86 THE MICROSCOPE. June ; 
sound, on right . side... Diagnosis — Fibro-tuberculosis, 
first stage. Treatment—To use the inhaler, because of 
the bronchitis and mixed infection and to go to the 
mountains. 
Commenced tuberculin (Koch’s) September 9, with 
ultimately gradually: increasing intervals: between the 
injections,’ The reactions were light and only occurred 
after a few of the smaller doses. About 60 milligrams 
as A maxinium dose ‘was reached. The sputum cleared 
up (the germs disappearing) and before Dec. 19 ceased 
altogether. 
Up to February 7, 1896, the lung condition continued 
most favorable, but ‘the tubereulosis had not been 
wholly eliminated from his blood, for a small abcess then 
came underneath the scalp above the forehead, the pus 
from which was found to contain tubercle bacilli. These 
conditions both improved under drainage, the renewal of 
tuberculin and ‘the- administration of hypophosphites 
with hydriodie acid. 
“April 15, .1896-—-Dr. J. J. Powers operated on the 
right elbow and we found, as we expected, necrosis of 
the ulnar (both front and back sides of it near the end), 
the joint; perhaps, just escaping. A conservative plan 
was decided upon—to rather freely expose and. scrape the 
diseased bone, after which the wounds were thoroughly 
packed with iodoform gauze. ron 
June 13— The dressings were continued until the — 
wounds had healed by granulations from the bottom. 
During the time of and’ preceeding the operation on the 
elbow for three or four weeks, no tuberculin was given, 
and it was during this period when the necrosis of the 
ulnar was well under way, that the first blood examina- 
tion—namely, that’ of April 11—was made by Dr. Holmes, 
indicating, as he stated, a’ serious inflammatory state 
of the blood and some bone affection— i. e., “an excess 
of bone’ marrow or spleen activity.” | 
