homogeneous jelly like layer, the thickness of which gradually diminishes until the fibre lies bare (Fig. 8.) The clubs stain easily with aqueous fuchsin solution, but they give up the color at once to alcohol. They are not stained by Gram's method, nor have I been successful in demonstrating nuclei either in clubs or hyphae by acetic acid or any nuclear stains.

After having once seen these structures I found them very frequently in tuberculous sputa and in these alone. I can now state with certainty that they occur in 30 per cent. of all cases where elastic fibres are demonstrable, whilst if one considers only those cases where rapid decay of lung substance is in progress the percentage is far higher (75-80 per cent.) Occasionally one sees only a few clubs upon a fibre, or on the other hand one finds a large meshwork of tissue 5 m. m. in diameter covered over and over with the fungus and presenting, even with a half-inch objective, so striking a picture that it seems inconceivable that it should have escaped the attention of so many careful observers.

I come now to other structures which stand I believe in genetic connection with those already described but which are met with far less frequently. With the view of ascertaining if possible whether the growth is to be regarded as a parasite on the pulmonary tissue or as a merely accidental inhabitant of cavities, I examined with the greatest care every particle of caseated tissue that came into my hand, and in every case (some twelve in all) I found the clubs present, generally in large numbers and indicating by their position that they had grown on alveolar fibres. Often enough, however, one sees only botryoidal masses of clubs and short hyphae which appear to have grown free in the mass of tubercle bacilli and disintegrated cells that constitute the cheesy mass. Sometimes a group of clubs radiate from a common centre and then present a most remarkable likeness to actinomyces "stars" (Fig. 7.) Besides all these structures, however, there occur in the caseated nodules, without exception as far as I have seen at present, structures whose appearance I can here compare with ears of wheat or barley (Fig. 10.) Sometimes these are present in such numbers that they penetrate the mass in all directions, either singly or in groups. I was long doubtful whether they were in any way connected with the clubs until I had the good

fortune to find various transition stages from the one to the other, and I now regard these "wheat ears" as the direct outgrowth of the clubs. Generally they are embedded so deeply in the detritus that one sees only an indication of their form, at best one sees a few spikes projecting from the edges. If one, however, takes a tiny particle of cheesy tissue, teases it finely in normal saline solution and presses it carefully under a cover-glass, one gets now and then a favorable preparation in which the structures can be seen freed from adhering detritus and even quite isolated (Fig. 10 c.) They consist of an indistinct granular central core thickly set with faintly refracting tapering bridle-like processes, so that the whole has a very striking resemblance to an ear of barley. The free ends of these processes are sharply defined, but towards the core they become indistinct. They behave towards stains just as do the clubs, but it is very difficult to obtain good permanent preparations. It is noteworthy that they occur only in the caseous masses-not in the purulent contents of cavities. The contours of all these structures are extremely faint and it requires very careful inanipulation of the sub-stage illumination to see any details. Where their position is least disturbed by pressure of the cover glass one can see occasionally that they arise from the clubs (Fig. 10 f.) Figs. 11-13 show structures which I regard as transition stages between the two. One can often see little tufts of bristles which do not possess the typical awn-like appearance, and it is just these which throw light upon the relations between the clubs and awns. A club grows out at its free end into one or several stiff pointed spikes; the "barley ears" must therefore be regarded as the outgrowth of a collection of clubs.

Up till the present time I have made but few attempts at culture. Since it is impossible to separate the growth from the embedding mass of bacilli, I have made use mostly of acid media but only in one case with any success. I had planted some particles of caseous tissue (after ascertaining that it contained the clubs in large numbers and typical form) on sterilized bread. After about a week at 37 degrees C. I could see no signs of growth, but on microscopical examination I found that the clubs had for the most part grown out into short hyphae, without, however, spreading out onto the nutritive medium.

Sections through caseous tissue throw no light upon the structure of the fungus. A distinct lumen is not visible and there are no signs of the segmentation seen on the untreated hyphae. From the fact that the elastic fibres attacked by the growth are always thickly coated with pus cells and their disintegrated remains, it would seem probable that the organism is progressive in its action. It is this detritus that makes investigation so difficult and renders it easier to see the structures more easily in unstained than in stained preparations. In view of the imperfection of the methods of preparation I have as yet employed and of the small success of cultures, it would be premature to discuss the probable systematic position of the fungus and the morphological import of its various forms.

All the above observations were made in Europe. Up to the present I have examined in Colorado but one case in which active destruction of lung substance was in progress, and in this case the clubs were abundantly present.

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of the efficacy of any remedy is the physician himself. Should he not, therefore, have the privilege of prescribing what he thinks will most benefit the patient? When he so prescribes, is it not to his interest, as well as that of his patient, to see that the remedy he prescribes is actually dispensed? Insist, Doctor, that when you prescribe Lactopepine that a worthless substitute is not imposed upon your unsuspecting patient.

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