dence of such an occurrence was adduced by the late Dr. Burton, in an interesting essay on the absorption of lead; and the question may fairly be entertained whether changes in the quantity or quality of the blood, characteristic of particular diseases, may not be occasionally manifested by visible changes in this part of the mucous membrane. Considerable attention to this inquiry has impressed me with a conviction of the frequent existence, in consumptive subjects, of a mark at the reflected edge of the gums, usually deeper in colour, than the adjoining surface, and producing a festooned appearance, by the accuracy with which it corresponds with the curve of the gingival border; this mark is in some patients a mere streak; in others, a margin, sometimes more than a line in breadth. In the most decided cases, this margin is of a vermillion tint, inclining to lake. The drawing† taken for me by Mr. Tuson from a patient of marked phthisical diathesis gives a correct representation of one of the most characteristic appearances. It is worthy of remark that the teeth in this instance are free from tartar, and that a coloured line also strongly marks the place where the mucous membrane of the lower lip is reflected on the gums. As a general rule, the line is most distinct around the incisor teeth, but it is frequently apparent also round the molars. I am not without a suspicion that the form of the mouth influences the direction in which the margin is most obvious, patients with a long upper lip applied closely over the jaw often presenting around the incisors either no line, or one only slightly * Medico-Chirurg. Trans., Vol. xxiii., p. 63. L marked, whilst around the canine teeth the margin is well delineated. In toothless individuals, when the gums smoothly cover the sockets, no mark is observable, but when imperfect stumps remaining prevent the smooth adjustment of the surface, the streak is found. With a view to put you fairly in possession of materials for forming a judgment respecting the significancy and importance of this particular symptom, I have requested my clinical assistant, Dr. Bateman (to whom, as well as to Mr. Hunt and to Mr. Edwards, our resident medical officer, I am indebted for much assistance in this inquiry), to draw up a table of the appearance of the gums in the forty-seven cases under his immediate supervision, and it is here offered for your consideration. In the first division, containing the particulars of twenty-six men, you observe that only six are free from the margin, and that the twenty who present the margin have also distinct symptoms of consumption. In five of those without the line, there is also freedom from other consumptive symptoms; the diseases in these patients being respectively emphysema of the lungs, hydatid cyst, diseased liver, pleurisy, and diseased heart. Only one of the phthisical males, a boy, aged twelve, has unstreaked gums; and although the margin is occasionally observable in children, it appears to me, as far as I have yet noticed, to be more frequently absent in them than in adults, It is fair to mention, that in about six of the male patients, chiefly those with the disease in the first stage, the streak is so slightly marked as to render its presence almost a matter of question. I may add that in the comfortable classes of society, under favourable circumstances of regimen, the mark is less constant than in my hospital patients; but with every deduction on the ground of these considerations, I am satisfied of its existence in a very large proportion of cases. The exceptions amongst the female patients are far more frequent, as is apparent from the table on the preceding page. You will see that of twenty-one phthisical women there are no less than eight without the margin, and it is remarkable that in each of these cases there is cavernous cough or other undoubted evidence of the existence of vomica. In two of them, namely, J. B. and M. A. M., there is cracked metal sound on percussion. On the other hand, among those exhibiting the streak, in six the disease is in the first stage, not having proceeded to softening. It is also worthy of note that, in seven of the men in whom the mark is observable, the disease has not advanced beyond the first stage. The gingival margin usually encompasses alike the upper and lower incisors. In the most marked cases the margin is not confined to the incisors and canines, but surrounds likewise the grinding teeth, although it commonly appears narrower and fainter in proceeding backwards. Amongst the patients in whom the margin is broadest and most vivid, I may instance J. L. When he whispers you may hear pectoriloquy under the left clavicle, and his cough, near the scapula on the right side, has a peculiarly cavernous and metallic character. This patient has been subject to dysentery. Examine M. M.; you perceive gurgling cough at the apex of one lung, and bruit de pot fêlé. Her pec toral symptoms have been associated with diarrhoea. There is a red, patchy appearance of the mucous membrane of the mouth. A similar condition formerly existed also in C. V., likewise affected with vomica; but under the use of refrigerant medicines, such as the citrate of potash, with hydrocyanic acid, the membrane is assuming a more healthy appearance, although the gingival margin continues distinct. In the next patient, Todman, you find the margin, and you know, from the presence of humid crepitation (clicking) at the apex of the left lung, that there is tubercular softening in that situation. You may object, that whatever may be the scientific interest of such an appearance, yet that it would be of little value as a means of diagnosis if confined to cases of advanced disease. Let me, then, bring before you instances in support of my assertion that it often appears among the earliest signs. A. H. was admitted into the hospital on account of winter cough. She has never had hæmoptysis, and although troubled with night perspirations, these are perhaps attributable to debility occasioned by menorrhagia. A hasty examination of her chest does not suggest a suspicion of phthisis, but her gums have the marks we are describing, and on a more careful investigation of the stethoscopic indications, prolonged expiratory murmur may be detected at the apex of the chest confirming the accuracy of the surmise which the gingival margin might lead us to entertain. The next patient, M. W., I formerly introduced to you as affording an example of wavy inspiration. She presents no special signs of phthisis, but both her upper |