On examination the spleen was decidedly large; the lower border of the stomach reached to the level of the umbilicus.  Two cardiac murmurs were present, the one a sharp and well-defined mitral regurgitant sound, confirmed by the dyspnoea and dropsy as organic, the other a loud musical murmur of haemic origin.  The trouble in deglutition proved to be due to an oesophageal narrowing.  The blood examination bore out the suggestion of probable pernicious anaemia, the red cells being only 1,500,000, haemoglobin 18 per cent.:  the microscope showed microcytes, megaloblasts, nucleated red cells, and a large increase in white corpuscles.  In order to study the effect of massage alone upon the blood no other treatment was used, though of course the patient was kept at “absolute rest.”  No drugs were given, electricity was not used, and extra food was omitted, as the irritability of the oesophagus made her unwilling to attempt the exertion and annoyance of frequent feeding.  The general chilliness was at once helped by massage, and in a few days only felt in the small hours of the night, and the patient gained weight from the first.  After one week of treatment a blood count was made:  red cells were 3,800,000, more than double the former figure; haemoglobin, 35 per cent., almost double its original value.  On the same day, one hour after the completion of an hour’s massage, the corpuscular count had attained 5,400,000, the haemoglobin remaining 35 per cent.

At the end of two weeks the haemic murmur had faded into a faint soft bruit, though the mitral murmur was unchanged, the skin had improved in color, the aches and weariness were gone, and the blood count had reached nearly five million cells, with 50 per cent. of haemoglobin.  The extraordinary results of the blood examination were confirmed by observations made by Professor Frederick P. Henry, Dr. Judson Daland, and Dr. J.K.  Mitchell, who all practically agreed.  Professor Henry made several studies and stained a number of slides, verifying in his report the statements of the presence of megaloblasts and nucleated red cells made above.

Owing to the necessity for an operation on the hemorrhoids, which caused loss of blood, the patient was somewhat retarded in her progress to recovery, but by the tenth week was so far better that the blood showed no microscopic abnormalities, the count was full normal, and the haemoglobin over 70 per cent.  Her color and strength were good, the heart was perfectly strong, the anaemic murmur was gone, and the oesophagus was so much less irritable that it was possible to begin dilatation of the stricture.

I have heard within a year that though occasionally annoyed by this last trouble if she becomes much fatigued, she has remained in other ways well.

Mrs. G., the daughter of nervous parents, was always a nervous, over-sensitive, serious child, worked hard at Vassar, broke down, recovered, returned to college, was attacked with measles, which proved severe, and by the time she graduated had been made by her own tendencies and the anxious attention of her family into a devoted member of the class which I may permit myself to describe as health-maniacs.