n and oppression of
the chest, particularly during deep respiration after exercise.
Palpitation is more severe. There may now be night-sweats, tire patient
waking in the morning to find himself drenched in perspiration,
exhausted, and haggard. Bleeding from the lungs occurs, and creates
alarm and astonishment, often coming on suddenly without warning. The
hemorrhage usually ceases spontaneously, or on the administration of
proper remedies, and in a few days the patient feels better than he has
felt for some time previously. The cough is less severe, and the
breathing less difficult. Indeed, a complete remission sometimes occurs,
and both patient and friends deceive themselves with the belief that the
afflicted one is getting well.

After an indefinite length of time, the symptoms return with greater
severity. These remissions and aggravations may be repeated several
times, each successive remission being less perfect, each recurrence
more severe, carrying the patient further down the road toward the "dark
valley." Now the cough increases, the paroxysms become more severe, the
expectoration more copious and purulent, as the tubercular deposits
soften and break down. The voice is hollow and reverberating, the chest
is flattened, and loses its mobility; the collar-bones are prominent,
with marked depression above and below. Auscultation reveals a bubbling,
gurgling sound, as the air passes through the matter in the bronchi,
with the click, to the air cells beyond. Percussion gives a dull sound
or if there are large cavities, it is hollow, and auscultation elicits
the amphoric sound, as of blowing into a bottle. Hectic fever is now
fully established; the eye is unusually bright and pearly, with dilated
pupils, which gives a peculiar expression; the paroxysms of coughing
exhaust the patient, and he gasps and pants for breath. The tongue now
becomes furred, the patient thirsty, the bowels constipated, and all the
functions are irregularly performed. Another remission may now occur,
and the patient be able to resume light employment, for an indefinite
length of time, which we have known to extend over three or four years,
when the symptoms again return.

If the patient is a female, and deranged or suppressed menstruation has
not marked the accession of pulmonary symptoms, the flow now becomes
profuse and clotted, or is scanty and colorless, sometimes ceasing
altogether. In the male, the sexual powers diminish, and copulation