The patient whom I shall exhibit to you this morning is a young woman, 23 years of age, unmarried, and by occupation a cook. She is of good figure, plump and apparently well nourished. But her countenance is abnormally pallid; the naso-labial lines are deeply chiseled around the corners of her mouth, and there is about her face an expression of painful anxiety that is unnatural in one so young. She tells us that for three years she suffered with uneasy, gnawing sensations behind the tip of the ensiform cartilage, and that these were aggravated by food or drink, or by the accumulation of gas in the stomach. Sometimes she felt a similar pain between the shoulder blades, usually near or under the tip of the right scapula. Still, she was able to work, and made very little complaint until one day, six weeks ago, she experienced a feeling as