The points of interest in this case are indicated in the title of the paper. These points have seemed of sufficient importance to warrant this report because none of the standard texts mention them and apparently they have not previously been described in the literature.
Mrs. A. O. was seen November 15, 1919, at Touro Infirmary in consultation with Dr. W. P. Bradburn through whose courtesy I am permitted to make this report. The patient was a white married woman of forty-eight years. On November 3 she had eaten a cream puff which did not seem fresh. The next day she had severe pains in the epigastrium and loose bowels with straining. On November 5 nausea began. All symptoms increased until November 10 at which time she was first seen by Dr. Bradburn. At that time Dr. Bradburn described her as being in a state of collapse; the surface covered with a cold perspiration, the pulse weak and rapid.