ing appendix. The time which elapsed between the development of peritonitis and the application of oil of camphor to the peritoneal cavity ranged from eight to eighty hours; the age of the patients from ten months to seventy years. The abdominal cavity was quickly opened, the appendix amputated, the pus wiped away and then 100 Cc. of a one per cent sterilized solution of oil of camphor was poured into the peritoneal cavity. It was carefully distributed over the whole area of the peritoneum by means of gauze sponges, etc. Then the abdominal cavity was closed and a rubber tube holding a strip of gauze placed in the wound. Dr. Krecke advocates the use of oil of camphor as a prophylactic measure in all abdominal sections where the peritoneum is already infected. He read his report on the treatment of his eleven cases at a meeting of a medical society in Munich last winter. In the discussion which followed Dr. Schlafl stated that very strong solutions are in use at Basle. Prof. von Herff introduced from 30 to 50 Cc. of ten per cent solution of oil of camphor into the peritoneum in fifty-three cases where the peritoneum was infected before operation. All but one case recovered. Dr. O. Burckhardt has proved that streptococcal infection of the peritoneum in white mice after injection of oil of camphor seemed to be completely neutralized, although other infected mice not treated with the oil died rapidly with all the symptoms of fulminating peritonitis. Immunity from Poliomyelitis. Muller, in Deutsche Med. Wochenschrift, states that one attack of acute infectious poliomyelitis probably produces immunity. This acquired immunity has been experimentally proved in monkeys, which suggests the presence of specific anti-bodies in the blood. Such bodies have now been demonstrated. A fine emulsion of the central nervous system, to which, as in rabies, the virus is attached, is injected into the brain of monkeys. The animals develop poliomyelitis. But if the emulsion is mixed with an equal volume of the blood serum of an animal which has recovered from the disease and the two are left in contact for a sufficient time, intra-cerebral injection of the mixture has no ill results. This neutralization of the virus by immune serum in the test tube has been proved so often and with so many modifications of technique that no doubt remains. The circulating anti-bodies are probably the cause of acquired immunity. They are not, however, the cause of congenital immunity, because the blood-serum of such naturally immune animals as horses, rabbits and fowls has no power to neutralize the virus in the test tube.-Med. Stand. Hemophilic Bleeding Checked by Foreign Blood. Patient. A boy, aged 13, of Danish parentage, with frequent attacks of rheumatism during the last few years. He was a hemophiliac and gives the history of several hemorrhages treated by physicians and dentists, with no complete control of hemorrhage in less than fifteen days. One of the worst was from the tongue, and was finally controled by actual cautery after two weeks of bleeding. Two days before my visit, the boy had been struck above the right eyebrow by a pump handle. The extravasated blood gravitated to the upper eyelid and formed a tumescence which projected at least one inch from the forehead. This burst at school and I was called twenty-four hours later. I found projecting from the eyebrow a hollow cone formed of blood which had slowly coagulated, from the end of. which blood was dropping at the rate of one drop per second. Treatment and Result.-I removed the cone, cleansed the parts, and found an opening in the skin, three-eighths of an inch long, from which the blood ran freely. I applied in succession hot compresses, ice, epinephrin, iron, caustics and collodion dressings following pressure, none of which had any effect for over five minutes at a time. I then determined to try the following experiment: I cleansed the wound thoroughly and had a hot compress applied with considerable pressure. I then made an incision in the third finger of my left hand, under sterile conditions, and removing the compress, allowed my blood to drop on the wound. A clot formed immediately and not one drop of blood again escaped. After assuring myself that the effect was not temporary, I applied a light dressing and left the patient. Thirty-six hours later the patient, in his sleep, tore away the dressing and reopened the wound. I was then called and found the hemorrhage as profuse as in the beginning. I again used my blood with the same instantaneous result. I then made a Gifford eye-shield, which I removed three days later, and found the wound completely closed. This procedure may not be a new one, but it was so to me, and may be of interest to those who are dealing with this class of cases.-J. A. M. A. Surgical Treatment of Puerperal Sepsis. Dr. Palmer Findley, in writing of the "Surgical Treatment of Puerperal Sepsis" (Interstate Medical Journal, Vol. XVIII, No. 11), concludes as follows: 1. As yet we possess no reliable clinical or bacteriological guides in the early management of puerperal sepsis. 2. Operative treatment, when administered in a timely and skillful manner, can do much to prevent the extension of infections. But it is well to bear in mind that untimely surgical interference and the faulty application of surgical measures may be productive of much harm. 3. Retained placental tissue should be removed before the onset of septic infection. Membranes may be left to nature unless they protrude from the cervix or interfere with drainage. In virulent streptococcic infection, the infection organisms may gain access to the blood through the wounds created in the act of removing the placenta; hence, in these cases, it is better to encourage the spontaneous expulsion of placental tissue by the administration of ergot. Failing in this the uterus must be emptied by mechanical means. The fingers are preferred to the curette or placental forceps. If, for anatomical reasons, the infected placenta cannot be removed, and no blood invasion or metastasis exists, hysterectomy may be considered. 4. Puerperal ulcers should not be curetted for fear of extending the infection. 5. If hysterectomy is to accomplish anything, it must be performed when the infection is confined to the uterus. Under these conditions, and in the presence of multiple abscesses of the uterine wall, of infected fibroids, of inaccessible placental tissue, of perforation of the uterine wall and possibly of infected appendages, hysterectomy is advised. It is questionable, with our present endowments in diagnosis and prognosis, if we are ever justified in removing the uterus in the early stages of puerperal infection, while the infection is confined to the uterus, and in the absence of the above mentioned complications. 6. The timely ligation of veins in puerperal pyemia may forestall a general infection; but as in hysterectomy it must be done before the development of a general bacteremia and metastasis, and the infected thrombi must not extend beyond the common iliac vein, nor can it be bilateral to this extent. 7. The treatment of acute diffuse puerperal peritonitis is free drainage, the problem involved is that of early diagnosis. 8. Pus accumulations within the appendages, the paramentrium or the pelvic peritoneal cavity, are seldom highly virulent and can therefore usually await the subsidence of the acute stage. In these cases drainage should be established per vaginum, rarely through an incision immediately above Poupart's ligament. New Typhoid Fever Test. Prendergast (in the Medical Record, December, 1911), describes a new means of making an early and sure test for the presence of typhoid fever. The test consists in injecting with a fine hypodermic needle a few drops of a suspension of dead typhoid bacilli of the strength of not less than 5,000,000 per c.c. This strength may be easily made by taking the ordinary typhoid vaccine now on the market and diluting it as follows: Take one drop of the 1,000 million vaccine and add to it twenty drops of sterile saline solution. Mix thoroughly. After the solution has been injected endodermally (care always being taken to raise as superficial a bleb as possible and with a well mixed solution), in twenty-four hours the non-typhoid patient. shows absolutely no reaction. The reaction (as a rule) begins to appear in twelve hours, reaches its maximum in twenty-four hours and has disappeared in forty-eight hours. Any redness after forty-eight hours is considered an infection and is not taken as a reaction. The test should be repeated with better precautions against infection. Rub the skin at the point of injection with alcohol, have a clean hypodermic syringe and needle and use fresh sterile vaccine. This test gives no constitutional reaction (rise of temperature, malaise, chill, etc.), and has no elements of danger. In the negative cases (controls) a few patients have complained of slight soreness and itching at point of injection twelve to twenty-four hours after the injection. This quickly subsided without treatment and gave no further trouble. The author makes a preliminary report of twenty-seven unselected cases. He enumerates the following advantags of the test: No danger to patient; no danger from live culture (as in Widal test); no constitutional or local after effects; no microscope, no blood of patient required; appears early, one case three days before the Widal; how early future cases and a greater number will show; simple and easy to apply; no wait for laboratory report; seems to establish the diagnosis of typhoid fever even after the lapse of years (in two cases, three and six years previously). |