cough and expectoration. Stomach condition good. Bowels regular. Sleeps well. Examination of sputum for tubercle bacilli negative. Pirquet test positive.

Moist rales over right upper lobe, with hyperresonance over left upper lobe.

The radiographs show extensive involvement of the lungs, the infection apparently coming in through the root of the lungs. There are two cavities in the upper part of the left lower lobe, and three in the right lower lobe. The heart is markedly enlarged, a cor bovinum. It is remarkable that this patient was examined by several physicians, men accustomed to physical examination of the chest, without noting the enlarged heart. The finding of the radiograph in this regard was readily confirmed, but the condition of the heart had previously been entirely overlooked.

Case XIII. Patient became run down, tired out, with loss of appetite, loss of weight, night sweats. Was told that he had tuberculosis six years ago.

Hebrew, male, aged 28 years, single, admits use of tobacco, has worked as janitor and previously in a factory. Gave up work two weeks ago. Was delicate as a baby and sickly as youth. Weight 147 pounds. Born in Russia, in United States 10 years, Los Angeles 5 years.

Tires easily, appetite good, suffers chest tightness and pain, especially in the back. Takes cold easily. Cough hard, especially at night, described as a tickling in the throat. No expectorаtion. Complains of chilliness and hot flushes. Has had night sweats for the past year. Constipated. Shortness of breath on walking. Blood spitting six years ago. Sleeps well.

which has gradually become worse for the past 17 months. Complains particularly of cough and expectoration. Had mumps one month ago.

American, female, aged 33 years, married, has had to give up her work as housewife. Previous health good. Weight 1602 pounds. Born in Kentucky, in Los Angeles 18 months.

Tires easily, appetite variable, complains of chest soreness, tightness and pain. Takes cold easily. Cough hard, worst at night. Expectoration white, worst at night. Complains of chilliness and hot flushes. Night sweats. Eructations of gas and soreness in the epigastrium. Bowels regular. Four months advanced in pregnancy. Has had seven children, all in good health except some throat trouble. Shortness of breath on walking. Blood spitting four weeks ago. Sleep poor. Hoarseness and sore throat.

Brunette of good development. Some enlargement of cervical and submaxillary glands. Tongue clear. Examination of sputum for tubercle bacilli negative. Pirquet test positive.

Inspection reveals retractions, depression, with lagging motion of the entire upper part of the chest. On palpation there is muscular resistance and vocal fremitus is increased over the upper part of the chest. Percussion shows hyperresonance over both upper lobes, anteriorly and posteriorly. Auscultation: Bronchial breathing over the upper lobes, to third rib anteriorly and fourth vertebra posteriorly, with a friction sound beneath the fifth rib in the nipple line.

The plates show bronchiectasis, especially marked dilatation of the bronchus in the right lower lobe. There is

There are numerous tubercles in both upper lobes, shown on the plates, and marked thickening of the bronchi in the right lower lobe.

Case XIV. First noticed weakness,

uper lobe. The heart is dilated.

Case XV. The first symptoms were heaviness in the chest and hemoptysis. Hebrew, male, aged 30 years, single, salesman, gave up work six weeks ago. Health fair until adult life, the poor. Highest weight within the year 134 pounds, average 125, lowest 114, today 1231⁄2 pounds. Born in Russia, in United States ten years, California one year, Los Angeles two months. Brother-in-law had lung trouble, and they lived together three months.

Tires easily, appetite fair. Pain in chest. Temperature 98.6° F. Constipated. Shortness of breath. Last blood spitting seven months ago. Sleep fair. Pirquet positive.

Percussion revealed dullness over both apices, anteriorly to the third rib on the right and to the fourth rib on the left side, and posteriorly to the fourth vertebra. Broncho-vesicular respiration found on auscultation.

The plates show thickening of the hilus shadow. The bronchi in the upper lobes are thickened. No cavities.

Case XVI. First noticed spitting of blood, later loss of weight and also of appetite. At present suffers chiefly from a tired feeling.

a

White, male, aged 29 years, single, has been doing light labor and formerly worked in kitchen. Temperament cheerful. Health good until adult life, and since has been fair. Highest weight within year 143 younds, average 140, lowest 127, today 1342 pounds. Born in Denmark, in United States six years, California four years, Los Angeles one year. Sister died of tuberculosis, and mother also had lung trouble.

Tires easily, appetite not good. Sometimes has pain over lower part of chest. Cough and expectoration. Temperature 98° F. Says he had night sweats two weeks ago. Eructations of gas. Constipation. No blood spitting since last summer. Sleep is poor.

White, blonde, of good development, with slight enlargement of the cervical lymphatics. Tongue coated. Pirquet positive.

On the plates, there is shown a tubercle in the lower part of the left upper lobe, beside two small cavities.

Case XVII. First noticed weakness and cough.

American, male, 56 years old, divorced, carpenter. Previous health good. Highest weight recently 175, today 130 pounds. Born in Ohio, in Los Angeles nine years.

a

Tires easily, appetite variable. Chest soreness. Takes cold easily. Has loose cough with expectoration. States that he has hot flushes and night sweats. Constipated. Has three children. Shortness of breath. History of blood spitting. Sleeps well. Sputum contains tubercle bacilli. Pirquet positive.

The plates show marked tuberculosis. There is a large cavity, nine centimeters in diameter when the chest is distended in deep inspiration. This is the only cavity. Its walls are thick and apparently well formed.

Case XVIII. First noticed tickling in the throat, irritation, followed by a cough and little expectoration. Has been under treatment in the throat clinic for tuberculous laryngitis.

White, male, aged 34 years, single, electrician, gave up work six months ago. Previous health good. Weight 1341⁄2 pounds. Born in Germany, in United States 32 years, Los Angeles two years. Mother died of tuberculosis eight years ago, and brother has lung trouble.

Appetite variable. A little cough in the morning. No expectoration. Condition of stomach good. Bowels regular. Sleeps well. Hoarseness and sore throat, with history of loss of voice.

Brunette, good development, cervical glands enlarged. The mouth is not in good condition, and the tongue is coated. Pirquet test positive. Some retraction of the apices and lagging motion of the chest noted on inspection. Palpation detected muscular resistance. On percussion, dullness was found over the right apex down to the second rib in front. Auscultation revealed hyperresonance and exaggerated bronchial breathing over the right apex, to the second rib in front and the third vertebra posteriorly.

The plates show involvement of both upper apices, and to a lesser degree of the right lower lobe. No cavities.

Case XIX. First noticed a slight cough six months ago.

White, female, aged 23 years, single, nursing a child until ten days ago. Previous health good. Highest recent weight 117 pounds, average 113, lowest 972, today 971⁄2 pounds. Born in Chicago, in Los Angeles three years.

Does not tire very easily, appetite good. Takes cold easily. Cough and expectoration, worst in the morning. Condition of stomach good. Has been constipated since in California. Menstruation regular. Throat hoarse and sometimes sore.

A demi-blonde, of fair development, with slight enlargement of the cervical lymphatics. Pulse regular, of good tension and volume. Sputum contains tubercle bacilli. Pirquet positive.

There is increased muscular resistance on palpation. Diminished vocal fremitus over the left apex. Dullness over the upper part of the left apex, in which region there is roughened respiration upon auscultation.

The plates show thickened bronchi in both upper lobes, and thickening of the hilus shadow. There are five small cavities in the right upper, and six in the left upper lobe, the largest not quite as large as a pea.

Case XX. The first symptom was hemorrhage.

White, male, aged 29 years, single, admits the use of tobacco, gave up work as gardener three weeks ago. Has depression of spirits at times. General health good up to sixteen years of age, since which time it has been poor. Highest weight within a year 160, average 150, lowest 141, today 1472 pounds. Born in Massachusetts, in California four months, Los Angeles three weeks. Father died of tuberculosis, and

he has a brother and two sisters with lung trouble.

soreness

Tires easily. Appetite good. Chest and tightness. Takes cold easily. Has a cough with night spells, but there is not as much expectoration now as formerly. Last night sweat about three months ago. Condition of stomach good. Bowels regular. Shortness of breath. Last blood spitting five months ago. Sleeps well. Hoarseness and sore throat.

Examination of sputum for tubercle bacilli negative. Pirquet positive. Percussion apparently shows fibrosis of the right upper lobe. There is hyperresonance down to the second interspace anteriorly on the left, with moist rales below down to the fourth rib.

The plates show general bronchiectasis. There is a cavity the size of a pigeon's egg in the right upper lobe.

CONCLUSIONS

1. No antemortem examination of the chest is complete without the use of the X-Ray.

2. The use of the radioscope is convenient and helpful, but will fail to recognize many lesions that may be recorded upon plates.

3. The X-Ray examination shows the location, extent and character of lesions more accurately than any other method at our command.

4. Small lesions, as well as large, do not need to be near the surface in order that they may be radiographed.

5. Many excellent diagnosticians would do better work if they were better radiologists.

6. X-Ray inspection of the heart and lungs, through greater accuracy in demonstrating lesions with precision, should encourage more rational treatment of affections of these organs.

7. It would add much to the health and longevity of our patients, were they subjected to thorough physical examination periodically, with the aid of the laboratory and the X-Ray.

1414 South Hope Street, Los Angeles, Cal.

ANCIENT MEDICAL HISTORY The Bulletin of the Los Angeles County Medical Association for July 17th contains the following:

Articles of Incorportaion
of the

Los Angeles County Medical Association Know all men by these presents, that we, the undersigned, have this day associated ourselves together for the purpose of incorporating, under the laws of the State of California, a corporation to be known by the corporate name of "The Los Angeles County Medical Association.'”

And we hereby certify that the objects for which this corporation is formed, are:

1. The cultivation and advancement of the science of medicine by united exertion, for mutual improvement, and contributions to medical literature.

2. The promotion of the character, interests and honor of the fraternity

by maintaining the union and harmony of the medical profession of the County of Los Angeles, and aiming to elevate the standard of medical education.

3. The separation of regular from irregular practitioners.

4. The association of the profession proper for purposes of mutual recognition and fellowship.

5. In pursuit of these several objects to avail ourselves of the provisions of Titles One and Twelve of Part Four, of the Civil Code of the State of California.

That its principal place of business shall be in the City and County of Los Angeles, California.

That the time of its existence shall be forty-nine years from and after the date of its incorporation.

That the number of its Trustees shall be seven, and that the names of those who shall be Trustees and serve as such officers the first year, and until the election of their successors and their qualifications, are

lung trouble.

Tires easily. Appetite good. Chest soreness and tightness. Takes cold easily. Has a cough with night spells, but there is not as much expectoration now as formerly. Last night sweat about three months ago. Condition of stomach good. Bowels regular. Shortness of breath. Last blood spitting five months ago. Sleeps well. Hoarseness and sore throat.

Examination of sputum for tubercle bacilli negative. Pirquet positive. Percussion apparently shows fibrosis of the right upper lobe. There is hyperresonance down to the second interspace anteriorly on the left, with moist rales below down to the fourth rib.

The plates show general bronchiectasis. There is a cavity the size of a pigeon's egg in the right upper lobe.

CONCLUSIONS

1. No antemortem examination of the chest is complete without the use of the X-Ray.

2. The use of the radioscope is convenient and helpful, but will fail to recognize many lesions that may be recorded upon plates.

3. The X-Ray examination shows the location, extent and character of lesions more accurately than any other method at our command.

4. Small lesions, as well as large, do not need to be near the surface in order that they may be radiographed.

5. Many excellent diagnosticians would do better work if they were better radiologists.

6. X-Ray inspection of the heart and lungs, through greater accuracy in demonstrating lesions with precision, should encourage more rational treatment of affections of these organs.

7. It would add much to the health and longevity of our patients, were they subjected to thorough physical examination periodically, with the aid of the laboratory and the X-Ray.

SOUTHE
PRA

A MEDICAL, CLIMATOLOGIC
This journal endeavors to
and Arizona.

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Dr. Walter Lindley, Dr. W. Dr. Cecil E. Reynolds, Dr Dr. H. D'Arcy Pow Dr. Olga McNeile Address all communications Suubscription Price, per annum, $1. EDITOR SOUTE

ANCIENT MEDICAL HI

The Bulletin of the Lo
County Medical Association
17th contains the following

Articles of Incorporta
Los Angeles County Medical
of the
Know all men by these pr
we, the undersigned, have t
sociated ourselves together f
pose of incorporating, unde
of the State of California,
tion to be known by the
name of "The Los Ange
| Medical Association.”

And we hereby certify t
jeets for which this
formed, are:

1. The cultivation and a of the science of medicine b ertion, for mutual improv contributions to medical lit

2. The promotion of th interests and honor of th