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at the site of injection. Phase V shows the terminal penicillin levels of 0.04 to 0.08 unit per cubic centimeter after penicillin therapy was discontinued. Autopsy on this patient showed ruptured chorda tendinae and healing vegetations on the mitral valve. Bacteria were not seen in the stained microscopic section. The patient tolerated exceedingly well for two months the injection twice daily of over 30 cc. (10,000,000 units) of penicillin. r REACTIONS In this series of patients the undesirable side reactions of penicillin therapy were few. A rash occurred in a patient with terminal carcinoma, who died a few days later. A rash also developed in a patient with Vincent's infection of the mouth, who had previously taken penicillin orally. Few patients complained of discomfort at the site of injection, and there was no instance of induration or abscess formation. Members of the house staff experienced little difficulty in the administration of penicillin. SUMMARY 1. Aqueous procaine penicillin in amounts of 200,000 to 300,000 units injected twice daily gave a minimum sustained blood level in the range of 0.16 to 1.28 units per cubic centimeter, which was adequate therapy for many of the usual bacterial infections.2. Adequate sustained penicillin blood levels necessary for therapy of more resistant bacterial infections were attained by injection twice daily of larger amounts of aqueous procaine penicillin.3. Renal insufficiency tended to elevate penicillin blood levels because of decreased excretion, and cardiac failure tended to depress penicillin blood levels presumably because of poor absorption.4. In this series few unfavorable side reactions and a high degree of patient acceptance were encountered. Twice daily administration of the drug facilitated nursing care.

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