must speak for themselves. If I have failed to find bacilli in a real case of tuberculosis, it proves nothing positively regarding my skill as an observer or the bacilli as an aetiological factor. As Prof. Clapp has very truly pointed out, bacilli may be present in the lungs and not continuously so in the sputa; and as the particle used in a single examination is very small, not a thousandth part of the expectorations of a single day, would it be strange if, in that small part, bacilli in a genuine case were sometimes absent? Then, too, the process of staining and searching for such minute objects is delicate; so that the fault may be in the observer through haste, poor luck, or lack of skill.

However, I am not here as an advocate. The evidence I bring for your consideration comes from the two score of physicians for whom I have done work of this kind. They have no interest in me, or in any theory that is not founded upon facts. Some of them have very kindly expressed their opinions regarding the value of this kind of work. You can have them for what they are worth; but I call you to witness if the evidence they bring is not entitled to more consideration than the opinions of a like number of physicians who never had a patient's sputa examined, and know nothing about it.

Of the fifty cases reported in my last paper, you may recall that thirty-seven of them contained bacilli, of whom not one had fully recovered; eight had improved, four were then living, and twenty-five had died. Of the other thirteen cases, in which no bacilli had been found, eight had recovered, four improved, and one had died from gangrene of the lungs. Not one, at that time, had developed consumption; which is more than I can boast of to-day. Thus, you see, of the twenty-four patients alive at my last report, twelve of them had bacilli in their sputa, and in twelve I had been unable to find them. These cases are of much more interest than my recent ones, and, naturally, come first.

Let me begin by reporting the death of my own wife, whose lungs began to fail her four years ago, whose sputa I examined in the fall of 1888, and whose case I reported in my last paper. At that time she was in the best health she had known since her lungs became affected. In July, 1891, she had an abscess gather in her right lung, and again I examined the sputa. No bacilli were present, and again she recovered so as to be free from cough. In August of the same year, she had another attack, which confined her to her bed for about three weeks; and she coughed and raised continually after. In March, 1892, I found her sputa full of bacilli; and on the 6th of May she died. Her history confirms a belief which I have long entertained, that many cases of pulmonary consumption are not tuberculous

at the start. The lung may become impaired from a variety of causes, and a lower vitality resulting therefrom renders it a prepared soil for the germs of tuberculosis, as a saccharine substance readily undergoes fermentive processes through the absorption of yeast.

Of the other eleven patients whose sputa I had examined without finding bacilli, two have left town, but were well when they left; eight are as well as when I gave the report; and one has not been heard from.

These cases have no such general interest as the remaining twelve, in whose sputa bacilli were found. In a slipshod way they may represent the character of the specimen examined and the ability of the man who did it, but they prove nothing either way. Even should they all die of consumption, as did my wife, it would not prove them to have had it at the time of the examination. Strong people have been known to take the disease, and the weak are surely much more liable to do so. I even believe that we may have a destruction of lung tissue to a great and perhaps to a fatal extent without its becoming tubercular, or even showing the characteristic bacilli. If such is the case, we must learn not to give too much weight to the value of a microscopic examination that does not reveal them. Even though repeated examinations have been made, with negative results, we are only presumptively better off. We are still agnostics so far as a possible tubercular condition is concerned. It may develop if it has not already done so, and it is simply foolishness to try and build up hopes on a foundation of ignorance, however permanent that foundation may be. On the other hand, we have no right to despair of our patients, even though we know them to be subjects of tubercular disease. If the reports of hospitals are true, one-half of all who die therein. have had it, three-fifths of whom having recovered, afterward died from something else.

I shall show you at least seven out of the thirty-seven reported in my last paper who are alive, and three of them in better condition than they were then. But thirty deaths out of thirtyseven patients is a pretty big mortality, and I would rather take the chances of a condemned murderer for life than those.

I think the cases which showed bacilli at my last report are of sufficient interest to merit individual notice, and, if you will bear with me, I will hastily review them.

CASE I. Maiden lady of 40. Is a maiden yet, and exceedingly vexed with me for placing her age so high, and not reporting her as perfectly well in my last paper. I should not dare to ask her how she was; but her neighbors have no fear of her dying for a good while yet.

CASE 2. Mill operative, who went to work upon a farm. For a time he seemed to be running down, but is now better than he was a year and a half ago.

CASE 3. Plumber (nobody can beat a plumber), whose sputa contained a few bacilli. He is decidedly better than he was two years ago.

CASE 4. Young married woman, reported to have a little dullness in the left lung. She has been living on a farm since, and apparently holding her own. She still coughs some, and, while quite comfortable, is not by any means well.

CASE 5. W. P. Reported as improving on calc. phos. and whiskey and sugar. Has spent his winters in Florida, but is now very slowly and surely running down.

CASES 6 AND 7. Both patients of Dr. Wilcox, of Willimantic, Ct., and both improving at time of my last report, one having gained fourteen pounds in weight in the three and a half months previous. Six months later saw them both in their graves.

CASE 8. Patient of Dr. Wilkins, of Palmer, in whom Dr. Clapp found a hardening of the apex of one lung. He developed no further symptoms of tuberculosis. Cough had disappeared before my last report, and he remains quite well.

CASE 9 I have been unable to hear from. He was a patient of Dr. F. L. Barnum, of Carlisle, Pa., and at last report was going down.

CASE 10. Nephew of Dr. Roberts, whose sputa was full of bacilli before his lungs showed any physical signs of disease. He picked up wonderfully in the Adirondacks, and returned to his home in Vermont nearly well. He continued comfortable for nearly a year from my first examination, but died in June of 1891, about a year later.

CASE II. Mrs. A., patient of Dr. Carl Crisand, of this city. Has enjoyed very good health since her illness in 1889, except during an attack of la grippe, which left her with a severe cough. In February she moved to Pennsylvania. The cough has left her entirely, and she has gained considerably in weight.

CASE 12. Patient of Dr. O. A. Palmer, of Warren, Ohio. He writes: "Patient died in about six months from the time of the examination, of consumption, after everything had been used to benefit him. He had been ill for about fifteen years with digestive troubles before he developed the fatal disease."

This, gentlemen, is the story of the patients last reported. There were twelve of them living then; there are only seven now. Tuberculin has been a failure, and all our efforts seem a failure when we recall our dead and lost.

I turn new to the histories of subsequent cases, all of which have been furnished me by physicians outside. I purposely refrain

from introducing any new cases of my own. This paper has already outgrown my expectations, and there is a limit even to a doctor's patience. I will be brief as I can without doing injustice to my friends; and right here I wish to thank all who have so kindly aided me. This production is not mine: it is their's, and they should have the credit of it. I have simply tinkered together their various contributions, and hope the undertaking will meet the approval of this board of health. The order will follow my necessity and convenience, and when the items are all in we will add up the account and see how it stands.

CASE 1. J. P.; young man of 21 years. Sputum examined Jan. 20, 1890. Though it contained bacilli, he has improved somewhat, and is now learning telegraphy; yet he is not well. CASE 2. C. A; age, 20. Sputa contained bacilli July 11, 1891. He had the usual ups and downs of the disease until last June, when he came near to being killed by a bolt of lightning. He was confined to his bed at the time, but has improved steadily ever since. Here is a hint for electricians. It is a very quick remedy, and little, if any, more dangerous than Koch's lymph. P. H. O. Irish. Bacilli found Oct. 7, 1891. still able to be about, but cannot work much, and will not probably recover.

CASE 3.

Is

CASE 4. Mrs. N. J. H.; age, 30. Died about a month after the finding of the bacilli.

All of the foregoing cases were patients of my brother, Dr. N. W. Rand, of Monson.

Next come the patients of Dr. P. R. Watts, of Stafford Springs, Conn.

CASE 5. Miss P. Has bronchitis, with emphysema. Sputa examined April 19, 1891. No bacilli present. She takes no treatment, and at present remains about the same as she was a year ago.

CASE 6. E. P.; age, 26. Bacilli found Sept. 17, 1891. He went to Colorado, from whence he writes that he is doing nicely, and expects to return home in a year or two, well. Please notice this case. If Colorado is not good for bacilli, we

all ought to know it.

CASE 7. Miss M. E. P. Bacilli found July 22, 1891. She died a few weeks later.

CASE 8. J. R. Bacilli found Oct. 4, 1891. He died a short time after.

CASE 9. F. G. B. Bacilli found Dec. 18, 1891. He also died. CASE 10. Dr. Charles L. Nichols, of this city, has reported on this as follows: "The case to which your date (Aug. 16, 1891) refers was one of undoubted tuberculosis coming on as a sequel to

chronic bronchitis, or the epidemic of influenza, two years ago. She passed into the hands of another physician at the time of my wife's illness, and died about two months later. My opinion regarding the value of bacilli as indications is governed by my very limited experience. I have seen death follow within a few months of the examination (not of the first existence) for bacilli in four cases, in spite of the treatment by careful homoeopathic symptom covering, accompanied by the plan of super-alimentation; and in spite of the recently vaunted kreosote treatment, as carefully tried."

CASE II. Our next report comes from Dr. W. H. Sawyer, of Boston. "Dear Doctor: The patient whose sputa you examined for me June 23, 1891, left town the following month, after which I did not see her. I have since learned that she died in November. The presence of bacilli in this case, to my mind, determined the nature of the disease. She had the general appearance of a tuberculous person, but physical examinations of the chest had given negative results up to July 14 (nearly a month after your examination), when I found a cavity in the left lung. Previous to her coming to me she had been treated at the Homoeopathic Dispensary, where she had been told that no trouble could be found with her lungs."

CASE 12. I have a word from Dr. F. E. Wilcox, of Willimantic, Ct., regarding this case, in whose sputa I found very many bacilli, June 20, 1891. "Dear Doctor: I am sorry I am unable to give you history of Mr. D. But he was not my patient; only came to me for a physical examination of lungs, my diagnosis and prognosis of his case. I diagnosed his case acute tuberculosis, and sent you the sputa, as a protection to myself possibly. You see, he had been under old-school treatment for bronchitis and dyspepsia, and I did not care to leave any loose ends in my diagnosis. He returned to the old-school lines with his information, and bronchitis, and died at 9 o'clock, P. M., Aug. 13, 1891. You came within three hours of being correct in your prediction of date of death. If he had had homoeopathic treatment, he probably would have covered that three hours and died on time.'

CASES 13 and 14. Specimens examined were not sputa at all, but pus from a diseased joint and fecal matter from a suspicious discharge. In neither of them did I find bacilli, and as a possible apology for myself in the first instance, allow me to quote the words of Friedlaender on this point. He says: "In tuberculous abscesses tubucle bacilli are naturally often observed, and they always possess a pathognomonic significance." On the other hand, they are not so invariably present as in pulmonary phthisis. Bacilli cannot be