THE patient-a well-nourished, healthy female, aged 23, of a slightly neurotic temperament-had always enjoyed good health, and, apart from the ordinary infantile diseases, had never occasion to consult a medical man. For some time she had been somewhat fastidious in her diet, often preferring sweets to meat and vegetables, but had not abstained from animal and vegetable food to any extent. There was no previous or family history of rheumatism. On May 21st, when I first saw her, she was suffering

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... from a general erythematous rash, resembling that of scarlet fever. The temperature was 99°. There was no vomiting and no sore throat. The rash entirely disappeared in two days. She then complained of pains in both knee-joints and muscular pains in the legs. The joints were not swollen, but very tender on palpation. She could not stand owing to the pains. The pulse and temperature were normal, and no relief was obtained from the administration of sodium salicylate. On May 25th she had a severe attack of vomiting, the vomit being distinctly "coffee-ground." This was soon followed by melaena, the evacuations being frequent, liquid, of a darkish red colour, and practically nothing but blood. Pain and tenderness were complained of in the epigastric region and slightly over the abdomen generally. Menstruation occurred on the same day, which was stated to be about the periodical time for its appearance. The discharge was net excessive. Following the vomiting the patient was exceedingly prostrated, the pulse was weak and thready, and varied from Io to Isoper minute. The temperature was slightly raised,but never exceeded IXoo F. Nourishment was administered by means of enemata, in each of which was given half-drachm doses of liquor calcii chloridi. The following day, May 26th, a thick petechial rash appeared on the legs and-to a slighter degree-on the forearms. On the dorsal surface of both feet, the buttocks, and both elbows larger exti avasations occurred, forming blebs, varying in size from a small pea to a threepenny piece. The gums were not swollen, anS did not bleed, but purpuric patches appeared on the mucous surface of the lower lip and on the gums. The pain in the knee-joints still continued, both elbow-joints-and particularly the right shoulder-jointbecame affected, and she was unable to raise the right arm from the bed. Flexion of the forearm could only be effected with difficulty and great pain. Pressure of the bedclothes on the legs was also complained of. The hlematemesis and melaena stopped soon after the appearance of the purpuric rash, and no fresh eruption occurred subsequently. There was no haematuria, and no albumen was present in the urine. There were no retinal haemorrhages. After the first twenty-four hours the enemata were usually well retained; the purpuric patches, undergoing the usual changes, gradually died away, except on the buttocks and elbows, where, owing to the constant pressure on these parts, the blebs broke, leaving small sores, which soon healed under boracic ointment, the pressure being relieved by pads of cotton wool. Sloughing followed the eruption on the lower lip Jeaving a clean, raw surface. The pains in the joints gradually disappeared. Nourishment by mouth was carefully made to take the place of the rectal feeding, and the patient eventually made a good recovery without a relapse.