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she went into the country; and I further elicited the fact that on her return home, after an absence of six weeks, apparently quite well, her parents had remarked that she looked somewhat sunburnt, which they attributed to her having been much in the open air. This slight dinginess of complexion still remained, but was insufficient to afford any decisive confirmation of the diagnosis. She had continued without any definite symptoms of illness until a few days before she was brought to the hospital, although her father had regarded her as “drooping” during the three or four previous weeks. On Sunday, Jan. 15th, she had been sick for the first time, but had continued to attend school until Wednesday, the 18th, on which morning the sickness recurred, and she complained of feeling cold. Her mother had then administered a strong cathartic powder, which was followed by copious purging and vomiting, and from that time intense depression had set in. The patient not wishing to come into the hospital, I attended her at home for several days, during which she slightly rallied, the sickness abated, and she was able to take and retain food. On Jan. 24th she began to cough, and expectorated a small quantity of glairy mucus, sometimes tinged with blood; the vomiting returned in its former severity, and she was admitted into Murray ward on the 26th.
On examination after her admission a slight duskiness was observable, not only on the face, hands and neck, but also on the abdomen and about the knees and axillæ; the nipples also appeared slightly dark. On examining the mouth minutely I detected a dark stain, of the size of a large pin’s head, upon the mucous membrane lining the inside of the right cheek, but no other definite patch or stain was found on any part of the body. There was slight dulness on percussion and bronchial breathing below both clavicles; but she had scarcely any cough, and no expectoration after her admission into the hospital. The asthenia, however, increased; she always vomited soon after taking food; and retching, faintness, and failure of the pulse came on whenever she moved. She scarcely slept at all, became very restless on the 27th, and died rather suddenly on the evening of Jan. 28th, retaining her consciousness to the last.
At the post-mortem examination, the aspect of the body was that of a person with a naturally dark skin, but with fair chest, feet and legs. There was a moderate amount of fat on the thorax and abdomen, and the muscles were firm and red. The apices of both lungs were puckered on the surface and consolidated by the deposition of tubercle, chiefly of the grey semi-transparent kind. There were no cavities, but the tubercle