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Otto Mays, age 58, pulmonary tuberculosis; had been sufferinf for several years. Appetite poor, coughed considerably, had slight hemorrhages several times in the morning. Weight, at the beginning of the treatment, December 1st, 135 pounds, lost flesh gradually until he reached 131 pounds on January 1st. Is now gaining and has gained 21⁄2 pounds between the first and 26th of January. Lung capacity at the beginning of the treatment, 110 cubic inches; January 26th, 160 cubic inches. This patient is one of those who had an abscess during the process of treatment, during which time he lost in weight without fever. He is now gaining.

Nicholas Robinson, age 61, pulmonary consumption in the second stage; duration two and a half years. His mother died of consumption. He had several hemorrhages, night sweats, coughed seriously at nights, expectoration great. Affection located in infra- and supra-clavicular regions both sides, dullness quite marked. Weight at the beginning of the treatment, 119 pounds; weight January 26th, 1311⁄2 pounds. Has gained 121⁄2 pounds in less than two months. Lung capacity 150 cubic inches December 1st; lung capacity January 26th, 180; increase of 30 cubic inches. This patient could not talk when brought to the hospital; was given up as hopeless. Laryngeal tuberculosis. Was sleepless; now sleeps well; coughs very little; has a good appetite and feels stronger.

John Cummings, age 49 years. Weight, 90 pounds December 1st; weight January 26th, 106 pounds, a gain of 16 pounds in less than two months. Lung capacity December 1st, 100 cubic inches; lung capacity January 26th, 110, a gain of 10 cubic inches. This man had hemorrhages all last summer and before that, and was almost bedfast. Very emaciated, bones almost protruding; the nurse was afraid of bed sores; the case was despaired of; appetite was lost, coughed considerably and expectorated a great deal. Is now improving continually; is up and about and able to go up and down stairs, and feels in better health in every way. (Is cured of a persistent constipation.)

John Broderick, age 24, pulmonary tuberculosis in the third stage, duration over year. Brother died of quick consumption. Was very weak, emaciated, had a cavity in the left infra-clavicular region; coughs continuously for two months previous to treatment. Weight January 1st, 1071⁄2 pounds; weight January 26th, 115 pounds, an increase of 71⁄2 pounds in less than eight weeks. Lung capacity 100 cubic inches December 1st; lung capacity has since varied between 110 and 140 up to January 26th, 1895. This is one of the two cases who had an abscess in the back. He was almost bedfast when treatment began; coughed a great deal night and day; was very weak. Now coughs very little; no more pains or distress; is up and about and on night detail duty.

Henry Riley, aged 34. Weight at beginning of treatment December 1st, 115 pounds; weight Janua.y 26th, 124 pounds, a gain of nine pounds in less than eight weeks. Pulmonary consumption in the second stage; duration one and a half years. Tuberculosis in family. Had night sweats, diarrhea, marked dullness in the right sura- and infra-clavicular region, appetite poor, coughed frequently at night, expectoration considerable. Was a very sick man, but has improved until now he is on detail duty.

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James McGafferty, age 48, pulmonary consumption, second stage; duration of cough several years; serious illness in the five weeks preceding treatment; spat blood during this period, diarrhea was frequent, dullness in the left supra- and infra clavicular region. Weight at the beginning of treatment December 1st, 1061⁄2 pounds; weiget January 26th, 1291⁄2 pounds, a gain of 25 pounds in less than two months. Lung capacity at the beginning, 130 cubic inches; lung capacity January 26th, 160 cubic inches, an increase of 30 inches. Was a very sick man, unable to do anything. Is now on duty at City Hospital. Diarrhea stopped.

Thos. Morrison, age 43, pulmonary tuberculosis, second stage; duration over three years; had hemorrhage in 1891. Cavity in left apex, pronounced dullness in the right infra-clavicular region, tubular breathing over the same region; appetite poor, cough and expectoration pronounced. Had been in the City Hospital off and on for several years. Weight at the beginning of treatment December 1st, 156 pounds; weight January 26th, 158 pounds. Lung capacity at the beginning of treatment, 160 cubic inches; lung capacity January 26th, 170 cubic inches. Is very slightly in better general health. John Hopkins, age 48, pulmonary tuberculosis, advanced first stage; duration two years. Mother died of consumption. Digestion was bad, cough getting continually worse, had lost flesh. Weight December 1st at the beginning of treatment, 1371⁄2 pounds; weight January 26th, 144 pounds, an increase of 61⁄2 pounds in less than two months. Lung capacity at the beginning of treatment, 250 cubic inches; lung capacity varied between then and now, between 260 and 270 cubic inches.

Conrad Hogan, age 32, pulmonary tuberculosis in the second stage. Family history good. Had slight hemorrhages, night sweats, was getting weaker daily. Right apex involved and dull; coughed considerably. Weight at the beginning of treatment December 1st, 135 pounds; weight January 26th, 142 pounds, a gain of 7 pounds in less than two months. Lung capacity at the beginning of treatment December 1st, 180 cubic inches; lung capacity January 26th, 200 cubic inches, an increase of 20 inches.

Henry Willer, age 46, pulmonary tuberculosis, third stage. No family history of consumption. Both apices involved, had hemorrhage, had been ill five years. His disease began with pneumonia. Lung capacity at the beginning of treatment, 140 cubic inches; lung capacity today is the same. Weight December 1st, 133 pounds; weight January 26th, 1321⁄2 pounds, a loss of 1⁄2 pound. Temperature normal; expressed himself as feeling in better condition. It is not a favorable case; was losing fast before treatment.

Nile Johnson, age 34, pulmonary tuberculosis, third stage; duration twenty months. Dullness on percussion of the apices, tubular breathing; hemorrhage a year ago; expectoration not very pronounced. Weight December 1st at beginning of treatment was not recorded. January 1st, 156 pounds; January 24th, 158 pounds, a gain of two pounds in less than one month. The patient is not a favorable case, has variable temperature and chills occasionally.

Nicholas Schappo, age 56, pulmonary tuberculosis, second stage, two years duration; night sweats; left apex dull; coughed considerably at night

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and expectorated very much. Weight December 1st, beginning of treatment, 108 pounds; weight January 26th, 107 pounds, a loss of one pound. Lung capacity December 1st, 140 cubic inches; January 26th, 150 cubic inches, an increase of 10 cubic inches. This man is ageing and broken down generally, and is not a favorable case, although he holds his own, and lung capacity is better. This is one of the patients who had an abscess on the back. He was going down hill fast before treatment. General tone undoubtedly improved.

Conrad Opperman, age 47, pulmonary tuberculosis in the third stage; duration of serious symptoms six months. Mother died of consumption. Had had night sweats; was exceedingly emaciated; very weak. Cavity in the right infra-clavicular region; coughed in the morning considerably. Has diabetes. Weight at the beginning of the treatment December 1st, 79 pounds; weight January 26th, 81, an increase of two pounds in spite of diabetic phenomena. Lung capacity at the beginning of treatment, 50 cubic inches; has varied since then between 50 and 70. This man was a stretcher case, brought to the hospital helpless, could not get up the stairs for a long time, even after he began treatment; was very thin. Is now improved, coughs no more, is in better health, has better appetite, sleeps better.

Fritz Arnold, age 59, pulmonary tuberculosis, second stage; duration two years. Tuberculosis in the family. Cough persistent, expectoration profuse, appetite bad. Weight at the beginning of treatment December Ist, 122 pounds; weight January 26th, 127 pounds, a gain of 5 pounds in less than two months. Lung capacity December 1st, 30 cubic inches; lung capacity has since varied between 80 and 100. This is a broken down constitution generally, but has improved in spite of it, whereas he was steadily declining before.

William Murray, age 41, pulmonary tuberculosis, second stage; duration one year. Family history good. Is a drinking man. Consolidation right apex, night sweats, blood sputum, appetite poor, coughed a great deal, expectoration profuse. Weight December 1st, 132 pounds; weight January 26th, 1342, a gain of 21⁄2 pounds. Lung capacity at the beginning of treatment, 70 cubic inches; lung capacity January 26th, 120 cubic inches, a gain of 50 cubic inches.

Thos. Bennett, age 64, pulmonary tuberculosis, second stage. Been coughing four months, very emaciated, affected with long-standing gastritis. Right supra-clavicular region involved, dullness, lungs emphysematous, appetite poor, coughed considerable, sputum sometimes tinged with blood. Weight December 1st, at beginning of treatment, 125 pounds; weight January 26th, 130 pounds, a gain of 5 pounds. Lung capacity stays at 110 cubic inches.

Martin Lemp, age unrecorded. Weight at the beginning of treatment, December 1st, 1311⁄2 pounds; weight when discharged January 10th, 151 pounds, making an increase 191⁄2 pounds in six weeks. Lung capacity increased from 170 at the beginning of treatment to 190 when discharged, a gain of 50 cubic inches.

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All of these records were kept accurately by the physician and nurse in charge of the cases at the City Hospital, and by Dr. Cale, physician in charge of the Poor House cases, whose valuable assistance I secured, chiefly to act as witness physician, as soon as I had gained the idea that blood serum was truly useful for the purpose intended. Dr. Cale was selected because of his qualifications in microscopy and surgery, accomplishments required in a man whose help it was desirable and policy to employ, to verify each case microscopically and to give an opinion on surgical cases of tuberculosis, which I then wished to secure for experiment. The sputum of every case treated contained the bacilli of tuberculosis before we began. Dr. Cale mounted specimens from each, and he and I examined every one of them. The sputum was again analyzed after several weeks treatment, with the results above explained. All mounts have been labeled and kept for future reference. At the City Hospital, after the inauguration of the treatment, the immediate supervision of the injections and attendance was by Dr. Ehrlich, who did his duty carefully and conscientiously. Mrs. Johnson, a very competent woman, was in charge as nurse.

Blanks, worded as the sample shown you, were used, blank A being for the daily reports, and blank B for the history, nature, etc., of each case, and the compilation of the daily records at the end of each month. And so, for each case, every precaution was taken that seemed necessary to insure reliable records and to convince the medical profession of the truth of the facts reported.

THE PREPARATION OF THE SERUM AND ITS APPLICATION.

By the use of the proper toxines we gradually rendered horses more strongly refractory to the action of the germ than they are naturally. Immunization was carried on with the assistance of a deputy state veterinarian. Dr. Rouif, of this city, who had previously kept the horses under surveillance and had examined and tested them carefully with me, and independently, until we had convinced ourselves of their healthfulness. He did his work admirably.

Having immunized horses and tested the serum by experimental processes and noted its effect on animals, and having injected it in myself to determine its reaction, it became necessary to procure a number of tuberculous patients to test its value in human consumption. With this object in view, I secured from Dr. Homan, Health Commissioner, the permission to select a few cases at the Poor House for treatment; and also secured from Dr. Marks, Superintendent of the City Hospital, leave to try the remedy in this institution. Both these officials have been very kind and entered into the scheme of test with a geunine scientific spirit. They turned over to

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me and my colleagues all the cases we wanted, and expressed their good will in many ways. I owe them my sincere thanks for their generous assistance, and am under obligations to them, as also to the physicians at the Poor House.

The treatment began with injections of ten drops hypodermically, in the back between the shoulder blades. In a few days we increased to twenty drops, then to thirty, forty and sixty. Some were given as many as seventy drops once a day for a while. In a few in private practice, I have injected as much as 150 drops at one sitting, every day for several days. No reaction whatever followed these injections, and the pain was no greater than after the usual injection of a morphine solution. There resulted no accidents whatever, from a total of over 1,500 injections in the various patients, except at the City Hospital, where two benign abscesses were produced, as occurs sometimes after other kinds of hypodermic injections. They were, without doubt, due to micro-organisms in the syringe, probably on the leather ends of the piston of the syringe used at the time, or in the needle. Careful disinfection of the syringe will always prevent this accident. serum was, in fact, inocuous; it seems absolutely so, if well prepared.

PROSPECTS OF SERO-THERAPY.

The

The future of the serum-therapy in several infectious diseases is secured beyond peradventure. We may have been too enthusiastic and may have expected more than we can now obtain, perhaps; and possibly, the enthusiasts may be painfully disappointed in their hopes for immediate wonders from the sero-therapy in diphtheria, tetanus, etc., but the fact will always remain that this system is unquestionably rational, and eventually it must yield success in therapeutics where all else must fail, for it is the one rational, truly physiological treatment; the only treatment, in my humble judgment, from which can be derived positive beneficial resuls in the cure of infections. It is Nature's own remedy. Man, with the serum, is using Nature's own weapon of defense; he has found out how he may add power to the natural resources of the organization in the fight for human existence. This system of treatment is not a spontaneous eruption in therapeutics. It is not an explosion in over-zealous laboratory delvers, with more theory than experience; it is the result of years of research in all the laboratories and in the chief clinics of the civilized world, particularly France and Germany. And it is not only yesterday that it appeared in practice. It was several yearsago that Kitasato applied his antitoxine successfully against tetanus. Diphtheria had been treated successfully for a year or more. Syphilis is now treated experimentally with it; and lastly, your humble servant begs to submit to your indulgent criticism, the result of his