Mrs. Sophie S., aged 54, came to me on Nov. 5, 1927. Other than typhoid during adolescence, her past history was irrelevant. The bowel movements were regular up to two months before I saw her, when she became constipated. For nine years, there was pain in the chest on exertion, but there never was any cough or expectoration. About six months before her visit, she began to have "nervous spells" at night with pain in the chest so that she awoke in fright. She went to the Jefferson Hospital in Philadelphia, where aspiration of the upper left part of the chest was performed, and several ounces of chocolate-colored fluid were removed. An attempt was made to relieve a resulting pneumothorax, but with little success. The nocturnal attacks continued. These spells—the patient objected to the use of the word attacks as not clearly describing the condition—occasionally came on during the day