According to the clinical notes furnished me by Dr. N. Doval of San Juan, Porto, Rico, the attending physician, A. B., a mulatto girl, aged 4½ years, native and resident of San Juan, who had never had any serious illness, and whose family history was unimportant, after a slight rhinitis lasting several days, without fever or any particular discomfort, complained of headache and severe pain in the right shoulder. This was about 6 p. m. Later she was noticed to have high fever. When first seen by Dr. Doval, at 8 o'clock, the temperature was 39.8 C. (103.6 F.); pulse, 130, and respiration, 28. She had vomited several times. About midnight, convulsions began and continued several hours; there were clonic spasms of short duration. The temperature was 40.2 C. (104.4 F.), the pulse weak and uncountable. The patient vomited a dark colored fluid. I first saw the patient at 8