Malt,

pulse varied from 76 to 110. hypophosphites, cod liver oil, and other remedies had been given, but had not been well borne.

"At home she was for a short time kept in bed, with extension, but soon she tired of this and insisted on being up and about on her crutches. She improved somewhat in appetite and felt much better, but still slept poorly. She had no pain in the hip, and took several long walks and rides in the street cars. She presumed too much upon her ability to do, however, so that restrictions were necessary. Extension hardly seemed called for, but I had a Thomas splint made for her -to thoroughly immobilize the joint. This she continually wore during the day, and with no discomfort save the awkwardness in sitting.

"September 1st I began the systematic use of yeast nuclein, and the improvement almost from the first has been noticeable and extremely gratifying. The remedy has been administered hypodermically, and the site chosen was the region immedi ately around the affected hip joint. The first few injections were made daily, but the reaction seemed to me so marked that I found treatment on

alternate days to be more satisfactory, It has been recommended, as a good precaution, to sponge the chosen site with a two or three-per cent. solution of carbolic acid, for its antiseptic and local anesthetic effect. This precaution, however, I did not find necessary, but used great care with needle and syringe, sterilizing both, each time, before using.

"From September, 1894, to January, 1895, the case was under constant supervision and care, and correct and detailed reports were kept noting the amount of nuclein solution which was injected at each visit. At the beginning twelve minims only were used in each twenty-four hours, this being gradually increased to fifty

minims with the happiest results. There were at times some pain and a burning sensation at the site of the injection. The temperature each afternoon was about 99° to 99.4°, on one or two occasions going as high as 101. 2°. At the time of the lastnamed date the patient experienced no pain whatever in the hip and expressed herself as feeling as well as ever. The nuclein was temporarily stopped, and I do not consider it accomplished all a continuance of it might do. The improvement has been most gratifying since I began giving the nuclein, and I think there can be no doubt that her comfort has been due, in a large degree, to this remedy. It was given with the idea. that her case was probably tuberculous, and for this suspicion the family history affords us more or less ground. The nucleins are said to be of avail in incipient tuberculosis, and this seemed a good case for their use, which is, of course, as yet largely empirical. The disease process in this case certainly seems to have been held in abeyance. Whether the action of the nuclein in such a case is simply to enable the cellular elements to resist encroachments of bacilli, or whether we may hope for so strong a germicidal action as to destroy entirely the bacilli, is, I judge, a question concerning which one can, as yet, only speculate. This patient understands that she is forbidden to step on her left foot or use the limb before next summer, and the day may then be still further postponed. I do not yet regard, or now report, the case as one of recovery, but it seems to me especially interesting as showing gratifying improvement under the use of an agent, quite new as yet, which may have a wide field of use. I hope eventually to have the young lady walking without apparatus of any sort and an evidence of what conservative treatment may accomplish, even in a somewhat unfavorable case.

In a postscript written in January, 1896, Dr. Hitchcock adds:

"This patient was kept under frequent observation until May, 1895,

the splint having beer discarded some time earlier. In May, first one crutch, then both, and later the cane were dispensed with, the injections of nuclein were discontinued, and the patient has since walked through the summer and fall without support of any kind and without any discomfort

whatever in the hip. She has been very happy and grateful for her relief from pain, and it has been de

ligh ful to see her evident joy in her ability to walk without suffering. Indeed, she has been altogether a pleasing fulfillment of what I hoped to do when I first reported the case in January, 1895, and this excellent result I attribute very largely, if not entirely, to the long and persistent use of nuclein."-New York Medical Journal, March 7, 1896.