He was much troubled with a nasty expectoration of mucus.  His breath was very offensive.  No enlarged glands could be felt in either groin—­perhaps a trifling enlargement in the right.  In middle of front border of right tibia a little irregularity is felt, and a small hollow, which he thinks is filling up; but it might be that the exudation on the bone immediately above and below the hollow is somewhat reduced, as this would equally give the suggestion that the hollow is filling up.  There is a similar but rather smaller irregularity on the left tibia also.  He felt rather weak that day, which he attributed to not having had his usual walk the day before.  The nasal cavity consists of a large grey septumless cavern showing dry crusts.  The issuing breath is most offensive.  Patient had drunk freely of water, he said, to the extent of 4 or 5 quarts a day during the fast but when I said—­do you mean that you have been taking over a gallon of water daily?—­he rather hesitated, and did not think it was so much as that.  He had not measured it and had taken it cold usually, though occasionally hot, and had taken it without stint as he wanted it.  On the forty-eighth day of the fast he complained of being weak but worst of all, he said, his breath was very offensive to himself.  It was so to me also—­faint, fetid, putrid.  His sense of smell was greatly impaired, so much so that he could not smell the offensiveness of the bowel-excreta which came away every day on using the gravitation-enema, and which were horrible to by-standers.  It would seem from this as if his distress at the bad smell of his breath was probably due to a perversion of the sense of smell, which can be easily understood if we reflect that the disease-process was going on in the region where the smell-apparatus is specially located.  The temperature was 96.2 degrees that morning the patient said.  At 2 P.M. when I saw him the pulse was 68, regular, even, steady.  He says he was feverish last night.  I suppose he felt hot.  He sleeps well, but says he hears the clogs of the mill-hands as they go to their work in the mornings.  Has lost 2 lbs. weight in last 2 days.  Temp. 93.6 degrees to my observation 2.30 P.M.  Says he feels “done at the stomach.”  His voice is poor.  Expectorates somewhat freely.  A small blob of green thickish mucus in ordinary white mucus came away in my presence.  Urine acid 1010.  No glucose.  Faint trace of albumin to heat and picric acid:  also to nitric acid.  The right lachrymal punctum is blocked; the tears run down the cheek; and I failed to get even a hair-thick wire into it.  Evening, pulse 65, temp. 97.2 degrees in bed with hot-water bottle.  Faeces most offensive, no bowel-excreta coming away except to enema.  Forty-ninth day.  In bed, temp. 97.2 degrees, pulse 65, soft, steady, regular.  No great emaciation of limbs.  Showed me some green expectoration.  He says it is from Salvarsan as it is exactly like what he was injected with!  The motion to the enema as offensive as before, but