The unusual clinical picture of the following two cases of gall-bladder disease prompts me to report them as examples of acute primary cholecystitis.
—The patient, a large heavily built Italian of intemperate habits, aged 47, was suddenly seized at 3 p. m., Dec. 21, 1911, while attending to business, with excruciatingly severe cramping pain in the upper abdomen. He was prostated with it and was soon bathed in cold perspiration. There was no chill or subsequent fever. My father attended the patient at his home shortly afterward, where this condition was noted. Morphin sulphate, one-fourth grain, and atropin sulphate, 1/150 grain, were given hypodermatically. At 9 p. m. the pain was still present in paroxysms and the morphin and atropin were repeated. At this time some delirium was noticed. At 6 a. m. the following morning the patient was still thrashing aboutthe bed in pain and more