flammation of the upper lobe of the right lung. There were pain and fever, copious, harassing cough. The chest presented marked dulness, and tubular respiration over the right upper third front. Elsewhere there were more or less bronchitic râles. The dulness was very obstinate, and lasted for several weeks, even after he was well enough to be about and work somewhat. The blood showed signs of tuberculous disease. He adopted the strict diet, and faithfully carried it out, and was finally rewarded by a restoration to full health. This case was a severe test of the diet treatment, as acute tuberculosis at his age has been one of the opprobria medicorum.

CASE LXI. In 1871, Mrs. W. G. C., thin, small sized, but well developed woman, aged about 34 years, complained of a chronic cough, expectoration, not copious, and pain under the shoulder blades. She was the mother of two children. Her own mother was a subject of chronic eczema. Family not regarded as consumptive. She resided in a rather low place, where water could be obtained by digging only a few feet. The physical exploration of the chest showed that there was some, but not very marked, disease. This was indicated by diminished resonance on percussion, and crepitant râles in the upper left side. The blood showed signs of the existence of tubercles. Under treatment, such as has been usually pursued in this series of cases, she entirely recovered, and remained so.

CASE LXII.-Miss Garvin, resident New York City, aged 20 years, in the summer of 1873, came on to Woburn, Massachusetts, to be treated. She had been sick some time, and lost flesh and strength. She had chronic cough, with free expectoration. No blood; night-sweats; pallor; weakness; Irish descent, but American born. The chest showed decided marks of tubercle in the first stages. The blood displayed the evidences of consumption, to which particular attention has so many times been called. She was put upon the baths, strict diet, and a tonic. In a few months she gained fifteen pounds, and returned home very much improved, with a prospect of a permanent cure. At last accounts her health was good, and no return of the disease-1880.

CASE LXIII-Mrs. S. G. P., came of a consumptive family. In 1871 she was seized with an alarming hæmoptysis. It seems that she had been subject to severe periodical attacks of quinsy,

that had undermined her health. She had a chronic cough, with not much expectoration. There was diminished resonance on percussion over the right upper third front; also, expiratory murmurs, with some crepitation. The throat was not much inflamed, except a small patch, as large as a finger-nail, on the middle of the right posterior pillars of the palate. The blood presented decided evidence of the tubercular state. She adopted a thorough course of application for the throat, also the strict diet, acid baths, and tonics suited to the case; and combined with these a change of air, which resulted in the apparent reestablishment of her health. The blood lost its micrographic tuberculous characters. Lately, August, 1877, after unusual excitement and labors in household affairs, she had a copious hæmoptysis, with crepitation and dulness over the right upper third front. The blood appeared normal. There was increased action and area of dulness about the heart. Rest, quiet, and the regimen have restored matters to their former standing, and she is now quite well, and presents no marked sign of physical lesion. The ambition of this lady leads her to perform tasks beyond her strength. It is easy to overwork, especially when the standard of capacity is one of "feeling well."

Dec. 1878. During the winter Mrs. P. was ill with local disease-pelvic. Her nervous system was very much disturbed; she had pains which were located in the chest, right upper third front; still there were no physical signs that I could detect, save a puerile murmur. This pain proved to be reflex uterine; still, the blood was found to be diseased with spores, and spore collects, mycelial, and fibrin filaments. These were cleared out by diet, so that at the present time they have almost entirely disappeared, and she is quite well, save a late attack of urticaria from eating cheese.

Oct. 1879. Still well.
Sept. 1880. Still well.

CASE LXIV. Miss P., 17 years of age, a boarding-school girl, came home in 1875 on account of a severe hæmoptysis. She had grown up fast, coughed much, raised considerable sputa, and was confined to her bed for the most part. Physical exploration of the chest did not reveal strongly marked disease of the lungs. The heart was beating normally, except its increased impulse. The blood was unusually full of fibrin and mycelial filaments,

of spore collects and of spores, many of which were very actively in motion, and also were of a decided copper hue. Some of the mycelial filaments were of a copper hue. Diagnosis-tubercle and syphilis. Under the treatment so often named she recovered her health perfectly, and apparently remains so now, 1878.

PRETUBERCULAR CASES TREATED THAT MAY COME UNDER THIS HEAD.

CASE LXV. In April, 1876, a young man of 18 years complained of feeling weak and listless. He had nocturnal and morning cough with slight expectoration. He was pale, thin, and loosing flesh and strength. Consumption was hereditary in his father's family. There were no physical signs of pulmonic lesion.

Inspection of the blood microscopically disclosed abundant signs of mischief, such as—

Fibrin filaments very marked in character.
Spores and spore collections.

Vegetative filaments.

White corpuscles much enlarged and too numerous.

Red corpuscles thin, flabby, pale, sticky, outlines not clearly cut-aggregated.

These taken together, with the history and the rational signs, induced a diagnosis of the pretubercular stage.

Under the use of acid baths and strict diet the sanguineous and other signs began to disappear, so that in a year he was enabled to proceed to Germany to study music. 1879 is still well.

CASE LXVI.-May 1, 1877, S. L., physician, Springfield, Mass., aged 45 years. Father had consumption in his youth, but recovered, and lives in good health at the age of 70 years. A sister died of the same disease aged 43 years.

He complains

Of taking cold easily on any exposure.

Of ulcerated sore throat.

Of feeling weak and debilitated.

Of loss of flesh.

Of cough and expectoration.

Of a nervous irritability that enables him to feel his lungs; and

Of such general malaise that he has left home on account of his health.

Physical exploration of chest shows a slight diminished resonance on percussion, diminished inspiratory murmur, strong expiratory murmur, no râles at the upper part of the right side. Otherwise the signs were normal, except, perhaps, as he himself suggested, there is increased communication of the carotid arterial murmur over the right thorax rather than the left. Heart normal.

5 P. M. The blood showed numerous spores in active motion, large masses of spores, enlarged white corpuscles, fibrin filaments, no mycelial filaments. The red corpuscles were not very pale, but were well defined, distinct, and somewhat in rouleaux. Diagnosis. Pretuberculosis.

9 P. M. The blood had large interspaces crowded with most actively moving spores-the motion was the most marked the writer ever witnessed in blood. In some places the spores were double.

May 2d, 10.15 A. M. 17 hours and 15 minutes after they were removed from the systemic blood streams, the spores were still actively running. The strict diet and acid baths were adopted as a mode of treatment.

June 23d. He writes: "I have been steadily improving in general health and strength. Nitrate of silver, grs. x-3j glycerine, relieved the throat. I have now no chest symptoms whatever, and my strength is improving."

Nov. 3d. Seen in person. Has not strictly lived on the diet since he was better. The spores and collects were present, but in less amount. The fibrin and mycelial filaments were marked. Chest symptoms disappeared. The importance of adhering to the diet was insisted upon anew. If he had done so his blood would have been better in appearance. Still he was personally very well satisfied and encouraged.

April, 1878. Much better every way.
Sept. 1880. Well.

CASE LXVII.—A man aged about 24 years took a severe cold in the spring of 1876. His cough was troublesome. Expectoration not copious. He had lost voice, flesh, and strength. He was pale, anæmic, not robust. His father died of consumption. He had a sister in the last stages of the same disease, who died subsequently to the period of which mention is made.

There were no physical signs of lesion in the lungs.

Inspection with laryngoscope revealed a reddened and thickened condition of the vocal cords and larynx.

Inspection of the blood with the microscope showed fibrin filaments abundant and marked. Spores and spore collections numerous and large. Vegetative filaments.

White corpuscles too numerous for health and enlarged. Red corpuscles thin, sticky, flabby, pale, outlines not clearly cutaggregated.

It was the most characteristic case of pretuberculosis it has been my lot to examine. Treatment was instituted upon this base of diagnosis. In a short time its benefits were shown by the clearing out of the morbid elements from the blood in a great measure. The voice, strength, and flesh were restored. The larynx appeared healthy under direct inspection. Eighteen months later he presented the rational signs of good health, and but slight tokens of disease in the blood.

Chest signs normal.

CASE LXVIII.-April 26, 1877, Miss B., school-teacher, aged 24 years, consulted the writer in relation to some enlarged lymphatic glands that disfigured the right side of her neck. She had some cough; phthisis was hereditary in her family. There was some disturbance of the nervous system, owing to a uterine displacement. Physical signs revealed a diminished respiratory murmur throughout the right lung. No dulness or diminished resonance on percussion. Inspection of the blood showed the morphological elements of tuberculosis. She was placed upon a diet of milk especially.

August 3,1877. Blood cleared up; respiratory murmur normal. Physical development improved; cervical lymphatic glands considerably diminished; some neuralgia still; general health restored.

September. She resumed teaching, and has continued well up to last accounts. This patient displayed a mind of rare firmness of character, and heroically pursued her course of diet though surrounded by adverse influences. It has been often noticed that the success in the diet treatment depends much upon psychological foundations, to wit, a firm and steady pur pose. The cervical glands at last sight were very much diminished, so as to be hardly perceptible. Dr. Salisbury has treated many such cases with similar success.