a fairly comfortable night and when seen on the next morning by Mr. Owen he appeared better. He died suddenly at noon. At the necropsy made the day after death a mass of enlarged glands was found compressing the trachea just at its bifurcation. Dr. J. M. Bernstein, assistant pathologist at the Westminster Hospital, has kindly made a microscopical examination of the glands and reports that they are lympho-sarcomatous. One very interesting feature of the case is the rapidity with which the compression of the trachea developed. In the beginning of January the patient, though weak from his recent attack of influenza, was otherwise well, and yet on Feb. 19th he was found to be suffering from severe dyepnosa. CASE 2.-The patient was a European male, aged 33 years. Two years previously he had sharp shooting pains in the left arm, after which he lost sensation and power in the fourth and fifth fingers. Three years ago brown raised spots appeared on the forehead and eyebrows, the left upper eyelid, the wrists, and the front of the thighs. These gradually disappeared, but others formed again and his face commenced to swell. When first seen the whole face was-enormously swollen, red, rough, dry, and thrown into thick folds. The leprotic infiltration was intense and general, giving the face a very peculiar appearance. There was just a quarter of an inch of healthy skin along the upper margin of the forehead. The nose was twice its normal size. (I knew the man before he got sick.) The ears were very large and swollen, especially the lobules. Leprotic infiltration extended down the sides of the neck. The outer half of the eyebrows had gone. Nearly all the beard was gone and what remained consisted of a few dry, pale, straight bristles. There was no sensation in the fourth and fifth fingers of the left hand. Sensation in the feet, round the ankles, and some distance up the legs was uncertain and feeble. The feet, legs, thighs, and buttocks presented a very peculiar appearance owing to diffuse nodular infiltration. I can only describe them as swollen, uneven, reddish in colour, some places being mottled with white. In some places it was distinctly nodular, very much like the face. The skin was dry and scaly. The feet and toes were enormously swollen. Very little remained of the nails of the first and second toes of both feet while the others were broken up and brittle. The hands, forearms, and upper arms, especially the outer sides, presented exactly the same appearance as the feet, legs, and buttocks (extensive nodular infiltration with streaks of healthy skin in between). The hands, like the feet, were very much swollen, the skin being smooth, dry, glazed, and blue. The trunk, especially the abdomen, was covered with innumerable spots of various sizes. There was a bluish-black discolouration of the skin of the front of the abdomen, with a number of pearly-white, raised, hard, flat spots which caused an appearance very much like a decomposing corpse. The ulnar nerves were very thick but not nodular. The liver was enormously swollen, measuring seven inches in the nipple line. The patient complained of an uncomfortable and painful sensation when the liver was percussed and palpated. There was very little muscular power anywhere, so that he was as helpless as a baby and extremely