creased desire for nourishment. The pulse varied from 128 to 135 per minute. Improvement began during this week. From August 21st injections were given every second day. After eighteen had been given the daily amount of sputum had diminished about 50 per cent. The temperature gradually declined until October 27th, when it became normal and remained so. November 18th tubercle bacilli were few in number. November 29th the weight was 111 lbs. and the patient was able to walk 300 yards to my office, in addition to sitting out of doors all day and going to table at least twice a day. March 16th, 1912, tubercle bacilli absent, weight 114 lbs. Patient now able to take exercise and feels very well except for occasional dyspnea on exertion due to extensive fibrosis in the lungs. In February, 1912, she was in New York for three days without fatigue; attended a theater and concert. She still has some cough and raises about one ounce of a mucoid secretion daily. Appetite is good, no indigestion, sleeps well. March 23rd tubercle bacilli not found, weight 116 lbs., has some dyspnea and tachycardia. March 30th. Left lung, flatness apex to base, bronchial breathing, moderately loud friction sounds, no signs of cavity, no fluid, very dense fibrosis, expansion better at the base than in the upper lobe. Right lung, dulness, crepitations and rubs reach from base almost to apex, bronchial breathing. Coughing does not change crepitations, except to intensify them. Fair expansion, left lung. April 6th, 1912, weight 117 lbs.

Results:-Disease arrested, gain in weight estimated 27 lbs. and still gaining. Tubercle bacilli have disappeared from the sputum in 8 months. Sputum greatly decreased and changed from purulent to mucoid. Cough greatly diminished. Voice regained (had local treatment), cords slightly thickened but no congestion. Dyspnea and tachycardia have improved under digitalin and

Blaud's mass. This patient presents the appearance of a healthy person. It will be interesting to follow the later history of this case.

CASE II.-F. R., age 40 years, male, pilot and captain of tug, normal weight 230 lbs. Was under my care for 4 months during the winter of 1903-4. Infiltration in the left apex, temperature normal, pulse 92, moderate number of tubercle bacilli, and weight 224 lbs. at that time. Returned home and to work until he again came under observation Mar. 23rd, 1911. Weight was then 205 lbs. Left lung, apex to nipple, increased voice sounds, dulness, fine crepitant rales, temperature normal, pulse 78, tubercle bacilli bacilli moderate number. May 15th crepitant rales also heard in the upper part of the right lung. During the summer he gradually lost weight, had considerable indigestion, poor appetite, and cough and expectoration were increased at times. There was no improvement in the physical signs. In July began to have evening temperature. Began Dioradin treatment August 4th, 1911. Left lung, apex to below nipple, dulness, crepitant rales, bronchovesicular breathing and moist crepitant rales on coughing. There were some signs of softening in the upper part of the left lung. Crepitant rales present in the right apex. Weight 186 lbs. Moderate number of tubercle bacilli. This patient had 48 injections. After the seventh injection, itching and an erythema developed on the arms at the sites of the punctures. Later, the skin in the ischiatic regions became swollen and a deep red color, with formation of vesicles which ruptured giving a raw appearance to the parts. After an interval of one week the injections were resumed. The treatment was abandoned February 9th, 1912, condition. only slightly improved and weight decreased to 168 lbs. The patient then went to the Southwest, where, I have heard, he has gained some 4 lbs. in weight and is somewhat improved.

slightly improved, cough and expectoration noticeably diminished. Loss of weight was not prevented nor was temperature reduced.

Case III.—E. L., age 34 years, female, salesgirl, normal weight 118 lbs. Contracted pulmonary tuberculosis 15 years ago. Weight then 103 lbs. Was a patient in the Loomis Sanitorium in 1897-8, where the disease was apparently cured. When discharged weighed 143 lbs.

Had anti-tubercle serum treatment. Six or seven years after resuming her occupation she came to Liberty again, remaining one year, returning home much improved and weighing 130 lbs. She again followed her occupation for 6 years, when her health failed and she returned to Liberty in 1910. Came under · observation Jan. 17th, 1911, weighing 98 lbs. For the past few years had weighed 118 lbs. Had laryngeal infiltration, poor digestion, probably tubercular enteritis, moderate cough and expectoration, pulse 124. Began Dioradin injections August 5th, 1911. Weight 87 lbs. Crepitant rales brought out by cough over most of the right lung, especially posterior. Left lung consolidated from apex to base with a large cavity in the upper lobe. Evening temperature 100.

Results: Had 26 injections. Ininjections. Increased weight 2 lbs., some improvement in appetite and digestion noted, throat improved, there was a slight gain in strength and patient was made a little more comfortable. She was compelled to return home about the middle of October, 1911, and died a few months later. CASE IV.-A. L., age 27 years, female, housewife, normal weight 125 lbs. Came under observation March 3rd, 1911. Left lung, apex to 3rd rib, slight dulness, pleuritic frictions sounds, very few fine crepitant rales. In the first interspace, trace of cracked pot resonance. Right lung, few crepitant rales at apex posterior. Disease not very active. Patient very neurotic. Temperature rare, pulse

lbs. Very moderate number of tubercle bacilli. Soon after this, because of the serious illness of her child, the patient went home for two months. July 13th found an extension of the disease in the left lung, crepitant rales from apex to below nipple and lower angle of scapula. Cracked pot resonance in the second interspace. Few crepitant rales at the right apex, weight 106 lbs. On August 22nd when the injections were begun, the physical signs were much the same as in July. Weight had increased to 109) lbs., evening temperature ranged from 993 to 100, appetite was capricious, had some indigestion and occasional vomiting after coughing. Treatment stopped Sept. 18th, 1911, having had 18 injections.

Results: Patient did not improve and returned to her home town to enter a sanitarium.

CASE V.-A. B., age 16 years, female. clerk, normal weight not known. Was first examined May 8th, 1911. Had been ill for 3 months. Very poor appetite, poor digestion and considerable vomiting. Right lung, apex nearly to base, dulness, crepitant rales, bronchovesicular breathing, almost bronchial at the nipple. Left lung, outer half upper lobe, crepitant rales. Weight 106 lbs. Afternoon temperature 1023, pulse 120, moderate number of tubercle bacilli, cough and expectoration troublesome. Disease active. Ordinary treatment was without result, altho the disease became less active. Weight gradually decreased to 10 lbs. on July 18th altho the physical condition was slightly improved and appetite betOn August 23rd, 1911, when Dioradin was begun, weight was 103 lbs., temperature 101, often over 102 at night, pulse 120 and weak, right lung, crepitant rales from apex to nipple with a cavity at the first interspace and second rib. Left apex some crepitant rales on coughing. Appetite variable and vomited one. to three times almost daily, patient weak. Weight gradually increased to October

ter.

9th, 1911, when it was 108 lbs. followed from now on by a gradual loss. On Nov. 22nd considerable albumin was found in the urine. Dec. 2nd. Moderate number of tubercle bacilli. The patient had 49 injections, stopping the treatment Dec. 23rd, 1911. Weight 103 lbs.

Results:-Slight improvement in appetite and digestion, quantity of sputum was reduced, lung developed more fibrosis. Had no effect on temperature or tubercle bacilli. Died of acute nephritis Jan. 22nd, 1912. History of Brights disease in Father.

CASE VI.-S. W. S., age 40 years, female, housewife, normal weight 120 lbs. Came under observation August 6th, 1908. First taken sick 6 years ago. In 1903 was pronounced cured and remained well until 1906, when health became impaired. Was in the Loomis Sanatorium from February, 1907, to April, 1908, weighing 140 lbs. when she left. She had lost 12 lbs. in the two months prior to my first examination, at which time she had dulness, crepitant rales, and increased voice sounds from apex to the 2nd rib right anterior. Posterior, apex to mid-line of scapula same signs more marked. Left lung, apex to 3rd rib, dulness, increased voice sounds, crepitant rales and bronchovesicular breathing. Same signs posteriorly from apex almost to the lower angle of the scapula. Weight 128 lbs. Evening temperature

Pulse A. M. 76, P. M. 102. Sputum not examined at this time, had previously had bacilli. By April, 1909, physical signs had extended to the 4th rib right and the nipple left. July, 1909, lesion had extended to base of left lung. During the summer had a poor appetite, but maintained her weight at about 118 lbs. Frequently very nervous, had palpatation and indigestion, with occasional troublesome dyspnea. In the spring of 1910 weight was III lbs., October, 1910, 104 lbs. Hemoptysis for several days. In Dec., 1910, had a severe attack of

bronchitis with marked dyspnea and great prostration. Patient must have lost more weight at this time. Compelled by weakness to remain in bed most. of the time until Nov., 1911, when she was able to go about the house as necessary but unable to perform any household duties. From July 9th, 1911, to August 23rd, 1911, received three ten day periods of treatment with sodium cacodylate hypodermatically, which stimulated the patient and improved the appetite. Dioradin injections were begun August 26th, 1911. Both lungs were involved from apices to the bases, dulness, crepitant rales, friction sounds, with troublesome cough and expectoration. Evening temperature varied from normal to 100, occasionally 101. Dec. 14th, 1911, moderate number of tubercle bacilli, sputum thick purulent. April 3rd, 1912, right lung, anterior apex to base, crepitations which are fairly loud and accentuated somewhat by cough, but not changed or increased, bronchial breathing and dulness. Posterior, same signs as anterior, from apex to lower angle of scapula. Left lung, anterior and posterior, apex to base, practically same signs as in the right lung. No indications of cavity. Expansion is fair considering the extent of fibrosis. No tubercle bacilli found in the sputum. April 12th, eightieth puncture.

Results:-General health has been much improved. Has made a remarkable gain in strength. Cough and expectoration have decreased over 60 per cent. Patient is able to be out of bed all day and to exercise about the house and porch. Temperature has been reduced to normal, sleep is natural and uninterrupted, the nervousness is decreased and dyspnea rare, and patient on the whole made very comfortable. Weight 107 lbs.

As in Case No. 1, it will be very interesting to follow the later history of this case.

CASE VII.-M. J., age 38 years, male,

clothing cutter, normal weight 138 lbs. Came under observation June 2nd, 1911. Had been sick for 5 or 6 years. Was in Saranac for 10 months. Cough and expectoration greatly disturb sleep. Chilly feeling afternoons, poor appetite, constipated, and vomits occasionally after cough. Weight 121 lbs. Evening temperature 101, pulse 108 to 116. Moderate number of tubercle bacilli. Dense consolidation of the left lung and the upper lobe of the right lung. Slight throat involvement. Injections of Dioradin begun Sept. 3rd, 1911, and discontinued Oct. 20th, 1911, having taken 29. Weight 119 lbs. on Oct. 6th.

Results: No improvement noted. Patient returned to New York the latter part of October and died Nov. 3rd, 1911.

CASE VIII.-C. J. P., age about 24 years, male, druggist, weight not taken. Came under observation August 8th, 1911. In the spring of 1911 had a hemorrhage after which his health steadily failed. When first seen had had several hemorrhages recently and the disease in the lungs was active. Right lung, consolidated from apex to base with a cavity in the upper lobe, greater part of the left lung consolidated. Had profuse sweats. Temperature 99 A. M. to 102 P. M., pulse 104 to 112, had been 125 to 130. Moderate number of tubercle bacilli.

Results:-Dioradin given as a last resort with the aim of making the patient more comfortable. Only three injections were given before the patient died Sept. 11th, 1911. This was an acute case and only seen in the last stages of the dis

ease.

CASE IX.-M. B. H., age 30 years, female, housewife, was a bed patient and weight not taken. First seen October 11th, 1911. Had been sick over a year. Right kidney, which had been removed, said to have been the site of the first infection. Later, the lungs became involved and her health has been failing for some time. Right lung, apex to base crepitant rales, cavity in the upper lobe. Left lung, rude respiration and crep

itant rales in the upper part of the upper lobe. Cough and expectoration very troublesome. At times had nausea and vomiting, and very poor digestion, also chronic cystitis. Temperature 102, pulse 88. Tubercle bacilli numerous. Dioradin injections begun October 27th, 1911, and discontinued January 6th, 1912, 20 having been given.

Results: No improvement was noted. Patient gradually became worse and died March 28th, 1912.

CASE X.-P. H., age 46 years, male, barber, normal weight 110 lbs. First consulted me May 8th, 1911. Had been ill about two years, during the first having had several small hemorrhages. Morning coughs and expectoration considerable in amount. Appetite very poor, weight 1023 lbs., patient quite weak, sleeps poorly and has slight laryngitis. Right lung, apex to nipple, dulness, crepitant rales and bronchovesicular breathing. Same signs posterior apex to lower angle. Left lung, apex to base, dulness, crepitant rales, bronchial breathing and increased voice. Temperature normal, pulse 108. Moderate number tubercle bacilli. During the summer the cough and expectoration decreased a great deal, appetite became almost normal, temperature remained normal, felt stronger and there was less activity in the lungs. August 17th weight 97 lbs. In Nov., 11, his condition was about the same except that the consolidation in the right lung included the base. Dioradin treatment begun Nov. 22nd, 1911, discontinued Jan. 31st, 1912. One series of 40 injections was given.

Results: This patient is very nervous and worries continually about his condition. He is a rank pessimist. Could note no effect of the treatment except an increased fibrosis of the lungs. Until recently he was just able to be about his room and occasionally sit on the porch. Is now confined to bed with constant dyspnea.

CASE XI.-M. C., age 45 years, female, housewife, confined to the house. Came

under observation Nov. 26th, 1911, having been sick for at least one year, probably longer. Husband died of tuberculosis just before she became ill. Coughing and raising a great deal, has a very poor appetite and has lost about 40 lbs. in weight. Right lung, apex to base, dulness, crepitant rales, with signs of softening in the upper lobe. Flatness at the base of lung. Left lung, apex to base, has fine crepitant rales. Temperature 101, pulse 120, has few tubercle bacilli. Had 25 injections beginning Nov. 26th 1911. Results:-Temperature was reduced and the rate and character of the pulse improved. Was able to take more nourishment. Had no effect on the disease. Early in the morning of Jan. 6th, 1912, had a very large hemorrhage which caused death almost immediately.

CASE XII.-A. F., age 28 years, male, steamfitter, normal weight 132 to 140 lbs. First examination June 22nd, 1909. Tuberculosis was discovered one month ago. Was specific six years ago. Indulged in alcoholics freely. Has been coughing and raising for the past 4 months. Has pain in the right chest, poor appetite and slight sweats. Weight 122 lbs., morning temperature normal, pulse 104, and has a moderate number of tubercle bacilli. Right lung, nipple to base, dulness, few crepitant rales, and bronchovesicular breathing. Apex to nipple, expiration slightly prolonged, slight dulness, and an occasional crepitant rale heard. A trace of cracked-pot resonance heard under the second rib. Vocal cords congested. Raising about 4 oz. of sputum daily. August 18th, 1909, physical signs in the right lung improved, weight 129 lbs., crepitant rales heard after cough in the left upper lobe posterior. Sept. 1st, also Sept 22nd, and on Oct. 26th raised traces of blood. Had fewer crepitant rales in the right lung and crepitant rales in the base of the left lung posterior. Cough and expectoration decreased 50 per cent. Dec. 13th weight 134 lbs., coughing more, sleeping poorly, appetite fine. Crepitant rales in the left

base after cough, scarcely any rales heard in the right lung. April 4th, 1910, coughing more and raising 6 or 7 ounces, temperature normal, pulse 108. Crepitant rales on coughing, especially left base, some in the middle part of the right lung posterior. Weight 128 lbs. June 17th weight 124 lbs., expectorating 3 to 4 ounces, evening temperature 99. Left lung, apex to base, crepitant rales. Scarcely any physical signs right. August 15th, increased cough and expectoration, vomits bile, evening temperature 100, crepitant rales in both lungs, especially after coughing. Weight 120 lbs. and has poor appetite. Dec. 22nd, had a dizzy feeling in the head for the two weeks past, vomits bile very morning, weight 117 lbs. June 12th, 1911, was feeling better until a week previous, when he lost appetite and had occasional attacks of dizziness. Weight 121 lbs., sputum 4 ounces, crepitant rales after coughing, from apex to base, anterior and posterior, in the left lung, also in the right lung posterior. By Nov. 27th, 1911, when Dioradin treatment was begun, he had lost a little more weight (119 lbs.), had no appetite, very little temperature, pulse 108 and was coughing and expectorating as usual. Had a moderate number of tubercle bacilli and purulent sputum. After 6 injections patient had hemorrhages and injections were stopped for 24 days, then renewed. After 8 more injections, had more hemorrhages and condition became worse.

Results: Further treatment refused and the patient passed from under my care. A few days ago he told me he felt a little better and had gained a few pounds in weight. I consider him an incurable case.

CASE XIII.-M. J. B., age 20 years, male, painter, normal weight 155 lbs. Came under observation October 23rd, 1911. Weight 1391 lbs., temperature at noon 99%, pulse 124. Had been sick 4. months, no hemoptysis, coughed and expectorated a good deal, had a poor appetite and some headache at night. Right