plaining chiefly of violent and persistent headache, languor, anorexia, and constipation. An examination of the blood by the Widal method, and of the urine (diazo-reaction), yielded positive results. No rose spots could be seen upon the abdomen. The tongue was coated, and there was some abdominal tenderness in the right iliac region.

Calomel, quinine, and coal-tar preparations failed to relieve the symptoms or influence the rising temperature. On the third day the patient was placed upon acetozone, 30 grains of which were administered each twenty-four hours; the effect was, the headache disappeared, the tongue cleared, and three days later she felt very comfortable. In addition to the acetozone, one teaspoonful of Epsom salt was given every other day. The nourishment consisted of beef tea, and later milk and junket. During the first four days there was some diminution in the quantity of urine, but this symptom soon disappeared.

Case 2.-Mrs. F, twenty-five years of age, the mother of

CASE 2.

one child, for one week previous to November 5, 1902, had a steadily rising temperature that failed to respond to quinine and coal-tar antipyretics. No rose spots could be observed; there was no abdominal tenderness, but a slight tendency to diarrhea was noted, with intense and persistent headache. The tongue was coated and showed no disposition to clean off after calomel medication. The diazo-reaction and the blood tests for malaria and typhoid were negative, though in a second examination of the blood, November 5, the Widal reaction was obtained.

The administration of 30 grains of acetozone, each twentyfour hours, was met with a prompt response. The temperature and pulse-rate subsided on the fourth day of treatment. Two alcohol sponge-baths were given, and ice-bags were applied to the wrists and head for three days. Within twenty-four hours the headache disappeared; the tongue cleared off in forty-eight hours, and the patient became comfortable. The only additional medication consisted of the use of a teaspoonful of magnesium sulphate every other day. The diet consisted of liquid beef peptonoids, beef tea, and junket.

Case 3.-Mrs. H, twenty-three years of age, the mother of one child, gave the following history: Though previously in good health she has been ill for a month, during which time she had been confined to bed and treated for malaria. She improved

sufficiently to be able to go about. She then removed to the northeastern section of the city, and a week later began to have chills that occurred irregularly, severe headaches, and pains in the lower extremities. She thought these symptoms denoted a recrudescence of the malaria.

An examination revealed a temperature of 102°, and a pulserate of 100. The patient was seen to be anemic; her bowels were constipated; no rose spots were observed, but there was some tenderness on pressure in the right iliac region. A blood examination for malaria gave a negative result. Magnesium sulphate was prescribed, with salipyrin, five grains, every two hours.

When seen two days later the patient was feeling much worse: her temperature had risen to 104°, the pulse-rate to 110 beats a minute, the headache was severe, and she was much nauseated. The blood test for typhoid (Widal) yielded a positive result. At this juncture acetozone treatment was begun, 30 grains being given each twenty-four hours, and the remedy being retained despite the persistent nausea. At once the temperature and pulserate began to decline, the headache disappeared, the tongue, which had been badly coated, became clean, and after forty-eight hours the patient stated that she felt well and was quite comfortable.

The additional treatment consisted of one or two alcohol sponge-baths, the application of ice to both wrists, and the administration of one teaspoonful of magnesium sulphate every other day. The diet was restricted to milk, junket, and tonic beef. The temperature remained normal after the thirteenth day, and the patient made an uninterrupted recovery.

Case 4.-I append the history of another case, of which I have no temperature record, but which presents some interesting features. A little girl of four years, frail and delicate, had infantile spinal paralysis when a year old, with resulting deformity of one foot. The child, who had frequent attacks of indigestion, had been ill for two weeks and under the care of a physician, who had made a diagnosis of malaria, and had prescribed calomel and quinine. During that period there had been a persistent though irregular elevation of temperature, which apparently subsided, but recurred three days later. At this point I saw the child. The axillary temperature registered 102°; the pulse-rate was 130; the abdomen was tense, tender, and tympanitic, and there was marked gurgling in the right iliac region. The bowels were constipated, and the quantity of urine was notably diminished. A blood examination yielded a positive reaction of typhoid fever. An enema of glycerin and water was administered, and acetozone, eight grains in twenty-four hours, was prescribed, with a restricted diet of milk and beef tea. Under this treatment the temperature promptly subsided, the abdominal tension and tenderness disappeared, the output of urine increased to the normal average, and on the fifth day of treatment the child appeared well.