tors are important in the above method-the use of large quantities of blood and the dilution of this blood in sufficient bouillon so that its bacteriological properties will not prevent the growth of organisms. Castellani lays special stress on this second factor, and attributes his success in his second. series of cases to the large amount of diluent used. He also mentions four cases in which the typhoid bacillus was found at a time when the Widal reaction was negative. Auerbach and Unger report one such case. Cole obtained the bacillus in six cases before securing a positive Widal reaction with a dilution of 1-50. In three of the New York Hospital cases the blood contained the typhoid bacilli before the serum, diluted one to ten, showed the Widal reaction. The New York Hospital series showed that the cultures taken carly in the disease were more apt to be positive than those taken later in the disease. The earliest positive results in the course of the original fever were obtained on the fourth or fifth day of the disease, as far as they were able to obtain the exact onset of the disease. Of those cases in which cultures were made during a relapse, all showed the typhoid bacilli. In these cases the onset of the relapse could be accurately determined, and the positive result obtained in them on the third, fourth or fifth days. Previous cultures in each case had been negative, so that a fresh blood injection had probably occurred at these early dates in the relapse. From only two of the cases of the last series were cultures positive after the fourteenth day of the disease, and in none was a positive result obtained after a previously negative culture, except when there was a relapse. Typhoid bacilli have been obtained from patients at the beginning of the fourth week of the fever in one instance by Cole, and once by Auerbach and Unger. There were no such findings in the New York Hospital series. The number of bacilli present in the circulating blood apparently does not depend upon the degree of intoxication present, for in one of the most serious cases reported in the last series, cultures were not made until the sixteenth day, when the result was negative; also on the twentieth, with the same result, while they were found in an intercurrent relapse at its onset, when the temperature was about 102°F. In another severe case of the same series, they were found on the eighth and thirteenth days, and results were negative on the nineteenth and twenty-third days. It is to be hoped that the pure culture method of diagnosis will be brought to the same state of accuracy that the Widal method has, for by it we can determine in the first week of a fever whether we have typhoid fever to deal with or not. The objection to the Widal method is that it is of clinical value only in doubtful cases. In the majority of cases the clinical signs are well pronounced before we get reaction. It is then only confirmatory. Dr. Rice said that he had seen a death in St. Joseph's Hospital from perforation of the bowel on the second day of admittance, but thought that perhaps the patient had been suffering for a longer time with an ambulatory type of typhoid fever. Dr. Henning said that after listening to Drs. Krauss and Reilly, he regretted that he is not a bacteriologist, but has more faith in clinical diagnosis than in bacteriology. He did not believe that all cases of continued fever are typhoid, and thinks that we have no antiseptic that will abort typhoid fever. Dr. Buford said that Widal's reaction was found in many diseases other than typhoid. Dr. Heber Jones said that true typhoid fever is a rare disease in Memphis. He does not believe in Osler's quinin diagnosis, and has more confidence in a Southern physician's diagnosis of Southern fevers than in the diagnoses of Northern men, who had no clinical experience with the fevers of the South. He said that he would hold to Widal's test until something more satisfactory was offered, his chief objection to the Widal reaction being that it is too slow. A satisfactory clinical diagnosis can be made in the same time. Dr. W. B. Sanford asked Dr. Jones what he called this unknown fever, and what treatment he used. Dr. Jones said that at present he thought best to call them malarial, and to treat them symptomatically. Dr. Jelks reported a case of typhoid fever in which he made a diagnosis on the fifth day, which was verified by Widal's reaction, and in two days was apparently convalescent. Then in three days there was a relapse, and the fever was reduced with guiaicol, and in a few days the patient was again apparently convalescent, and had another relapse on the 25th day with typical rash and hemorrhage. In this case there was no reaction with Widal's test after the fifth day. Dr. Meyer thought Widal's reaction of special value in making a diagnosis of typhoid in a negro, for the eruption could never be seen in the negro. In his service at the City Hospital he had seen twelve cases of typhoid in the negro. The Widal reaction was present in all of these cases from the fifth to the twelfth day. Dr. Stanley said that he had no faith in Widal's reaction and in bacteriology in the diagnosis of these fevers. Dr. Krauss, in closing, said that in many cases Widal's reaction would appear late in the disease. He thought Widal's reaction better than blood culture. Blood culture would be better if made on the fourth or fifth day, but there are many objections to blood culture. Widal's reaction is correct in 97 per cent., and blood culture in 87 per cent. He did not believe in guessing when you have a test which is accurate. A cure will be obtained in malarial fever when the spore parasite is in the blood. When sporulation is not active there is a post malarial malaise, and quinin will do no good. Dr. Rice read a paper on The Preparation of the Patient for Surgical Operation, with a Consideration of Anesthesia and Shock. (This paper will be published in the March issue of MONTHLY). Dr. W. B. Sanford, opening the discussion, said that before operating upon a patient we have two features to deal withfirst, moral; second, physical. The moral is overlooked by many operators, and it is very essential for securing a successful operation, to first obtain the confidence of the patient. He believed as much in internal as in external preparation of the patient. If the blood, excretions and secretions are in a normal condition, we would never have shock. Dr. McCown complimented the essayist for his excellent paper. Cases for surgical operation should be divided into two classes-acute and chronic. In the first class, in many cases the necessity for quick action outweighs the necessity for preparation of the patient, but in chronic cases preparation of the patient, both external and internal, should be carried out in detail. When a doctor gives an anesthetic, he should consider all patients bad patients to take an anesthetic, and this would make him more cautions. There is a larger percentage of patients infected in hospital cases than in patients treated in private homes in surgical cases. He thought ether the safest anesthetic for inexperienced men. Dr. Ellett emphasized the necessity of making a careful examination of the patient for some acute disease before giving a general anesthetic. He related a case upon which he was going to operate, and a moment before starting to give an anesthetic it was discovered that the patient had diphtheria. Dr. Alfred Moore said that the bladder should always be emptied, and that the anesthetic should never be given in the operating room. The operator could not be too careful in choosing clean and reliable assistants. Dr. Rice, in closing, said that he did not believe that as many cases were infected from hospitals as from the operator. He reported a case where a patient was operated upon for a small ovarian cyst in which ether was used, and the patient died from the effect of the anesthetic. Necropsy could show no other cause for death. Under the order of business, Drs. J. F. Graham and E. C. Blackburn were elected to membership. BOOK REVIEWS. THE PRACTICAL MEDICINE SERIES OF YEAR BOOKS. Comprising ten volumes on the year's progress in Medicine and Surgery. Issued monthly, under the general editorial charge of Gustavus P. Head, M.D., Professor of Laryngology and Rhinology, Chicago Post Graduate Medical School. Volume 1, General Medicine, Edited by Frank Billings, M.S., M.D., Head of Medical Department and Dean of the Faculty of Rush Medical College, Chicago, with the Collaboration of S. C. Stanton, M.D. Price, $1.50. October, 1901. Chicago: The Year Book Publishers, 40 Dearborn Street. The Year Book Publishers have undertaken to publish a practical medicine series of year books, which will comprise ten volumes and be issued monthly. It is the purpose of this series to cover in a concise yet sufficiently full manner the entire year's progress in medicine and surgery. Volume one of this series, which considers general medicine, is edited by Dr. Frank Billings, with the collaboration of Dr. S. C. Stanton. The work is well arranged and seems to fully cover its field. The merits of The Year Book on the Diseases of the Nose, Throat and Ear, as published by these publishers, would go to indicate that they will achieve considerable success with the present venture. A MANUAL OF PERSONAL HYGIENE. Edited by Walter Pyle, A.M.,M.D., Philadelphia. Illustrated. Price, $1.50 net. Saunders & Co., Philadelphia and London. 1901. In this splendid work the editor who has written on the subject "Hygiene of the Eye," has been assisted by the following contributors: "Hygiene of the Digestive Apparatus," Charles G. Stockton, M.D.; The Skin and its Appendages," George Howard Fox, M.D.; "The Vocal and Respiratory Apparatus,” E. Fletcher Ingalls, M.D.: "The Ear," B. Alexander Randall, M.D.; "Physical Exercise," G. N. Stewart, M.D., and "The Brain and Nervous System," J. W. Courtney, M.D. To present this subject in a manner which shall appeal to the educated layman without pandering to popular prejudice or fads, is by no means an easy matter. To offer neither too much nor too little and to make all clear and distinct involves careful discrimination. To say that all of the contributors have attained this is the truth. In Dr. Stockton's section, the mechanism of digestion and absorption is ably described. There is a description of the teeth, with directions for the preservation of them, and the deformities of the jaws. There are also some valuable things said upon the diet. Dr. G. H. Fox, in dealing with the skin, extols the cold bath as a stimulant and tonic. He discusses the relation of the clothing to the skin and the deformities resulting from improper shoes. The care of the hair and scalp is extensively described, and the massage of the scalp and shampooing are strongly advocated. There is a discussion of the relation of eye-strain, and directions on the proper wearing of glasses. J. W. Courtney, in discussing the hygiene of the nervous system, naturally begins with the influence of hereditary and educational environment. There are excellent chapters on worry, overwork, neurasthenia, alcohol, rest and exercise. This article is one of the strongest in the book. Dr. Stewart closes the work with a short chapter on the physiology of the muscular movement. This includes exercise and muscular training. On the whole the work is an excellent contribution to hygiene, and it is all the more valuable from the fact that there is no attempt made in its pages to make every man his own physician. HAYDEN ON VENEREAL DISEASES. A Pocket Text-book of Venereal Diseases. For Students and Practitioners. By James R. Hayden, M.D., Chief of Clinic and Instructor in Venereal and Genito-Urinary Diseases in the College of Physicians and Surgeons, New York, etc. New (3d) Edition, thoroughly revised. In one handsome 12mo. volume of 304 pages with 66 engravings. Cloth, $1.75 net. Flexible leather, $2.25 net. Lea Brothers & Co., Publishers, Philadelphia and New York. It speaks well for the popularity of this little work that it has promptly come to its third edition. This opportunity has been utilized to revise it thoroughly. New sections on vegetations and herpes progenitalis have been added, and also a number of new illustrations. The book furnishes in clear and compact form a practical working knowledge of gonorrhea, stricture, chancroid and syphilis, together with their complications and sequelæ. It will be found very convenient and handy for students, but will also serve as a reliable guide for the practitioner in the management of this class of cases. BACTERIOLOGY AND SURGICAL TECHNIQUE FOR NURSES. By the late Emily M. A. Stoney, Superintendent of Training School for Nurses, St. Anthony's Hospital, Rock Island, Ill. 190 pages. Philadelphia and London: W. B. Saunders & Co. Price, $1.25 net. Illustrated. 1901. This is an admirable little book for the purpose for which it was written. The first sixty pages are devoted to a general statement of a history of bacteriology, bacteria as the cause of disease; the theory of antitoxins, antiseptics and disinfectants and deodorants. Then follows the practical portion of the work, which deals with such topics as the care of the operating room, the methods of sterilization, and the care of instruments. There is a special chapter on gynecological examinations and operations, and there is an excellent one on operations in private practice. The directions regarding anesthesia are excellent, and nothing is to be desired in the description of surgical dressings. The preparation of the patient is carefully given. The work closes with a brief description of the signs of death and method of preparing for autopsies. For a work that deals with such a mass of detail, it is exceedingly practical. In this, we judge, its greatest value will be found, not only to nurses, but for all who read its well-written pages. Every nurse will be a better nurse for the reading of this book of Miss Stoney's. |