To the Editor: We wish to report a case of accidental intoxication of a fetus with local anesthetic and the subsequent successful treatment by means of exchange transfusion.A healthy primigravida, eighteen years of age, was admitted to the hospital at term after a normal pregnancy. The course of labor was unremarkable. Five hours before delivery she received an intramuscular injection of meperidine (Demerol), 50 mg., together with promethazine (Phenergan), 50 mg. Maternal vital signs and fetal heart tones were checked frequently and found to be normal. After eighty-five minutes of the second stage of labor induction of caudal analgesia . . .