Illustrative Case.--R. Z., a woman, aged thirty-six years, was seen July 26, 1916, in coma. There was a history of typhoid fever at nineteen years, but no other disease. She had had nine full-term pregnancies, the last one thirteen months previously. For a week before the onset of the present illness she had complained of severe headaches and dizziness. There were no heart symptoms. For the past year she has had nycturia. Physical examination revealed tubular breathing beneath the manubrium, a few rales in the chest, an enlarged heart (left side), with a systolic murmur over the aortic area. Blood pressure was 178-125-53, the pulse rate 96, leucocytes 27,250. Venesection of 500 c.c. of blood and intravenous injections of 500 c.c. of 5 per cent NaHCO_3 in normal saline were employed. Lumbar puncture withdrew 60 c.c. of clear fluid under pressure with 6 cells per cubic millimeter. The eye grounds showed distinct haziness of the disks and dilatation of the veins. Blood pressure after venesection was 164-122-42, pulse 76, but in a few days rose to 222-142-80, pulse 70. A second venesection of 400 c.c. and proctoclysis of 1000 c.c. saline solution was tried. The blood-pressure now was 198-140-58. The pH of the blood was 7.6, the alkaline reserve was 35 volume per cent (van Slyke), and the CO_2 tension of the alveolar air (Marriott) was 25 mm. The phthalein on the day following the second venesection was 45 per cent in two hours. The urine at first showed 500 c.c. in twenty-four hours, specific gravity 1016, albumin and casts. Later she passed 1300 to 1600 c.c. with specific gravity around 1010. The blood-pressure fluctuated considerably, reaching as low as 138-98-40, pulse 88. She was discharged improved September 10, 1916. She had constant headache but managed to keep up. In June, 1917, she suddenly died in an uremic coma.