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CASE III.- Reported by Mr. Williams.
His habits have been somewhat intemperate; his drink chiefly malt liquor and spirits. With the exception of a sister, who died of phthisis, all his relations are healthy. He has been married four years. The patient states that up to six months ago, he enjoyed very good health, but then began to be troubled by what he calls “rheumatic” pains in the right leg, which, without laying him up, gradually extended to his hips and side, and thence to the bottom of the spine. His back latterly has been very tender, a jerk or jarring movement giving him great pain at that part. He has noticed his lips to have become dark-coloured for the last three months, and more lately his face to be similarly discoloured in patches. For the last month he has discontinued work on account of attacks of giddiness and dimness of sight, accompanied by a peculiar pain at the back of the head and partial loss of consciousness. These attacks would occur several times in the course of the day, upon any unusual exertion, always whilst in the standing posture, and were instantly relieved by sitting or lying down. Since he has discontinued his employment, they have only occurred on getting out of bed in the morning.
It is for the pains and tenderness at the back, and occasional attacks, as above described, with general debility, that he has been attending this hospital as an out-patient.
Present condition.- The patient presents a highly strumous appearance, being thin, pale, and the hair dark and dry. Over the face and forehead, which are of a general yellowish hue, are several patches of darkened