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increased consistency and diminished sensitiveness of one or both testicles, to indurative atrophy of the base of the tongue, leukoplakia and the like, and scarring and deflection of the epiglottis, to scars of the pharyngeal vault, to perforation of the nasal sep¬ tum, to the presumptively syphilitic nature of aortic régurgitation, to the ophthalmoscopic signs of chorioretinitis pigmentosa, and similar discoverable signs of syphilis, any one or any combination of which, as the case may be, is less apt to lead one astray than the results of a Wassermann reaction. These and like signs were sought by the clinicians of the generation that passed with Delafield and the elder Janeway ; but the generation that holds the responsibility of the future is being inculcated with an almost reverential, respect for artificial methods that neither clinician nor pathologist can explain or control. CONCLUSIONS

This paper is based on an experience with about 250 cases of angina pectoris, seen for the most part in office and consultation practice. The records of 200 were complete and accurate enough to be the basis for a statistical study which has been made by Dr. Nuzum. The histories of a few cases under the care of other members of the medical staff of the Presbyterian Hospital, Chicago, and the necropsy records of twelve cases, furnished by Dr. E. R. LeCount, have been laid under contribution and incorporated in the statistical study. No cases of so-called false, mock or pseudo-angina are included. Only such as were believed at the time to be dependent on an organic cardiac or aortic lesion have been considered. SPECIAL CLINICAL FEATURESWithout discussing the familiar clinical features of angina, it may not be amiss to refer to a few facts that have seemed worthy of mention because of their unusual character or because they have been forcibly impressed on us.By all odds the most frequent exciting cause has been walking-walking rapidly, up hill or against a head wind. But we have been impressed by the numbor of patients who voluntarily add as a corollary that the attacks are prone to appear when the patients walked soon after a heavy meal. This has often on analysis seemed the explanation for the occurrence of the seizures in the early evening, that is, after the heavy dinner. The patient's attention is also attracted to the stomach by the belching that often accompanies the attack or immediately precedes its termination.A fit of anger is one of our classical textbook causes.In our experience it has been rare. After waiting more than twenty-five years for such a history, we obtained it for the first time-a typical John Hunter case-a iew months ago.We have known one patient who by choice would lie prone during every attack. One got on her hands and knees. All the others have assumed the sitting or standing posture. Nearly all have remained quiet, immobile. Some have merely slowed up in their rate uf walking. One man insisted that he continued walk¬ ing, "walked it off." This fact, coupled with his insis¬ tence that the constriction in the chest was not a pain, just a viselike tightness, made us hesitate somewhat as to diagnosis. But it was evidently angina, for he died a few months later, in such a seizure, before his physician reached the house in response to an emer¬ gency call. The sense of constriction without pain occurring after the ordinary exciting causes of angina is always highly suggestive.We have been interested in four patients with high grade anemia who described perfectly typical anginal attacks on walking-constriction, pain, radiation, erect posture, immobility. One man in the terminal stages of pernicious anemia died in an anginal seizure. Another with a marked anemia of secondary type with neoplasm in the abdomen improved under digitalis so far as the cardiac manifestations were concerned.A third died of his metastatic carcinomas appearing after the amputation of the penis for the primary tumor. A ...

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