lung, apex to 4th rib, few faint crepitant rales, increased vocal fremitus and resonance. Respiratory murmur was very slightly changed. Urine negative. Slight general congestion of the throat, tubercle bacilli numerous, and muco-purulent sputum. When he began the injection treatment Nov. 27th, 1911, his weight had increased to 1433 lbs. Morning temperature was normal and the pulse was 96. Had some evening fever and slight hemoptysis. Right lung, upper lobe, few crepitant rales. Left lung, some crepitant rales in the region of the nipple and in a corresponding area posterior. After the 7th injection he reported less cough and that he felt better. Had II treatments when he passed from observation.

Result:-Had insufficient to draw any conclusion.

CASE XIV.-S. B., age 29 years, female, housewife, normal weight 149 lbs. Came under observation Nov. 24th, 1911. Had been ill eight weeks. Began with chill, aching and temperature for three days. Soon felt very weak and lost appetite. Weight 128 lbs., a loss of 21 lbs. Had heavy sweats on waking, began coughing 3 or 4 weeks ago, expectorated a little mornings, no nausea or vomiting, afternoon temperature 1003, pulse 128 and weak. Few tubercle bacilli in a mucoid sputum. Urine negative. Hemoglobin about 70 per cent. Slight dulness at apex of left lung. From apex to nipple, increased vocal and tactile fremitus, bronchovesicular breathing, very few fine crepitant rales in the suprascapular space. Heart dilated and there was a loud blowing presystolic murmur. Dioradin injections were started on Nov. 29th. Rest in bed ordered which reduced the pulse to some extent. Had 24 punctures, the last being given Jan. 5th, 1912. The patient died Jan 28th from hemiplegia (second attack) caused by embolism due to endocarditis. The first attack occurred about 3 weeks before on the opposite side, and recovery had been completed when the second and fatal attack occurred.

CASE XV.-L. S. P., age 28 years, male, bookkeeper, normal weight 119 to 124 lbs. Two brothers died of tuberculosis. First seen Jan. 6th, 1912, being referred by Dr. John Horn of New York. Eighteen months previously had begun to have throat trouble. Jan. 6th, had some morning cough, expectorated a great deal, appetite was good, but the throat was painful on swallowing and he could not take very much nourishment. The noon temperature was 991, pulse 92, weight 113 lbs., had a moderate number of tubercle bacilli, some large cells being filled with them. Urine negative. Left lung, apex to third interspace, dulness, crepitant rales, bronchovesicular breathing and voice sounds slightly increased. Below the nipple had some crepitations, breathing scarcely changed. To the left of the uvula on the soft palate there was a fair sized tubercular ulcer. The right tonsil was extensively ulcerated, the epiglottis was greatly thickened, red, and covered with minute ulcers. The arytenoid cartilages were much swollen and red. The parts were densely covered with thick, tenacious, purulent secretion. The voice was slightly hoarse. Could not see the vocal cords on account of the condition of the throat. Various treatments were applied to the ulcers without success. On Jan. 18th weight was 109 lbs., could take scarcely any nourishment. Ulcers had spread to the posterior pillars of the fauces and the soft palate. The right tonsil was more involved, there was an ulcer on the upper part of the left tonsil, a large ulcer on the right margin of the epiglottis and a smaller one on the upper margin. The posterior surface of the epiglottis was also ulcerated. The throat was in worse condition than at any previous time. Thick purulent secretion covered the parts. The patient could not swallow more than a cup of tea and milk a day. Injections of Dioradin were begun on this date. Jan. 25th after 7 injections the throat felt much relieved, notwithstanding local treatments were discontinued on Jan. 22nd. Jan.

29th after the tenth injection, the patient could take certain foods with very little pain. The pharynx appeared much better, the larynx was not examined at this time, the patient being confined to bed. on account of intestinal trouble caused by constipation.

Feb. 4th after 13 injections, he was able to take nourishment with greater ease and in larger quantities. Feb. 8th, sixteenth injection, he came to the office again, weighing 110 lbs. and taking solid food with very little pain on swallowing. The ulcers on the soft palate were practically healed, on the left tonsil nearly healed, the upper part being partially destroyed. The right tonsil was almost entirely gone, there still being some ulceration deep between the pillars, which was painful when probed. The epiglottis was covered with healthy granulations and nearly healed. It was, also, less thickened and congested, and there was very much less of the purulent secretion. Punctures were made daily for the first 10 treatments, then every other day until Feb. 14th, when the nineteenth injection was given. On this date the larynx and epiglottis were more reddened, the throat was sore and there was some hoarseness. Patient felt as if he had taken cold. Treatments were again given daily. Feb. 15th a swollen gland was noted on the right side of the neck which soon disappeared. Feb. 21st there was still some ulceration between the pillars of the fauces on the right side which was sensitive on swallowing. Insufflations of iodoform and orthoform, equal parts, gave some relief. Feb. 23rd prescribed calcium creosote, one teaspoonful in water every 3 hours, and an iron preparation t.i.d. Feb. 29th the tonsils were in about the same condition so began applications of a 25 per cent. solution of argyrol, followed by the insufflations. March 2nd weight 111 lbs., patient able to take a greater variety of foods. The temperature and pulse have become normal. April 1st contracted coryza, became hoarse, the larynx being congested

and irritated. Temperature over 100. Weight dropped to 107 lbs. April 6th throat again in good condition. April 11th seventy-first injection; began to give treatments every other day. April 15th tubercle bacilli very few, numerous staphylococci, and watery mucoid secretion. The character of the expectoration showed marked improvement. The ulcers on the left tonsil, epiglottis and soft palate were well granulated and practically healed. Ulceration on the right tonsil well granulated and nearly healed. There was no pain on pressure with a probe. The arytenoid bodies were not so swollen or congested. The vocal cords which could now be seen were slightly thickened and pink; the voice a trifle hoarse. Left lung apex to third interspace, dulness, few crepitant rales, some rude crepitations and almost bronchial breathing at the apex, broncho-vesicular below to the third rib. Same signs posterior, from apex to just below the spine of the scapula. The lesion was in a more fibrous state.

Results: This patient has had 74 injections. The treatment will be continued until 80 punctures have been made, when an interval of rest will be allowed. Whether another series will be given will depend on the progress the patient makes. While his weight has not increased, the temperature has become normal and he is very comfortable and able to take considerable exercise. He can eat anything that he desires and has a very good appetite. The effect of the treatment has been very surprising to me for I did not expect any improvement in the beginning and started. the Dioradin only as a last resort. This is another case in which the later history will be very interesting to ob

serve.

CASE XVI.-Mrs. S. G. B., age 37 years, female, housewife, normal weight 135 lbs. Had been ill over two years when she came under observation Oct. 6th, 1910. Then feeling quite well and had been gaining in weight. Appetite

quite good, it never had been very keen. Had some evening temperature at times. Pulse 102. Few granular tubercle bacilli, muco-purulent sputum. Weight 115 lbs. Right lung, apex to base, dulness, crepitant rales, and loud voice. Whispered voice and almost amphoric breathing from first to third ribs. No cracked-pot resonance made out. Left lung, apex to nipple, dulness and crepitant rales. March 4th, 1911, weight 125 lbs. Felt very well, cough and expectoration had diminished, highest temperature during the past month was 99%. Right lung, dulness, very few crepitant rales, increased by cough. Left lung, less dulness, crepitant rales increased by cough. Mar. 30th. Few tubercle bacilli, average 4 or 5 to the field. April Ist. Scarcely any sounds in either side except on coughing. Condition improving. May 18th no temperature, but felt tired, coughed and expectorated more than during 3 months previous. No appetite. Few more crepitant rales in both lungs. June 7th, cough had become harder. Weight 119 lbs. Went to Northern Vermont for the summer. Oct. 6th returned to Liberty, cough is rather hard, expectorated about the same amount as last June, not much appetite and very easily tired. Weight 116 lbs. Right lung, crepitant rales from apex to base, signs of softening (amphoric breathing and moist rales) first and second interspaces. No cracked-pot resonance distinguished. Left lung, crepitant rales from apex to nipple, dulness not so marked as on right side. Vocal cords Vocal cords slightly thickened. Dec. 4th felt fairly well, had very poor appetite, no temperature above 99, condition in the lungs much the same. Urine negative. About Urine negative. About Christmas time the patient went to New York for a few days and contracted at severe bronchitis. Had temperature, was prostrated and had troublesome cough and expectoration. Jan. 17th, 1912, weight III lbs., felt very weak, had no appetite and it is very hard to take any food. Had more crepitant rales.

Feb. 6th was advised to remain in bed on account of weakness and an afternoon temperature of 102. As the patient was growing gradually worse Dioradin injections were begun on Feb. 14th, the temperature then ranging between 100 and 101 in the afternoons. Few granular tubercle bacilli in the suptum. The injections were usually administered at the patient's home. She came to the office on the sixth and seventh of March (weight 108 lbs.) for static electricity, which I thought might stimulate her, but the exertion so exhausted her that she had an attack of tachycardia and was again compelled to remain in bed. March 17th after 22 injections, the cough and expectoration were less, the sight of food caused less revulsion and a trace of appetite appeared. Began to sit out on the porch. March 23rd, twenty-fifth injection, has more appetite; exertion sends temperature up to 100%. April 22nd, the first series of injections was completed. The patient felt better than she had in months and was much encouraged. The appetite had been regained, the long standing distaste for food having entirely disappeared, cough and expectoration had improved and the afternoon temperature had been gradually reduced to 99%, being on some days normal. Pulse 100. Patient on porch all day, but not allowed to take any unnecessary exercise. Weight stationary at 108 lbs. Right lung, apex to fourth rib, increased voice, bronchial breathing and crepitant rales anterior. Some crepitant rales under the right breast. Posterior, about the same sounds from apex to lower angle of the scapula. Left lung, apex to third interspace anterior, and nearly to the lower angle posterior, crepitant rales and broncho-vesicular breathing. Coughing increased the loudness of the rales, but did not increase the number. Urine negative. Tubercle bacilli few, average 2 to 4 to a field, some fields negative. Bacilli mostly large and granular.

Results:-The general condition of the patient as well as the lung condition have

improved. Comparison of the notes made April 22nd, with those of Jan. 17 tells the story. After an interval of a week or two, the second series will be commenced.

Disregarding Case XIII as being neither far advanced, nor having had sufficient treatments from which to deduct any conclusions; Case XIV who was incipient, but the unfortunate posessor of a very serious heart lesion, and Case VIII who was moribund when given his 3 injections, we have left 13 cases of advanced disease, many of years standing, from which to draw conclusions as to the useful ness of the Dioradin treatment. Of this number four, or 30 per cent., showed decided improvement. This, to me, is remarkable when I consider how long some of these patients have had the disease and how serious was the condition in each case. Case I was considered to have only a few weeks to live when treatment was begun. Case VI was nearly bedridden. Case XV was as advanced a throat case as I have ever seen. Nor have I ever known one in his condition to recover as he has. Case XVI I had prognosed as hopeless and both the patient and

her husband had completely given up hope of her improvement.

Then too, with the exception of Case XV, these patients had lived for months (years in one case) under exactly the same conditions before Dioradin treatments were begun, as during the course of treatments.

Whether these encouraging results. are temporary or permanent, time only can determine.

Of the 70 per cent. that were not affected favorably there is little to be said. They were hopelessly far advanced and either have met, or are bound to meet their inevitable doom. Conclusions:-I may say in favor of the treatment that:

I. It improves the appetite and digestion.

2. It decreases cough and expectoration.

3. It reduces temperature and strengthens the pulse.

4. It causes a gain in weight.

far as I know, has the patient-if he followed it.

It need not be repeated here that I disagree with my overzealous and sensational friends who like to assert that "once a gonorrhea always a gonorrhea." and who would forbid the man. who once had the misfortune to harbor the gonococcus, even for ever so short a time, ever to marry. If we were to

Such

apply this injunction in practice, the world's population would in a short time become pretty well thinned out and the number of unmarried women would increase a thousandfold. severity against those once gonorrheally infected is not only cruel, it is unnecessary, because it is false and has no justification in fact. That many men who consider themselves cured not infrequently infect their wives is as well known to me as to anybody.1 But it is absurd and pernicious to go to extremes in the matter. In medicine as elsewhere common sense must not be dispensed with.

Can we tell when a gonorrhea is perfectly cured? Yes. If a man has been free from any discharge whatever for a month, while living his regular life; if his urine, particularly his morning urine, is free from shreds, or contains only small particles of shreds, which are free from gonococci; and if three expressed samples of secretion from the prostate, taken at different times, are free from gonococci, then the patient is cured. Does that mean that we can assert positively that the man does not harbor a single gonococcus? No. But it is not necessary. A person who harbors a tubercle bacillus, but is otherwise perfectly well, does not suffer from tuberculosis, and is not a dangerous individual. We cannot assert about any person with absolute positiveness that he does not harbor some germs of some kind, but that does not render that individual dangerous.

To come now to the definite practical points. When a man answers the requirements outlined above, we have no hesitation in permitting marriage. But suppose a man does have a scanty discharge or a drop in the morning, or 1 See Author's "Never-Told Tales."

a few shreds? If they are free from gonococci, we also give permission, tho we advise caution, that is, to be moderate in intercourse and to have the wife take a mild antiseptic vaginal douche after coitus.

If the scanty discharge, or the shreds, or the expressed prostatic discharge contains a few gonococci, what then? Then we refuse permission. But it sometimes happens that all arrangements have been made for the wedding, and then only the man comes to be examined. He should have had himself examined before he made the arrangements for the wedding, but he hasn't, and that's all there is to it, and you cannot undo the past. We examine him and do find gonococci. To put off the wedding would lead to great trouble and perhaps to scandal. He begs that something be done for him, to help him out of the difficulty. We may do it reluctantly, but we generally help the patient out. An antiseptic vaginal suppository and some antiseptic tablets, are prescribed, with the directions that the wife use a suppository a few minutes before intercourse and an injection after. This course has been pursued in a number of instances, and in not a single case has infection resulted. The husband in the meantime took treatment until he was cured or practically cured.

Sometimes a man comes to you in the acute stage of gonorrhea, with profuse discharge, and tells you he is going to get married in three or four days. He was all right but three or four nights ago on the occasion of his bachelor dinner, he "went out with the boys," and here is the result. By the use of condoms it would be probably be possible to avoid infection, but a man in the acute stage of gonorrhea should not get married, and we would