Bristol Infirmary, under the care of Dr. Shingleton Smith, on October 6th, 1881, complaining of difficulty in swallowing food, great weakness, shortness of breath on exertion, and swelling of the ankles and legs. His history was fairly good. There was no predisposition to hereditary complaints, and no evidence of syphilis. He had been a butler and accustomed to partake freely of stimulants, but seldom to great excess. He had had two or three mild attacks of gout, and three years previously he had dropsy of the lower extremities. Seven years ago he had occasional attacks of violent pain in the pit of the stomach, followed by profuse vomiting. With these exceptions he had enjoyed very good health. He first noticed that he could not easily swallow solids two months before admission. For a few weeks prior to admission he had lived entirely on liquid food, being unable to swallow the smallest bits of solid material. He had got very thin and weak, and his ankles had become much swollen.