July 12th. He had daily chills until on the 16th, and 17th he missed, but on the 18th there was a slight rise of the temperature above the normal.

Parasites were demonstrated in the blood in considerable numbers each day. On the 19th he had another distinct chill, and there was noted an increase in the number of parasites present in the blood. He was now put on ten grains of quinine sulphate four times a day for two days, and then he was given three grains three times daily until he left the hospital, July 27th. The blood was examined on this date, but no parasites could be found.

CASE 3 was of the estivo-autumnal type. This case, on August 4th, through mistake, was put on two teaspoonful doses of elixir of iron, quinine, and strychnia three times a day. His temperature came to normal on the following day. The parasites were seen to be quite abundant in the peripheral blood, so on the 7th he was placed upon methylene blue, twenty grains per day in four doses. The parasites were observed to rapidly disappear.

CASE 4. This case was admitted August 17th, and was put on twenty grains of methylene blue per day in four doses, and continued until the 28th. A blood examination made on the 30th showed no parasites present, but on account of the development of a bubo he was transferred to the surgical ward, where it was opened and drained. On September 3rd patient had a chill. He was put on tr. ferric chloride and Fowler's solution and methylene blue. The parasites had entirely disappeared by the 11th of September. He was given elixir of iron, quinine, and strychnia as a tonic, and dismissed.

CASE 5 was one having present two groups of tertian parasites in the blood. He was admitted on the 21st of August, just after having had a chill, the temperature being 103 degrees F., and with the sweating stage following soon afterward. His blood was examined on the 22nd and a few parasites were found. Several blood examinations were afterwards made, but no parasites could be again demonstrated. Notwithstanding no parasites were again found, he was put on methylene blue, which was continued until the 29th. The temperature never rose above normal after midnight of the 21st. We feel that this was a case of spontaneous cure, as the

patient had a normal temperature and no parasites present before the methylene blue was given.

CASE 6 was one of estivo-autumnal fever, the blood containing many crescents and ovoid forms. After four days' treatment no parasites could be demonstrated. This case had no fever when admitted to the hospital, nor did the temperature rise above the normal during his stay in the ward.

CASE 7 was one of malaria and amoebic dysentery. The parasites disappeared from the blood after two days' administration of the methylene blue. He had been admitted September 13th for dysentery. Chaparro armagosa was given for the dysentery, with complete relief. On the 16th, he had a distinct chill, but the parasites had been found on the 14th, and the treatment for malarial fever was begun. Although the parasites had disappeared from the peripheral blood, the temperature remained up. He insisted upon going out, so he was discharged on the 25th. He may have been suffering from an abscess of the liver, thus giving rise to the abnormal temperature. No symptoms other than the constant temperature and the fact that amoebae had been found in the stool pointed to this condition.

CASES 8 and 9 were cured in three days and six days, respectively. CASE 10 was one of unusual interest, as we failed completely to clear the blood of parasites after giving methylene blue, twenty grains per day, from October 8th to October 21st. He had, however, been free of fever four days of this time, from the 12th to the 16th, inclusive. During these days of intermission it was noticed that the parasites were increasing in number. On the 17th he had a regular malarial rigor. The temperature gradually came down until on the 21st it reached the normal, but again on the 22nd the parasites had increased in numbers sufficiently to cause another chill. He was now put on five grains of quinine sulphate every four hours, and was discharged on the 28th, cured.

Summary. We may say that we cured sixty per cent. of the cases with methylene blue. One case, we think, was a spontaneous cure and in three others the blue failed entirely. Taking this sixty per cent. of cures they required on an average six and one-half days treatment to effect a cure.

The cases treated with quinine were cured in an average of 5.8 days and there were a hundred per cent. of cures. In addition to this we cured the cases upon which we had failed with methylene blue.

With methylene blue there was more or less burning or pain on micturition, and in Cases 3, 7, and 10 there was nausea and vomiting. There was headache which seemed to stop when the blue was discontinued in Cases 1, 2, 3, 5, and 8. Case 9 we may say is the only one treated on methylene blue without any complications.

We were compelled in some of our cases to stop the methylene blue for a few days so as to relieve the burning on micturition. We often observed that the leucocytes contained granules of methylene blue. In no case were we able to find a parasite stained. We noticed frequently after the first two or three doses of the blue that the parasites were less active and that the leucocytes were much more phagocytic in their action. We many times saw them actively engaged picking up the parasites. These effects upon the parasites and the leucocytes have been also noted many times in patients taking quinine.

Conclusions. Our conclusions do not differ materially from those of Thayer and others who have tried methylene blue.

1. Methylene blue will destroy malarial parasites in many cases, but is less certain than quinine.

2. Methylene blue is probably most valuable in chronic cases, but has no advantage over quinine.

3. The effects of methylene blue are ordinarily more unpleasant than quinine.

4. It is useful in cases that can't take quinine on account of some idiosyncrasy to it. Its use in cases of pregnancy is undetermined.

5. It is probably valuable in treating hematuric and hemaglobinuric fevers on account of its diuretic action; this has to be determined as yet. We have had no chance to test its use in such cases. 6. We believe that quinine is quicker and much more certain and would rely upon it rather than upon methlyene blue.

See Charts 1 and 2 for further comparison of results of treatment.