“PERNICIOUS ANAEMIA,” APLASTIC OR TOXIC

The ilia were considerably enlarged. The right shoulder girdle was only yery slightly affected. The right humerus was markedlv affected in the head and lower part of the shaft. Ttie upper third of the right ulnaand whole of the right radius' were involved, tlie arm slhowing considerable -bowing. The small bones of the right wrist and hand were not affected in any way. The left shoulder girdle, clavicle, and coracoid were slightly involved; the head of the left humerus and the shaft scarcely at all. The olecranon process and head of the left ulna were involved, but the rest of the bone and the radius had almost entirely escaped. The small bones of the wrist and hand were normal. The head of the right femur was involved to a certain extent, as was the shaft, and the ischium was slightly affected. The lower endof the riglht feniur was markedly affected, as were the tibia and fibula, the lea sh6wing decided bowing. The left pubis ischium and femur were very markedly affected, and there was a decided superimposed arthritis in the left hip-joint. The tibia was very markedly affected and the fibula to a less degree, the knee-joint showing a mild arthritis. Small bones of the an.kle and foot were inot affected, nor were the lower portions of the tibia. The articular surfaces were, on the whole, free, except for the left hip and left knee. These were painiful on extreme movement in any direction, but more particularly in abduction and external rotaticln of the hip. Examination of the heart and lungs was negative. No abnormalities were found in the abdomen, with the exception of slight piles botlh external afid internal. This did not trouble him to any great exteut except for slight bleeding about once in six weeks. The teeth, though many had had fillings, were healthy and the gums showed no pyorrhoea. Mr. Mumford kindly examined tle nose andl throat, and reported as follows: A chronic post-nasal catarrh with chronic pharyngitis. Pus was exuding from the antrum in considerable quanitities. He did not advise operation, as in the porous conidition of the skull bones infection might be spread farther. The tonsils were comparatively healthy. Blood examin'ation slhowed no abnormalities, and the urine examination was negative. The Wassermaun reaction in the blood was negative. The diet had been so varied, owing to his residence in India, Canada, and England, that no conclusions could be drawn. Tlreatnient.-He was given ionization to the left hip, as this bad given him relief before, and he was instructed in the use of nasal antiseptics. After four weeks the pain in the hip was somewhat relieved, but otherwise be remained in statu qu(o.