ninety-five pounds; the babe, ten. One-half hour after the delivery of the placenta, the mother ate a good meal of beefsteak and a small portion of bread. A few weeks ago I heard from her, that this second child, which she called the "meat-baby," had done much better than the first; that she had plenty of milk for it and was in good health. The mother and child reside in New York City.

MORPHOLOGY OF THE SPUTUM IN ASTHMA.

The following in quotations is from the work entitled, "The Clinical Morphologies," by Ephraim Cutter, M. D., LL.D.; published by the author, New York:

"Cholesterin; cystin; oxalate of lime; phosphate of lime; triple phosphates; uric acid and urates; calculi made up of the salts; contents of giant cells escaped outside of walls; crystals with two or more terminals; foreign substances inhaled; fusiform crystals; gravel crystalline, gravel granular, gravel massive.

"Mucous corpuscles distended with albuminoids; with crystalline and other bodies; with cystin; with giant cells; with melanotic matters; with oxalate of lime; with triple phosphates; with uric acid and urates.

"Other crystals whose names have not been made out. Spirilina splendens, Salisbury, 1865.

The therapeutical indication from this morphology in asthma is to feed the cases so that there will be the minimum of fermentation and thus stop the paralyzing action of the carbonic acid, etc., on the eliminative glands; give tonic and liquefying medicines, and if the case is watched closely, and will follow the orders to the letter, a cure may be expected in time. It hardly needs to be said that bacteriology is far behind clinical morphology because it can only treat of bacteria, yet clinical morphology is able to show physical causes of the asthma and hay fever.

THE MORPHOLOGY OF THE BLOOD.

MODE OF STUDY.-"It is necessary to have the patient, the light, the means of withdrawal of the blood-a lancet, spring lancet, the sacrificator of the writer, (E. Cutter) or a needle, which is not the best thing-all together.

"There is no such thing as taking the blood home to examine. The changes are so rapid that most of the important ones disappear in ten minutes' time. Still, after these are gone, many valuable points remain to be looked for.

2

KIND OF BLOOD.-The capillary-not the venous or arterial.

"SITE OF WITHDRAWAL.-On the radial or ulnar side of the forearm near the wrist. The skin should be clean and free from soap. If dirty, wash with soapsuds or ammonia water. (It is well that the beginners should study the skin surface, dirt and epithelium, before looking at the blood.) Take the patient's forearm in the hand, and make the skin tense in the interval between thumb and forefinger. A quick puncture is then made, about one-eighth of an inch deep. The tension of the grip will squeeze out a drop of blood. The size of the drop should bear direct relation to the size of the cover. Very much depends on handling the drop rightly. When the drop evenly diffuses itself, it is presumed that the film is about uniform in thickness, so that one can judge somewhat as to the comparative number of corpuscles in each specimen. The process of transferring the blood should take only a few seconds of time; a fraction would be sufficient.

"MORPHOLOGY OF THE BLOOD IN HEALTH.

"COLOR.-Bright, fresh, clear, strong. "CLOTTING.Rapid and firm.

"RED CORPUSCLES.-Arrange themselves in nummulations, or are scattered evenly over the fields. Normal in size. Non-adhesive. Central depression well marked on both sides; periphery well rounded, clean cut. Hold coloring matter firmly. Pass readily to and fro the febrin filaments; appear fresh and fair.

"WHITE CORPUSCLES NORMAL IN SIZE. -Not enlarged by internal collections of foreign bodies. Amoeboid movements strong or not. Proportion, one to three hundred of red corpuscles. Consistence good. Not sticky. Color a clean white. Freely moving at will.

After

"SERUM.-Clear and free at sight from any form. five minutes, most delicate, semi-transparent fibrin filaments appear, forming a very light network in the field, which offers no obstacle to the passage of the corpuscles.

"There should be no spores nor vegetation in healthy serum, though they may be found by very minute examination, or by letting the blood stand for several days in closely stopped phials at a temperature of from 60-75° F. This is not saying that spores and filaments can not be found in blood of persons calling themselves healthy-for some dis

eases exist in a latent condition, like rheumatism, syphilis, cystinæmia and consumption. I have met with people who, on finding vegetations in their blood, have decided not to accept the evidence because they deemed themselves healthy. Again, it is difficult to find a perfectly healthy person in the community; this was made public during the 'late unpleasantness,' when drafts were made for soldiers. The blood evidence must be taken in connection with that of other physical signs.

"MORPHOLOGY OF THE BLOOD IN RHEUMATISM.

"Rheumatism may be called the gravel of the blood. "Color varies from that of health to the paleness of anæmia.

"Consistency and rapidity of clotting increased.

64

"Red corpuscles. Color usually impaired, not always. Adhesive, sticky, often drawn out into elongated lozenge-shaped bodies with pointed ends, and sometimes filaments joining with one or more of their fellows.

66

Clot in winrows, ridges and huddled masses; sometimes quite formless. This is caused by the massive febrin filaments holding them fast, as it were, in their firm meshes. The same thing is seen in consumptive blood, but to a less degree.

"White corpuscles usually enlarged; adhesive, sticking to each other and to the red corpuscles, and matters found in the serum. Indeed, it seems to be the office of the white corpuscles so far as possible to swallow and envelop any foreign substance that may find its way into the blood. Thus we find crystalline matters in the white blood corpuscles in rheumatism, though not always.

"They undergo amoeboid movements as in healthy blood -they have independent locomotion. Disease does not seem to impair their automatic movements.

Often they are increased in number. If there is fatty degeneration going on, they will be found to contain fat in globules.

"The serum.

"Fibrin filaments in massive, strong and sticky threads, in abundance-in meshes, which are finer than in health, visible plainly-strong, and hold the red corpuscles like prisoners-in skeins, like tangled skeins of silk-in masses forming thrombi, which, when fastened, form emboli.

46

'These thrombi are apt to involve and embrace white

and red corpuscles and crystalline bodies to be named below. Sometimes the fibrin filaments are found in large round strings, curled up fancifully by the motion of the blood stream, and looking like the mycelial filaments of vegetations, from which they can be distinguished by the absence of entire cylindrical outline-ragged broken edges here and there and dichotomcus and polychotomous divisions of the trunk, differing from vegetations of syphilis for example. It is the presence of these fibrin filaments that makes the blood ropy, adhesive and sticky. They have the tendency to block up the blood stream, and besides to be locally deposited in the tissues specially when the circulation is sluggish, as near the extremities and the joints.

CRYSTALLINE BODIES, OR GRAVEL OF THE BLOOD.— These are numerous and readily recognized; some of them are as follows:

"I. Uric acid and urates of soda.

"2. Phosphates-especially the triple phosphates of lime and soda.

"3. Oxalate of lime.

"4. Cystine. This quite common and easily detected. "5. Carbonate of lime, rare. "6. Stelline and stellurine. These occur mostly in granular form in the serum, but in old cases, where the system is saturated, they are crystalline.

"7. Black, brown, aniline blue, bronze, orange, red and yellow pigments in the form of flakes or small masses are common in rheumatic blood, and may be termed gravelly matters that should have been eliminated by the kidneys or bowels or skin.

"LATENT CONDITION OF THE CHARACTERISTICS OF RHEUMATIC BLOOD.-The morphology of rheumatic blood exists. in a latent condition in persons apparently well; but when they are exposed to cold, the blood-vessels contract, catch and detain these abnormal elements, and we have a stasis of the blood which may be active or passive, and manifests itself in heat, fever, pain, swelling, inflammation or passive congestion, effusion, etc., and which make up what is known as an attack of rheumatism.' The fever may result from the effects of nature to get rid of the intruders, just as a householder will become hot in expelling from his premises a thief whom it is difficult to remove. Or, to use other simili, the attack of rheumatism is like the explosion of a gun. The charge in the gun is the morphology of rheu

matic blood, and the cold is the pulling of the trigger. The charge may be latent in the gun for years, but is there with its potential energy ready to become actual from an exciting

cause.

“Fibræmia is where the fibrin is in excess in filaments, skeins, curled massive fibers like strings-thrombi and emboli. These are in a more exaggerated condition and form than in consumption or rheumatism, and are not necessarily associated with the crystalline matters or gravel. Sometimes the fibers look like a scalp that has been taken from the head of a woman with long tresses of hair.

"Thrombosis is where masses of fibrin accrete and consolidate together, including or not the red corpuscles, white corpuscles, crystalline and pigmentary bodies, spores and mycelial filaments or vegetations, one or all.

64

Embolism is where a thrombus has been caught or engaged in a blood-vessel and acts as a plug disturbing the circulation.

66

PRE EMBOLIC STATE.-As thrombi precede emboli, so they can be detected in the blood before the embolism, simply by the morphology of the blood. In this way sudden deaths from embolism, especially in the puerperal state, can be averted."

Here again we have a subject which bacteriology can not. touch, as the morphology of the blood in rheumatism shows the causes of the inflammation, pain and deposits to be purely physical and chemical.

Dr. Asa F. Pattee, of Boston, told us at the last meeting of the American Medical Association that he had had gout for years, and accepting the popular idea, he chewed beef and ate vegetable food mainly. Finally he changed his ideas and ate beef largely, with the result that his swollen joints are decreasing in size. I see that the English writers are beginning to think that beef does not have so much todo with the cause of gout. Indeed, beef has had many sins that other foods should have borne the complaint of, laid at its door. Stop the Englishman from eating his puddings, pastry and sweets, and feed him on beef rightly prepared, and I think he will have less gout. The morphology of the blood in these old cases of gout is very interesting and beautiful. One case I examined several years ago, had a most remarkable display of crystals of cystine.

A lady has recently come under treatment who had been for three summers at one of the large sanitariums of the