CASE III.--Mr. P. B., aged twenty-six years. Removed to Reception Hospital, December 16, 1893, on suspicion of typhus fever. On December 17 he presented the following appearance: The face and the entire trunk and upper portions of the thighs and shoulders presented an eruption which could easily have been mistaken for scarlet fever. The eruption was dotted with dark or black papules; some vesicles were noticed on the trunk. The eruption on the thighs was shotty and umbilicated and quite characteristic of variola. The face presented the same appearance as in Cases I. and II. On the legs and forearms, where the general redness was not present, the eruption had hardly gone beyond the macular stage, but was very dark,--almost black. As in the other cases, the finger drawn across left no white mark. It was stated that epistaxis had occurred. The patient became rapidly worse, without much change in the eruption, and died on December 17. CASE IV.--Mr. L. R., lawyer, aged forty-three years. Removed from boarding-house, December 24, 1893, to Reception Hospital. Seen at home previous to removal, December 24. Patient felt badly on December 17. On December 20 was quite ill; pains in different parts of the body; nausea and vomiting. This condition continued until December 23, when an eruption appeared. Diagnosis, scarlet fever. On December 24, with the exception of the legs and forearms, the entire body and face was involved in a general eruption resembling scarlet fever. However, as in the preceding cases, it was of a darker hue than that found in scarlet fever, and pressure upon the skin made no impression so far as changing its color. Over the legs and forearm was distributed a profuse papular eruption, very dark in color. On other parts of the body were scattered some dark or almost black papules, with a few vesicles; typical umbilication was also present in some. A few small vesicles were noticed on the nose. These had the appearance of inflamed follicles, and were not as dark colored as the rest. The conjunctivæ were very much congested, and the membrane of the mouth was so much swollen that it was impossible to examine the throat. Hematemesis was present, also great prostration from the outset. The patient died on December 25. CHAPTER II. DIAGNOSIS. There are few diseases the prompt recognition of which is of greater importance to the physician than variola. On the one hand, failure to recognize the disease may subject the family of the patient and the community at large to the danger of contagion, and thus even be the starting-point of a widespread epidemic; on the other hand, to pronounce a case smallpox when it is not, entails so much needless pain and anxiety that the physician guilty of so grave an error merits the severe condemnation which will certainly be visited upon him.