published as payment for the article. A request for the reprints must accompany the manuscript of the article. Asking our readers' pardon for having so much to say about ourselves, and returning our sincere thanks to subscribers and advertisers for their generous support during the past year, we wish each and all a Happy New Year, and such a measure of prosperity as may best promote your present and future welfare. Abstracts. ROLE OF THE STREPTOCOCCUS PYOGENES IN HUMAN PATHOL OGY.—(William Bulloch, Lancet)—The opinion now almost universally held is that there is but one species of streptococcus which plays a part in human Pathology; viz., tnat generally termed "streptococcus pyogenes." The differentiation into species probably arose from the number of varieties of pathological lesion in which chain cocci are found. Clinical and experimental evidence unite to show that diversity of lesion may be explained otherwise than by the presupposition that the infecting micro-organisms differ in species. There are four main factors the variations of which determine the nature and extent of streptococcic lesions. 1. The first and most important of these factors is the extraordinary variability in the virulence of the microbe. Starting from a streptococcus harmlessly inhabit. ing the bnccal cavity, we pass experimentally through all stages till we obtain an organism of such exalted virulence as to be capable of producing a rapid and general infection (bacteriemia). Any one of such experimental lesions finds its parallel in human pathology. 2. A variation in the site and depth of the infection produces a difference in the nature and severity of the lesions; this seems to explain why at one time an erysipelas is developed and at another time a phlegmon. 5. Varying resistance on the part of the body is the third factor in the production of a diversity of lesion; witness the severe streptococcic lesions met with in advanced cases of diabetes and Bright's disease. 4. The association of the streptococcus pyogenes with other microbes, pathogenic and non-pathogenic. These associations the author designates "polymicrobic infections." The wide distribution of the streptococcus pyogenes renders it difficult in certain cases to determine what has been the immediate source of the infecting cocci. Undoubtedly in a great number of cases and exogenous infection must be assumed. In the polymicrobic infections, however, while this mode of origin cannot be excluded, it is quite possible that the secondary streptococcic infection may be from cocci normally inhabiting the skin or mucous membranes (endogenous infection) and leading a saprophytic existence there under normal conditions. There are two further possibilities: 1. That the virulence of the streptococcus pyogenes is exalted by being associated with other microbes, pathogenic (e. g. baeillus typhosus) and non-pathogenic (experimentally,, bacillus prodigiosus); or 2, that the apparent exaltation is really an expression of a diminished resistance on the part of the body, caused by the primary infection. In some of the polymicrobic infections both factors seem to be at work; in others only one.-Amer. Med.Surg. Bulletin. -- FOR PSYCHICAL TROUBLES ARISING AFTER THE OPERATION CATARACT. (R. Lowry, Allg. Ztschrft. f. Psych.) Lowry reviews the work of Magne, Sandelberg, and others in this line, and directs particular attention to the work of Franckl-Hochwart who has classified these psychic disturbances in four main groups: 1. Confusional hallucinations in patients between the ages of 30 and 60. 2. Simple confusion in the aged. 3. Psychoses in chronic alcoholism. 4. Confusion in cachectic. patients, followed by death. The first are characterized by halluciations of danger, producing fear, anxiety, and confusion. These are apt to be persistent for long periods of time, and the prognosis is not the best. The second class have a better prognosis. The symptoms are rapidly developed but are not as pronounced. In the third group simple hallucinations predominate, the progress is favorable, and the last group comprises the deliriums of inanition. The author gives a case of his own observed in a man past the middle of life, who, on account of the gloomy outlook for the future, was persuaded by his friends to have his cataract removed; which, on being accomplished, was followed by a condition of chronic hallucinatory disturbances producing fear, anxiety, anger and ideas of persecution. These psychic disturbances are not the results of senility, in the author's opinion, which he claims is in accord with the views of Franckl-Hochwart and Mendel.—Ibid. THE SERUM DIAGNOSIS OF TYPHOID.-Dr. J. J. McKenzie (Canadian Practitioner) reports having used the serum test of Widal in the diagnosis of typhoid with satisfactory results. After mixing the culture and the watery extract of the blood of a typhoid patient, as a rule no change is observed for a few minutes, the bacilli moving rapidly backwards and forwards through the field with their characteristic motion. Then one notices individuals sticking together in pairs or in threes moving clumsily, and in a short time others join the clumps, the movement becoming always slower, until finally all the bacilli are tangled together in large clumps containing ten or more individuals, and all movement stops. The reaction takes longer in some cases than in others. In one case it was complete before the preparation could be placed under the microscope, i. e., in about two minutes. In the majority of cases it takes thirty minutes. My own experience is that if there is no evidence of reaction within an hour there is not much chance of its appearing, but it is well to observe the slides for twenty-four hours. In order to be sure of accurate results one must use a very motile culture, ie., a fresh one, and it is well to have it so dilute that not more than, say, fifty to a hundred bacilli appear in the field. A magnifying power of about 480 diameters is all that is necessary, and it should be used without the Abbe condensor, preferably with artificial light. My results with this method have so far been very satisfactory, and I feel very confident that it will be found an important aid to diagnosis. I have tried the reaction in eighty-two cases, in some of them upon several samples of blood taken at different times. Sixtyone of these cases were typhoid, or subsequently turned out to be typhoid, and in fifty-seven of these I got a positive reaction; in four I got no reaction. I am not prepared to offer any expla nation of the negative results in these four cases, except that in In twenty one I had an exceedingly small sample of blood. one cases not typhoid, I got a negative reaction in all; there were, amongst other non-typhoid cases, tuberculosis, acute dilatation of the heart, artlcular rheumatism, septicemia, and blood from healthy individuals. A number of tuberculosis cases were tried, including two cases of meningeal tuberculosis, with negative results in each case. I have tried cultures of baccillus coli in parallel preparations with the typhoid bacillus without obtaining the reaction. THE BETTER OPERATION FOR HEMORRHOIDS-Dr. F. L. Vaux (The Canadian Practitioner) reports 500 cases of hemorrhoids operated upon in Mt. Sinai Hospital, New York, by the clamp and cautery without a death. One case of pyæmia, from which the patient recovered, is recorded, and a few slight hæmorrhages. The following points in the technique of the operation are emphasized: 1. Apply the clamp in the long axis. of the hemorrhoid so that the scar may be a radiating one, and thus avoid any chance of cicatricial stenosis. 2. Dip the distal end of the clamp well down, so as to include the mucous membrane of the hæmorrhoid in its entire length, though only clamping off about one-third of its substance. Be sure that no skin is included, otherwise the subsequent oedema will be very great and time of recovery lengthened. 3. Sear the hæmorrhoid slowly from above downward, layer by layer, the cautery being only at a dull red heat. By observing these precautions any subsequent hæmorrhage is avoided. 4. Insert a tampon cannula as described below, which must not be removed until expelled by the first stool. When the anathesia wears off the pain will be intense, and opiates must be given. The Mt. Sinai formula is Tr. opii deod., m. xv., every eight hours. At 5 a. m. on the morning of the third day a half ounce mag. sulph. is given, and at 7 a. m. an oil enema is administered through the tampon cannula. This is important, as it saves much pain when the tampon is expelled. The enemas being expelled bring the cannula with them, and the first stool is comparatively painless. On each successive morning a half Sunce mag. sulph. is given, and on the fifth day the oedema will have disappeared in great part, and by the eighth day patient is ready to go. No dressing save a piece of iodoform gauze and a T binder is used. In a ligature operation the bowels are moved on the fourth day, and in a Whitehead on the fifth. The tampon cannula mentioned above is made by taking a piece of half-inch rubber tubing, sterilizing it, and wrapping around it several layers of iodoform gauze. It is then anointed with sterilized vaseline, and after the operation is inserted in the rectum. The tampon cannula serves a double purpose. It allows the escape of secretions and flatus, so that all danger of retained hæmorrhage is avoided, and also allows the primary enemas to be given without much pain. THE TREATMENT OF WARTY GROWTHS OF THE GENITALS. William S. Gottheil, in a paper on Epithelioma of the Penis read before the Society for Medical Progress, November 14th, 1896, concludes as follows: (International Journal of Surgery, January 1897). 1. Warty growths of the genitals, more especially in the male, are always to be suspected of malignancy, no matter how innocent they seem. 2. They should either be left entirely alone, or be thoroughly removed by knife or cautery. 3. Imperfect attempts at destruction, as with nitrate of silver, carbolic acid, etc., are especially to be avoided; there being many cases recorded in which they have apparently stimulated a benign growth into malignant action. THE TREATMENT OF ULCERS AND OTHER SURGICAL CASES BY OXYGEN.-Dr. George Stoker (The Hospital) contributes a paper on the use of oxygen in the treatment of old ulcers and also in the treatment of ozona and suppurative middle ear disease. The treatment consists in the exposure of the affected part to oxygen gas. The method in its simplest form is seen in the treatment of the arm or leg. The limb is placed in an air-tight box, which is then attached to a bag containing about 4 cubic foot of the gas. This is sufficient, under ordinary circumstances for about twelve hours' use. The exposure may be either continuous or intermittent. daily with warm water. The wound should be cleansed twice |