Meningitis is a fatal affection which sometimes causes sudden death, but more frequently produces unconsciousness without very much warning, and the unconsciousness lasts until the death of the patient. Meningitis is seen much more frequently in children than in the adult. Ordinarily it is due to tuberculosis. Sometimes, however, there are epidemics of cerebrospinal meningitis--spotted fever, as it used to be called. In about one-half the cases this affection is fatal. Unfortunately this disease gives very little warning of its approach in many cases before unconsciousness sets in. We have had renewed epidemics of the disease in the eastern part of the United States in recent years, and the affection is likely to occur more frequently for some time to come. The first hint of the onset of the disease during an epidemic should be the signal for the administration of all the rites of the Church. Of late years we have learned that the pneumococcus, that is, the bacterium which causes pneumonia, may produce a fatal form of meningitis. The first symptom of meningitis is usually a stiffness of the muscles at the back of the neck. If this stiffness becomes very marked in a patient suffering from tuberculosis, or who has, or has recently had, pneumonia, or at a time when there is any reason to suspect that epidemic cerebrospinal meningitis exists in a neighbourhood, the {149} prognosis of the case is always very serious. Every precaution should be taken to prepare the patient for the worst. Unconsciousness may ensue at any moment and no opportunity for satisfactory administration of the consolations of religion be afterwards afforded. While Bichat put the lungs down as one of the vital tripod on which the continuance of life depends, affections of these organs very seldom lead to sudden or unexpected death. Pulmonary affections usually run a very chronic course. Acute bronchitis, however, occurring in a patient with kidney trouble, may lead to the development of oedema of the lungs, and death will usually ensue in a few hours. It may be well to note here that individuals who have what are called clubbed fingers, or as the Germans picturesquely put it, drumstick fingers, that is, fingers with bulbous ends, the finger beyond the last joint being larger than the preceding part, nearly always have some chronic affection within the thorax. This means that there is some organic affection of the heart or lungs which has lasted for many years. The existence of such condition makes them distinctly more vulnerable to any serious intercurrent disease, and this sign alone may be enough to put the attending physician on his guard as to the possibility of fatal complications in the case. JAMES J. WALSH. {150} XII UNEXPECTED DEATH IN SPECIAL DISEASES