Recent Progress in Medical Science.

PATHOLOGY.

IN CHARGE OF

E. S. ALLEN, M. D.,

Professor of Pathology, Kentucky School of Medicine.

HYGIENE.

IN CHARGE OF

SIDNEY J. MEYERS, M. D.,

Professor of Medicine, Clinical Medicine, and Hygiene, Louisville Medical College.

The July 1st issue of Lancet records an epidemic of typhoid fever at Bridgend in which the medical officer of health attributes the epidemic to the blowing about of infected particles in dust.

Spirochetes in Syphilis.-July 8th issue of Jour. A. M. A. records Dr. McWeeney as demonstrating spirochetes in minor cases of undoubted syphilis in primary and secondary stages. In case of advanced tertiary ulceration of the palate he failed to find them, and also failed in a case of muco-purulent vaginitis, unaccompanied by ulceration and not considered to be of a syphilitic nature. The organisms found are described as follows Sprirally-twisted, entremely delicate organisms, actively mobile, with peculiar corkscrew movement in either direction. Length from 7-18 microns, averaging about 12 microns. Thickness too small to measure. Some were equally thick throughout; others, more especially the longer ones, were decidedly thicker in the middle and tapered slowly at first, afterward more rapidly, toward the ends. The coils were often seven or eight in number, not regularly spiral, more open toward extremities, sometimes nearly effaced. The smaller spirochetes looked like detached flagella of typhoid bacillus in a Pitfield preparation. McWeeney is convinced that his findings verify those of Schoudin and Hoffmann.

Method of Determining Active Hydrochloric Acid in Stomach Contents. Wilcox, in July 8th issue of Jour. A. M. A., describes his method as follows:

Two equal volumes of the filtered gastric contents (20Cu) are taken. (a) One portion is diluted to about 60CC with distilled water 10CC of pure nitric acid, about 5CC of iron alum, and a measured excess (30CC) of decinormal silver nitrate solution are added. Decinormal ammonium sulpho-cyanid solution is run in from a burette until a permanent reddishbrown tint just results. The difference between the quantity of silver nitrate solution and the ammonium sulpho-cyanid solution used give the amount of total chlorid present as decinormal HCl. An evaporating dish may be conveniently used for doing the trituration. If the quantity of

gastric contents is limited, 20CC may be used for the determination of total acidity, with decinormal NaOH and phenol phthaline. This liquid is then used for the estimation for the total chlorids exactly as described above (b). The other portion of gastric contents is placed in a porcelain evaporating dish (four and a half inches in diameter) and evaporated to dryness on the water bath. The solid residue is heated for about an hour on the water bath. The dish is then placed in a wire gauze and heated with a small bunsen flame, the flame not coming in actual contact with the dish. The heating is continued for about ten minutes until the residue is well charred. The dish is cooled, about 60CC of water and the pure nitric acid are added, the contents being well stirred with a glass rod. The trituration is then performed exactly as described above (a), and the quantity of chlorids present given in terms of decinormal HCl. The difference between the chlorids found in (a) and (b) expresses with great accuracy the amount of physiologically active HCl.

The effect of igniting the dried residue of the gastric contents is to drive off the free HCl and to decompose the organic bases, which have combined with HCl, thus causing the latter to be volatilized. The loss in chlorids, therefore, represents "the active HCl." It is important that the dish be 'not heated over a free flame, or else inorganic chlorids may be volatilized in small amount. The presence of the black particles due to charring does not in the least interfere with the accuracy of the trituration, since the white precipitate of silver chloride and silver sulphocyanid forms an effectual contrast to this, and the appearance of a redbrown tint in the trituration can be immediately seen. It is not necessary to filter the charred particles, as this introduces errors and makes the process unnecessarily complicated.

Location of the Pelvis for Temperature and Pain in the Tract of Gowers. The July 1, 1905, number of the Lancet gives a case recorded in the Journal of Nervous and Mental Diseases, by Prof. W. G. Spiller, giving evidence of more positive location of the center in Gowers' tract.

A man aged twenty-three, who, four months previous to consulting Dr. Spiller, had pain in the lumbar and abdominal region. Soon numbness was felt, and gradually involved legs below knees. There was extreme genu valgum, which existed for about five years. On the abdomen were scars which the patient said were due to painless burns during childhood. In the lower limbs sensation to passive movement was diminished, and sensibility to touch was normal, or nearly normal, while sensibility to pain was abolished, or almost abolished. Sensibility to temperature was almost lost below the knees, and was much impaired in thighs and lower part of trunk. There was slight kyphosis about the tenth dorsal vertebra. After a fall backward down a flight of stairs, the patient became completely paralyzed in the lower limbs. Sensibility to touch was completely lost in right lower limb for a time. Sensibility to pain. and temperature was lost in right lower limb and foot and in left foot.

The knee jerks were increased and Babinski's sign was present. Later sensibility to touch was found everywhere in the lower limbs, and sensibility to pain was irregularly present, the response being very uncertain, and sensibility to temperature was much impaired. The patient died four months after the accident.

The necropsy showed tubercular meningitis and necrosis of the vertbra and a small tubercle in the right lateral column at the lower end of thoracic column, involving Gowers' tract. About an inch higher another small tubercle was found involving the left tract of Gowers. There was some myelitis, which evidently had chiefly developed after the fall, for previously the weakness in the lower limbs was slight.

Methyl Alcohol.-When one reads in current literature the deaths and the cases of blindness resulting from wood alcohol, we may well be staggered by the audacity of some firm placing upon the market a deodorized and tasteless wood spirit known as Colonial Spirits.

Being relieved of its nauseous odor and disagreeable taste, it is expected to replace grain alcohol, especially for local use. This should be decried, and the physician can do much to prevent its use by insisting on grain alcohol being bought. It is being used as an adulterant for cheap wines and brandies, and the Internal Revenue Service should awaken to the civil crime which carries permanent infirmity or death with it.

Summer Camps.-There is no doubt that a word of advice given to campers at this season would have far-reaching benefit. How often are these pleasure outings turned into sad home-comings; how often do the campers bring back typhoid fever or some other infectious disease.

These camps which dot the country everywhere are established without thought of health of campers, and certainly none think of the menace they are to those living in vicinity. The doctor often accompanies these parties, but he lays his professional duties aside and allows affairs to regulate themselves. Impress upon campers the necessity of thorough disinfection or destruction of excrement and garbage, the procuring of a good water supply, the washing of all foods eaten, and the careful regulation of the cleanliness about the tents. The mess tent should be screened so as to be sure that contamination from the insects is eliminated.

Preservation of Urine.-By J. Bergen Ogden, M. D., Boston Medical and Surgical, June 22nd. Dr. Ogden, as do all of us who examine urine carefully, realizes that the specimen must be in a fresh condition in order that a satisfactory examination be made. It is often necessary to collect a twenty-four-hour specimen or to transport a specimen some distance for examination, so that twenty-four or forty-eight hours will elapse from time of voiding to examination, so that the use of a preservative is at times imperative.

It is, of course, essential (as Dr. Ogden states) that a preservative be used which will modify the composition of urine as little as possible, and

one which will not interfere with the chemical test or microscopical examination of sediment.

Dr. Ogden enumerates the following conditions: The length of time that a urine, free from preservatives, will remain for examination, will depend upon, first, Temperature at which it is kept; second, degree of concentration; third, the presence or absence of pathological elements, such as albumen and sugar, for urine decomposes more rapidly at 80° F. than at 60°. That a urine of low specific gravity will decompose more rapidly than one with a high specific gravity (free from sugar). When I per cent. or more of sugar is present in urine, ammoniacal decomposition rarely occurs. The following are conclusions from 140 experiments with various preservatives in urine of varying compositions :

Boric acid is undoubtedly the best and safest preservative that we possess-it modifies the urine least. It does not interfere with any of the ordinary tests used in analysis of the urine, and does not interfere with the microscopical examination of the sediment, and five grains of boric acid dissolved in four ounces of urine will preserve it from three days to nearly three weeks, depending, of course, on the character of the urine. and temperature at which it is kept. Diabetic urine will not keep longer than three days. Boric acid tablets containing starch or sugar of milk must be avoided.

Formaldehyde. The value of formaldehyde as a preservative is well known, but as a urinary preservative it has its limitations, particularly if not used in the proper quantity.

The chief danger is in using too much. One drop will preserve four ounces of urine. More than this will reduce Fehling sal, and also react to Heller's nitric acid test for albumin.

Urotropin.-Dr. Ogden has demonstrated that urotropin has absolutely no preserving action on the urine, and that no available formaldehyde is obtained when the tablets go into solution.

Salicylic Acid.-Salicylic acid is a very good preservative of urine, in the proportion of two grains to four ounces of urine. It has the objection that when used in larger proportions it throws down uric acid in the form of fine needle crystals, which obscure the field for examination, and there is no way to dissolve these crystals, leaving the sediment intact, so that it can be examined microscopically. Another objection is that it re

duces fenic chloride in much the same manner as acetic acid.

Benzoic Acid.-Benzoid acid, in the proportion of one grain to four ounces of urine, preserves the urine fully as well as salicylic acid, but is open to the same objections.

Corrosive Sublimate.—Corrosive sublimate is a good preservative, but precipitates some of the albumin in albuminous urine, and there occurs a black deposit which adheres to the sediment.

Chloroform.-The objection to chloroform is that it is not soluble in one drop to four ounces of urine, and is apt to interfere with examination

of sediment. Another objection is that it reduces alkaline solution of copper.

Chloral.-Chloral has comparatively little preserving action of the urine, and it reduces Fehlings sal.

Camphor.-Camphor is objectionable on the same ground as chloral and chloroform.

Thymol.-Thymol is sometimes used to prevent the growth of bacteria, but its preservative action is very slight.

Dr. Ogden concludes his paper by stating:

1. That boric acid is the most practical urinary preservative that we possess, when used in the proportion of five grains to four ounces.

2. Formaldehyde solution should be used only by the physician or a responsible party. It should be remembered that one drop of the solution will preserve a pint of urine for about a week.

3. Other substances than boric acid and formaldehyde should not be used.

4. The name of preservative and the quantity that has been used should always accompany the specimen to be examined.

Diagnostic and Prognostic Significance of the Diazo-Reaction.— (Medical Record, July 15, 1905.) While by no means so valuable from the diagnostic standpoint as the agglutination phenomenon, the diazoreaction described by Ehrlich is still deserving of a certain degree of recognition in this connection. Although present in the overwhelming majority of cases of typhoid fever, it is, however, not specific of or peculiar to this disease, being observed also in many cases of measles, in a considerable number of tuberculosis, and in conjunction with other affections, especially puerperal septicemia. It has further been thought to have some prognostic significance in relation particularly with tuberculosis, its presence being considered a less favorable indication than its absence. Observations with a view of corroborating or correcting these opinions have been made on a large scale by Mr. Chas. W. Budden (British Medical Journal, May 6, 1905), who studied the diazo-reaction in 3,000 persons, 600 in health and 2,400 suffering from various disease states. A negative response was obtained with the urine from all of the healthy persons, and in 564 cases of various acute maladies, while a positive response was obtained in 96 of 672 cases of various forms of tuberculosis, in 18 of 25 cases of measles, in 17 of 21 cases of typhoid fever, in all of 5 cases of typhus fever, in 4 of 41 cases of acute lobar pneumonia, in 1 of 16 cases of acute broncho-pneumonia, in 1 of 96 cases of acute bronchitis, and in all of four cases of puerperal septicemia. The cases of pneumonia and bronchitis were eventually found to be complicated by underlying pulmonary tuberculosis. In many cases the test was made daily, and in none was it made less frequently than twice a week. Death occurred in nearly all of the cases of tuberculosis that yielded a positive reaction, but these were precisely the cases in which