more to him than any other treatment.

We want no better evidence of

the uncertainty of treatment than its wide range. He reported the following case in advocacy of Dr. Winn's early induction of labor. The patient was short and fat. In the morning there was one pain, and the bag of waters broke. In the early night she was very nervous, but recovered, and labor went on slowly, there being progression and recession. Suddenly there was a terrific convulsion. Chloroform was administered, and she laid in stupor so long that it was hard to tell when the stertor of the convulsions stopped and that of chloroform began. The uterus was emptied, and the patient recovered consciousness; and is now doing well. He did not mean to say that this sustained in toto the treatment. Albumin was never found.

Dr. W. S. Beazley described the following case, a II para. On reaching it he found labor far advanced, with no untoward symptoms, and everything went on normally. He left the house, but in two hours, having been sent for, he found the patient in a hard convulsion, which passed off in a few minutes. She did not regain consciousness, and, in a half hour, went into a second attack. Enemata of bromide of potassium and chloral were given, and chloroform administered, but to no avail, as she grew worse and died. There were no convulsions with the first labor.

Dr. Upshur, in conclusion, remarked that he wished to say that Dr. Oppenhimer had gotten the cart before the horse. The digestive symptoms of which he spoke, and the consequent accumulation of gas, were due to an attempt on the part of the stomach and bowels to relieve the system by vicariously eliminating effete matters which should go off by the kidneys; the irritation thus set up caused the indigestion and consequent flatus. The frequent vomiting, the renal asthma, etc., which we see in several forms of Bright's disease is illustrative, the mucous lining of the stomach and bowels, and bronchioles, seeking to help the kidney. The pregnant woman's blood is in a condition of increased plasticity; there is over-nutrition and over-stimulation of the kidney; it thus fails in its eliminative function, and the presence of albumin in the urine is the external manifestation of this condition; toxic matters remain in the blood, poisoning the nervous system, and find expression in a convulsive explosion when the proper reflex comes, from an overloaded stomach, or the pains of labor.

ABSTRACTS.

WIDAL'S SERUM TEST IN THE DIAGNOSIS OF TYPHOID FEVER.

We have already published an article referring to this, but the great importance of all to do with typhoid in India, leads us to notice now a full review of the subject published in the Journal de Médecine de Paris.

Widal's test is founded on the observations of Pfeiffer and Koll and of Max Gruber, who had remarked that the serum of animals immunized against typhoid, and of man convalescent from typhoid, when mixed in vitro with a culture of Eberth's bacillus, has a reaction enabling us to distinguish that germ from coli-bacillus.

Widal describes the reaction as follows: "If tubes of bouillon be "sown" with Eberth's and with the coli-bacillus separately, and if a few drops of the serum from animals strongly immunized against typhoid infection, be then added to each tube and the tubes be then placed in a stove at 37° C., the following is seen to occur: During the four or five first hours the coli-bacillus bouillon becomes "troubled," while that containing Eberth's bacillus remains almost clear. At the end of 24 hours the contents of the tube "a coli" is seen to be strongly troubled throughout, while that containing Eberth's bacillus is very little troubled, if troubled at all, and the microbes in it are seen to be precipitated in the form of flatus or white pellicules at the bottom of the tube. A drop of the coli-bouillon examined then under the microscope, will show the bacteria quite separate from each other, and for the most part very mobile, while in a drop of the Eberth's bouillon will only be seen disjoined agglomerations of immobile, deformed microbes, glued to one another. "It is this formation of a precipitate visible to the naked eye, this inoculation, agglomeration and distortion of the contained microbes that is the distinguishing feature in the test."

Widal, then, put this reaction to a clinical use. For this but little in the way of instruments or appliances are required. Dieulafoy has said: "It is only necessary to have a pure culture of Eberth's bacillus in bouillon -and that will keep for weeks-a microscope with immersion lens and a few drops, or even one drop, of serum from the blood of the person tested."

The simplest way of operation is as follows: The palmar surface of the finger end of a patient is aseptically cleaned, and pricked then with some instrument previously sterilized. Any blood that exudes should not be allowed to flow over other parts of the finger, but should be received directly into the "sown" bouillon, in the proportion of one drop of the blood to six drops of the bouillon. This proportion,, seems the best, but

one of blood or serum in sixty of the bouillon has been found to give excellent results.

That, then, is the method at its simplest; but modifications have been proposed, giving more defined results and yet not losing much of this simplicity.

For instance, it has been found better to test the serum instead of the blood complete, and for that, instead of receiving the blood directly into the germ-bouillon, we collect it in a sterilized test tube. The serum which separates almost at once we draw off then, with a sterilized pipette, and we use one part of that serum to ten of the germ-bouillon as before described. Again, instead of blood serum, we may use the serous flow from blisters. Widal and Sicard obtained equally good results with that.

As to the period of the malady at which the serum is capable of giving this indication, Widal, though he had seen it on the fifth day, tells us that we must not depend upon it before the seventh or eighth day, and that from then it continues throughout convalescence.

Exceptionally it is seen in individuals who have been for a long time cured of the fever. Widal found the reaction in two persons who had suffered from very severe typhoid, three and seven years before, respectively. It is necessary to remember this, but given the rarity of multiple attacks, such occasional occurrence is really of small importance.

In all cases for this test, two bouillon cultures should be used to only one of which the serum is added, while the other is kept for comparison.

Widal states: "If on microscopical examination at first, I see groups of confluent bacteria distributed throughout the preparation, resembling islets in an archipelago, my diagnosis is made. If, however, the appearance is not at once characteristic, or if I find isolated moving bacteria, I leave the mixture to be examined again after some hours, as by then frequently the phenomenon, though not declared at first, has become most distinct. If results are negative, I repeat the test at intervals of a few days, so long as the symptoms last."

With very old cultures, even a few days old, it is well to renew them by sowing again in a pure bouillon. In less than twenty-four hours then, these new bouillon cultures will have become sufficiently "troubled" to give the reaction plainly and at once, upon addition of a typhoid serum.

The cause of this reaction is still under discussion. As to its clinical value we conclude by quoting Widal again: "A negative result obtained with the serum of a patient gives probability against a diagnosis of typhoid. This is only probability, however, and is least to be depended on when the test is applied during the first few days; and the examination should always be repeated at intervals."

"An" agglutination "obtained with the serum of a patient without history of previous affection is a certain sign of typhoid fever.”—Indiana Medical Record.

ON THE DISINFECTING ACTION OF SODIUM HYPOCHLORITE.

By E. KLEIN, M.D., F.R.S.,

Lecturer on Physiology at St. Bartholomew's Hospital.

In the Journal of the Society of Chemical Industry, Vol. XV., No. 5, Dr. Clayton draws attention to the disinfecting action of solutions of sodium hypochlorite, and describes experiments conducted by himself and Professor Boyce, of University College, Liverpool, which show that sodium hypochlorite even in weak solutions-e. g., containing only 0.2 or even o.I per cent. of available chlorine-has a decided disinfecting action on nonsporing microbes. The sodium hypochlorite which was used in the experiments of Dr. Clayton and Professor Boyce, and with which I have also made a series of experiments confirming their results, is a fluid of strong bleaching power, and is described as containing 10 per cent. available chlorine. It was used in my experiments as solutions in distilled water— I in 10, 1 in 100, and 1 in 200—and was tested on the following microbes: (1) proteus vulgaris; (2) bacillus coli communis (these two representing typical putrefactive microbes); (3) bacillus typhosus; (4) bacillus diphtheriæ; (5) bacillus of swine fever; (6) vibrio of cholera Asiatica; (7) staphylococcus aureus or ordinary pus; (8) spores of bacillus anthracis; and (9) spores of the anaerobic bacillus enteritidis.

In the case of the first seven microbes cultures on the surface of nutrient agar were made and kept at 37° C. for forty-eight hours; there was by this time copious typical growth in a very active state. The spores of anthrax were derived from an agar surface culture; when transplanted to gelatine or agar they produced typical growth and when injected into the guinea-pig caused fatal anthrax within thirty-six hours. The spores of bacillus enteritidis were derived from an anærobic culture in grape sugar gelatine that had been established about ten days; the culture was by this time full of spores which, when transplanted into fresh sugar gelatine, yielded normal active growth. The disinfectant fluid-i. e., the hypochlorite of soda-was used in solution; a definite quantity of the fluid is dissolved— i. e., poured into a definite quantity of sterile distilled water kept in a sterile glass-stoppered bottle. Immediately after a small quantity, generally 5 c.c., of this solution is poured into a sterile test tube, and then a particle of the microbe culture above mentioned is taken up with a sterile platinum loop, introduced into the 5 c.c. of the disinfectant solution, and well shaken so as to form a uniform distribution or emulsion. In all instances the emulsion contained the microbes in very great numbers, being distinctly turbid. By making a similarly turbid emulsion in sterile distilled water, and then making plates to ascertain approximately the number of microbes present in the emulsion, it was found that one platinum loop of the emulsion yielded colonies far too numerous to be counted.

After exposing the microbes in the above emulsion to the disinfectant fluid for a definite time, cultures are made so as to see whether, and to what extent, the microbes have been affected. Of the first eight microbes-viz.: (1) proteus vulgaris, (2) bacillus coli, (3) bacillus typhosus, (4) bacillus diphtheria, (5) bacillus of swine fever, (6) vibrio of cholera, (7) staphylococcus aureus, and (8) spores of bacillus anthracis-the inoculation of the sub-culture was made from emulsion into nutrient broth and on to nutrient agar and then incubated at 37°C. for four days. By this time any living microbes introduced into the sub-culture would have had ample time. and opportunity of producing easily visible growth. In the case of the anærobic spores of bacillus enteritidis the sub-culture was made anærobically in deep sugar gelatine and incubated at 20.5° C. for six days. In every instance the sub-culture was made by introducing into the culture medium three platinum loops of the emulsion so as to transfer as many microbes as possible from the disinfectant emulsion. As stated above, each loop would hold an uncountable number of microbes.

An important comparative experiment was made at the outset. It was this. By introducing from the disinfectant emulsion three loops of the fluid into the culture medium it might be said that this culture medium received a comparatively large addition of disinfectant which might interfere with-i. e., inhibit—the subsequent growth of the microbe transplanted into the new culture from the disinfectant emulsion, and therefore if no growth occurred in the sub-culture this absence of growth might not be due to the fact that the microbes had been previously killed, but rather that although still living, they were incapable of growing owing to the addition to the culture medium of three loops of disinfectant fluid. In order to ascertain whether the addition of three loops of disinfectant emulsion to the new culture medium had any such inhibitory action on the subsequent growth of microbes a series of cultures were made in the following manner: Of disinfecting mixtures (1 in 10, I in 100, and 1 in 200—that is, in the strength in which they were used for disinfecting purposes, as will presently be shown), five loops were transferred to each broth and agar in test tubes, then these test tubes were inoculated separately with the above microbes I to 8, and incubated. The result was that in all tubes normal and active growth took place, thus showing that the addition of five loops of the disinfectant mixture per culture tube, even of the strength of 1 in 10, had no inhibitory effect on the subsequent growth of the microbes. The experiments on disinfection made with the above nine species of microbes were as follows:

Series 1.-The hypochlorite of soda was used as mixture of I in 10i. e., containing 1 per cent. of available chlorine. The following microbes were used: proteus vulgaris, bacillus coli, bacillus typhosus, bacillus diphtheriæ, bacillus of swine fever, vibrio of cholera, staphylococcus aureus,