commencing pleurisy is sometimes detected over a tender intercostal area, but soon giving place to the uniform quiet of effusion rising to a given horizontal level. Later still there may be the creaking sound of organizing false membranes in process of being stretched, and which is so often confounded with crepitation. The indications of pneumothorax (tympanitic resonance, and metallic tinkling), are rare. In advanced stages there may be tympanitic sound from the cavities of abscesses or the sacs containing sequestra. The urine is always scanty and high colored and may at times prove red and hæmorrhagic. Albuminuria is usually present when the disease is at its height. The same is true of uric acid, which replaces the hippuric acid, in cases of high fever and complete abstinence so that the products are drawn from the disintegrating tissues alone. The returning appetite, and the restoration of a neutral or alkaline condition of the urine, therefore tend to occur simultaneously, and to mark improvement. Great tenderness of the throat, protrusion of the nose, and difficulty of swallowing mark the localization of the lesions on the pharynx and larynx. It is liable to be accompanied by the introduction of exudation and food materials into the larynx and trachea with the occurrence of inhalation bronchitis and pulmonary gangrene. Symptoms of pericarditis, endocarditis and myocarditis, are especially common in the more severe types of the disease. With soft, weak or imperceptible pulse and tumultuous heart beats they may be suspected, and further indications are a transient friction sound, synchronous with the beat of the heart, intermissions, murmurs with first or second heart sound, and an increasingly low, distant, or muffled heart beat, as pericardial fluid accumulates. As in the case of troubles with the kidneys or liver, stocking of the legs, or dropsical swellings elsewhere may appear. Exceptionally, acute nervous symptoms may appear, due to functional derangements caused by circulation of the toxins and metabolic products, or even to congestion or inflammation of the brain or its membranes. This may occur at the outset of the disease indicating the election of the nerve centres for the colonization of the microbe, and advancing to a rapidly fatal issue (Friedberger and Fröhner). It may set in with hepatization (Rey), or it may coincide with pulmonary gangrene (Cadeac). There may be merely dulness, prostration, or stupor; or trembling, unsteady gait, or falling; there may be rolling of the eyes, or amaurosis, or vertigo occurring intermittently; or there may be epileptic attacks or paraplegia.