Assistant Professor of Clinical Medicine at the University of Pennsylvania. I want to take the opportunity of showing you a case admitted to Ward 1, a number of which probably you will see as the winter goes by, and yet it might happen that you would not see any. In my rounds in the wards Monday, I found this patient, and noticed the flushed appearance of his face across the ward. It was striking, because one cheek, the left, was more flushed than the right. On looking at his temperature chart, I found his temperature high, as I expected-104°; on the morning of admission it showed 1033°, at noon and at 4 P.M. 1033°, and 104° in the * Delivered at the Philadelphia Hospital, November 11, 1891. Stenographically reported for THE SOUTHERN PRACTITIONER by J. How e Adams, M.D. He was evening. He was admitted on the 9th, two days ago. perfectly well up to the night previous, when he had a chill. This chill was followed by flushes of heat. At the same time he complained of pain in the region of the heart, which was increased by deep breathing and coughing. The cough arose at the same time as the chill, and it was unproductive. The pain shifted around to the left axilla during the first day, and the cough continued. At the same time there was headache, but no general pains in the back or limbs, as often develop. To recapitulate, the chill, followed by fever, with pain in the side, seized a male adult of twenty-five while in good health, and twelve hours afterward we found him with rapid, full pulse, continuance of fever, a constant, dry, unproductive cough, a little pain in the side, accompanied with headache. The tongue was furred, there was anorexia, and the bowels were costive. The skin was hot and dry, the urine scanty and highly colored. He remained in bed, not restless, but perfectly quiet, although oppressed in breathing. The cough and oppressed breathing, of course, led to an examination of his lungs. They were gone over carefully, and, with the exception of oppression and interference with breathing, so that the inspirations were short and followed by quick expiration (as much as thirty to the minute), there were no physical signs of disease in the lungs; neither rales nor breathing that was apart from the normal respiratory manner. On the night of this day the fever, having continued very high, fell, and by 2 o'clock in the morning was as low as 100°. Now, he had administered to him that night some phenacetine and quinine, five grains of each at 8 o'clock, and the same dose repeated at 10 o'clock. There was a fall in the temperature, but no relief to the local symptoms. The cough continued; its character seemed a little changed; it was accompanied with some expectoration; the oppressed breathing remained the same. Therefore, yesterday we found fever, cough with expectoration, oppressed breathing, hot and dry skin. Yesterday, also, the respirations were rapid-32, 30, 28 to the minute. The pulse was not very rapid, only as high as 90 to 98. The urine was loaded with urates, did not contain albumin, and the chlorides, which we look for, of course, were not present as yet. On physical examination yesterday, there was present at the base of the |