BY A. C. W. BEECHER, M.D., Assistant to the Obstetrical Clinic at the Jefferson Medical College. MR. _, æt. 26, born in the West Indies, Spanish parentage, married. His father is still living, but his mother died when he was an infant. He was nursed from the breast of a house- servant, a negress, who was unmarried, but had several children by different individuals. As far as known, she was healthy, with the exception of sores upon her feet. He had none of the diseases of early childhood, excepting measles and mumps. He enjoyed good health until he was fifteen years of age, when spots appeared upon the trunk; these were yellowish-pink in color, and very abundant, seeming to be just beneath the skin. There was neither pain nor itching in them. They remained about one year, and disappeared during a voyage to Spain. While in Spain he had an attack of neuralgia in the little finger of the left hand, running along the course of the ulnar nerve to the elbow, This was relieved, and he returned to the West Indies. Six months after this he had another attack of the same trouble, which, however, lasted only a month. In 1862 he came to this country to complete his education. Having been here about one year, he became subject to catarrhs, which would centre about his throat and cause him annoyance. Soon after this he was conscious of itching in both arms, from elbows to hands, and in legs, from thighs to feet. In 1866 his hands and feet began to swell, and this would extend no farther than the wrists and ankles, producing the sensation of stiffness and inability to move the fingers and toes. While the hands were so swollen, blebs of various sizes appeared suddenly upon the dorsum of the hands and fingers, extending over their whole length. At times he would be aroused at night with a sharp pain in hands and fingers, and in the morning would be surprised to find a large blister, which had come on through the night. These bullæ contained a whitish fluid, and upon bursting would be followed by scabs, which were dark-brown in color and transversely cracked and fissured over the joints. The tips of the fingers became involved, having similar ulcers, the nails growing over them, and breaking off when long. The feet were similarly affected. Following this eruption, he had fre- quent hemorrhages from the nose, coming on while in hearty laughter or in mental or physical excitement. The nose now became tender, was much swollen, and discharged matter, though not very offensive; at the same time the nose began sinking to its present condition. About a year after the first outbreak upon his hands, his face was attacked in the same manner with vesicles and ulcers. These healed slowly, and left the cicatrices, which are now visible. As rapidly as some of these sores healed, others formed; and this process has gone