976 well seen, for we all regard Mr. Booth as one of the very ablest and very best students at (Juy'f4, but perhaps the main fact was that all were quite sure that there was only one bacterium. Next lecture we will take up in detail the consideration of the history of contagion. ATTENTION has lately been drawn by Dr. Sidney Coupland, Dr. Wilks, and others, to a rare and interesting form of ulcerative endocarditis with pycemic symptoms. In most, if not all, of the cases there has been old

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... r mischief of the heart, upon which the fresh ulceration has been grafted, and some importance has been attached to the presence of former cardiac mischief. In the following case the symptoms came on during the course of a first attack of rheumatic fever, the heart being quite sound; and it has this further interest, that the case is absolutely complete, having been under observation from the first appearance of the rheumatic fever until the closing scene. I am indebted to Mr. C. A. 'Vigan, resident medical officer, for the carefully prepared notes of the case. M. J-, aged twenty-two, a single woman, was admitted into Charing-cross Hospital, under the care of Dr. Pollock, on Sept. 7th, 1882, suffering from a first attack of acute rheumatism. On admission she complained of pain in both knees and ankles and in the shoulder of the left arm. She also had .some pain and stiffness in the joints of the right hand. Temperature 141 2°; pulse 84 ; heart normal, with no irregularit,y nor bruit. From her previous history she appears to have had measles when an infant, but no other serious complaint. Her father died of pleurisy (double) aged fortyfour ; had always been a healthy man. Her mother is still alive and healthy. Three brothers and five sisters alive and healthy ; four died quite young. The patient states that on Sept. 3rd, the day before she felt ill, she had a hot bath and went out for a walk directly afterwards in the rain, and got wet through. The same night she felt chilly and sick, and vomited shortly after getting into bed a greenish fluid with a bitter taste. Patient got no rest during the night, owing to the feeling of sickness, which continued. The next day (Sept. 4th) she got up. She did not complain of any chilliness or fever, but felt some stiff'ness and experienced loss of power in the left shoulder. On the 5th the joints in both legs became painful and swollen, so a doctor was sent tor, who recommended her to go into a hospital, and accorrl. ingly she was admitted into Charing-cro's Hospital on Sept. 7th. Her temperature on admission was 101'2°, and the pulse 84. There was the usual souNmelllDg sweat, and the urine was high-coloured and acid, but otherwise normal. The heart was carefully examined, and found to be normal. As the bowels were confined, she was ordfred ten grains of colocynth and calomel pill for that night, and the following mixture: Salicylate of soda, fifteen grains; carbonate of ammonia, four grains ; decoction of cÌuchona, one ounce, every six hours. A chart of the temperature, taken every four hours, was started.-Sept. 3rd : No change in temperature. The urine contained no albumen, but was found to be very acid, and thirty grains of bicarbonate of potash and three grains of iodide of potash were added to the mixture. Pills repeated. The patient shortly lost all pain in the right arm, both knees, and ankles, but suffered much in her left shoulder and arm, the slightest movement causing great pain. Pulse about 90 ; heart Dormal.-28th : Patient still complains of great pain in the left arm, especially in the muscles of the upper part. The temperature at 6 P.M. was 102'8°, consequently the old mixture was discontinued, and the following ordered :-Sulphate of quinine, two grains; carbonate of ammonia, two grains; bicarbonate of potash, twenty grains; chlo. roform water, two drachms; to one ounce of water: to be taken three times a day. This seemed to have a very beneficial effect, as the temperature fell to normal, and remained so until the morning of October 2nd, when at 9 9 A, :B1.. without any apparent cause, she was seized with a severe rigor, lasting fifteen minutes, and followed by a profuse sweat. The temperature ran up from 98° to 1024°, but fell at 2 P.M. to 100'60; rising again to 14°"6° at 6 P.;M.-3rd: The temperature at 2 P,1BI. was 98°, bUG another rigor, as severe as before, occurred at 12 P.n" the temperature rising to 103°.—4th: Another rigor at 6 P.M.; temperature 104-4.—6th: Another rigor at 9 temperature 10'?'S-. The rigors were followed by a profuse sweat III a quarter of an hour. Up to this date the heart-sounds had been normal, and excepting some increase at the time of the rigors, the pulse-rate had varied from 76 to 96 per iiiiaiite. but on the morning of the 6th a very soft and indk.'ioct wbiff was heard with the first sound at the apex of the be,lIt. This gradually developed, until, on the morning of the 12th, a characteristic murmur was plainly heard at the apt:x with the first sound, and was gradually lost when traced into the axilla.-14th : Three grains of the sulphate of quinine were given in milk three times a day, and four 01IDetS of brandy per diem. -16th : The murmur is now very dis-