170  New  Agent  in  Pulmonary  Tuberculosis.  ^Am-/p°^-^rm- 
a  few  exceptions  all  were  studied  according  to  the  following  routine : 
Each  was  observed  in  bed,  for  forty-eight  hours  before  beginning 
treatment,  during  which  time  two  hourly  records  of  temperature 
(rectal),  pulse,  and  respiration  were  made,  twenty-four  total  amounts 
of  urine  and  sputum  examined,  and  a  haemoglobin  estimation  and 
differential  blood  count  made,  in  addition  to  a  complete  physical 
examination.  Thereafter  temperature  (rectal),  pulse,  and  respira- 
tion were  recorded  every  twenty-four  hours  or  twice  daily,  weights 
were  taken,  twenty-four-hour  total  amounts  of  urine  and  sputum 
examined,  and  a  haemoglobin  estimation  and  differential  blood  count 
made  weekly.  Twenty-four-hour  total  records  were  also  kept  of 
urine  and  sputum  daily.  Physical  examinations  were  made  at  fre- 
quent intervals,  and  at  least  once  a  month.  The  patients  were  in 
bed  or  up  and  about,  as  their  temperatures  or  general  condition  re- 
quired, and  no  other  treatment  was  given,  except  cathartics,  and 
heroin  or  codeine  occasionally.  In  some  instances  an  iron  prepara- 
tion was  used  to  study  the  behavior. of  the  haemoglobin.  The  diet 
consisted  of  three  wholesome  meals  daily,  and  one  raw  egg  in  one 
glass  of  milk  twice  daily.  Partly  through  circumstance,  partly  with 
the  design  of  checking  up  and  controlling  results,  the  period  of 
observation  was  divided  into  three  epochs :  the  first,  for  three 
months,  in  the  city ;  'the  second,  for  two  and  one-half  months,  in  a 
sanatorium  in  New  York,  at  an  elevation  of  1500  feet ;  and  the  third, 
for  three  months,  in  a  sanatorium  in  New  Jersey,  at  slight  (500  feet) 
elevation.  During  these  epochs  an  opportunity  was  afforded "  of 
observing  and  contrasting  the  effects  of  ideal  sanatorium  regime 
without,  and  also  with,  oxypinene  treatment.  In  no  other  respects 
were  the  routine  and  conditions  of  observation  varied.  During  the 
first  epoch  treatment  was  given  continuously,  with  only  sufficient 
open  air  for  proper  ventilation,  and  several  of  the  patients  had  no 
direct  sunlight,  their  windows  opening  on  a  court.  During  the  second 
and  third  epochs  treatment,  when  given  at  all,  was  continuous  during 
the  night,  and  for  periods  of  from  one  to  two  hours  twice  during  the 
day,  the  remainder  of  the  time  being  spent  in  the  open  air.  The 
blood,  sputum,  and  urine  examinations  were  made  by  the  Lederle 
Laboratories,  the  Higgins  Laboratories,  and  by  my  assistant  and 
resident,  Dr.  W.  A.  Glanville.  While  there  is  probably  some  varia- 
tion of  results  because  of  differing  personal  equation,  they  have  been 
so  checked  up  as  to  make  this  negligible,  and  in  Cases  XX  and  XXI 
all  these  examinations  have  been  made  by  the  same  examiner. 
