DEPARTMENT OF PATHOLOGY AND BACTERIOLOGY.

BY R. B. H. GRADWOHL, M. D.

ST. LOUIS.

The Bacillus Subtilis in Panophthalmitis.-(Silberschmidt, Annales de l'Institut Pasteur, Vol. xvii, No. 4, April 24, 1903) directs attention to his finding of the bacillus subtilis in a number of cases of panophthalmitis. He had occasion to study a number of cases in the clinic of Haab in Zurich. It seems that panophthalmitis was due in these cases to the penetration into the interior of the eye of small particles of iron, the patients being in all cases workers in agriculture in the vicinity of Zurich. Bacteriologic examinations (smears and cultures and animal experiments) from the enucleated eye in each instance showed up a bacillus which closely resembled the bacillus subtilis or so-called "hay bacillus." Injections were made into the vitreous body in rabbits and panophthalmitis followed in the course of twenty-four hours in most of the experi nents. In some cases, the injection was made only into the subconjunctival tissue; when this was done, only chemosis took place, without any panophthalmitis. Different routes were taken when the injection was made into the vitreous body; in all cases, panophthalmitis followed. It was also possible to produce a panophthalmitis in rabbits by the injection into the vitreous body of an emulsion of earth which, on bacteriological investigation, showed up the bacillus subtilis. This author also determined the reaction of the vitreous body toward infections in general. It was found that when the bacillus anthracis or the pneumococcus was introduced into the vitreous body, the animals died rapidly of general infection. No panopthalmitis was produced in these cases. Yet panophthalmitis always followed closely upon the introduction of the bacillus subtilis into the vitreous body.

The Effect of Incorporating Different Chemicals with Tuberculosis Sputum upon the Staining Reaction of the Tubercle Bacillus. J. Sabrazes (Annales de l'Institut Pasteur, Tome xvii, No. 4, April 25, 1903) undertook an investigation as to what effect mixing different chemicals with tubercle bacilli has upon its staining characteristics. He found that if sputum containing tubercle bacilli is allowed to undergo putrefaction and liquefaction for several years, an examination at the end of that time will still reveal the tubercle bacilli. Tubercle bacilli immersed for months in water, in urine, in artificial gastric juice, in alcohol, vinegar, solutions of corrosive sublimate, carbolic acid, boric acid, sulphate of copper, and tannic or gallic acid, retain their charateristic staining reaction, according to the Ziehl-Nelson method. The following experiments were also tried; sputum of various kinds, muco-purulent, nummular and liquid, all containing the tubercle bacillus, was agitated to a homogenous mass. One-fourth of a cubic centimeter of this agitated mass was mixed with various solutions, 5 cubic centimeters in quantity. At the end of 48 hours, each mixture was examined for the bacillus tuberculosis according to the Ziehl carbol-fuchsin method. The tubercle bacillus could be easily identified from

the following solutions: distilled water, boiling water, anilin-water, water oxygenated (12 volumes), Lugol's solution, glycerin, alcohol, ether, chloroform, xylol, benzine, saturated aqueous solutions of acetic, boric and picric acids; carbolic and salicylic acids, saturated in alcohol, sal-ammoniae, carbonate and sulphite of sodium, potassium iodide, saturated solutions of aluminium sulphate, copper sulphate and barium chloride, bichloride and cyanide of mercury (1 to 100 and 1 to 1000), mixtures of creolin and Van Wieten's solution, Esbach's and Flemming's reagents. Some of these chemicals are used in disinfection of sputum; consequently, later microscopic examination of the sputum thus disinfected would still disclose the tubercle bacillus. Some of these reagents are used for clearing up sections for fixation and for dehydration, such as alcohol, ether, etc. This in no way will hinder the employment later of the Ziehl method of staining for the tubercle bacillus. On the contrary, the following solutions mixed with tubercle bacillus-containing sputum, will prevent later identification by the Ziehl method of this bacillus; hydrochloric acid, nitric acid, sulphuric acid, and oxalic acid (undiluted in each case), one per cent osmic acid, four per cent permanganate of potassium, saturated aqueous solutions of bichloride of tin and nitrate of bismuth; sulphate of ammonium, Boas' reagent and sulphomolybdic acid. This experiment proves that it would be impossible to demonstrate the tubercle bacillus in bone which has been decalcified by strong acids, and also that the tubercle bacillus cannot be microscopically identified after fixation of tissue in osmic acid. The following solutions will also prevent the later identification of the tubercle bacillus; two per cent solution of chromic acid; formalin of commerce, twenty-five per cent sulphuric acid (after two hours' exposure), saturated aqueous solution of plumbic acetate, one per cent solutions of nitrate of barium and silver nitrate; hydrochloric acid-aclohol (2 parts to 100); four per cent solution of chromate of potassium and saturated aqueous solution of bichromate of potassium; creolin, spirits of turpentine; nitro-prussiate of sodium and ferricyandide of potassium (to saturation in water); alcohol solution of pheno-phthalein; aceto-picric reagents, Fehling's, Kleinenburg, Tanret's and Uffelman's solutions and tincture of iodine. Thus chromic acid, formic acid, alcohol-hydrochloric acid, Kleinenberg's reagent, should not be used in tissues which are later to be studied for the tubercle bacillus. It was found that solutions ferricyanide of potassium and nitro-prussiate of sodium not only prevent the subsequent demonstration of the tubercle bacillus, but really confuse the worker by depositing fine, red-tinged hair-like bodies which simulate the appearance of the bacillus tuberculosis.

Osteogenesis Imperfecta. -F. Michel (Virchow's Archiv fuer pathologische Antomie und Physiologie und klinische Medicin, Bd. 173, H ft. 1, July1, 1903) gives in detail gross and microscopic findings in a case of osteogenesis imperfecta in fetus which was sent to the University of Marburg laboratory by Dr. Schneider of Fulda. Brief clinical history of the case showed that the father was an epileptic; the mother healthy, 33 years of age and had given birth to six children (all girls) in twelve years. These children were weakly, and slightly affected with rachitis and scrofulous

predisposition. Syphilis of both parents was excluded. The last mentruation occurred August 15, 1901; delivery of this child on May 23, 1902. The woman was healthy during this pregnancy, but had never noted movement on the part of the fetus. The bag of water ruptured on the 23d of May and severe hemorrhage ensued. Examination showed a foot protruding and a pulseless umbilical cord. With tamponade, labor supervened (foot presentation). The placenta which was immediately delivered, was of very large size. The cord was strong, excentric inserted; placenta and membranes normal. Section of this child: length 37 cm.; length from neck to umbilicus 14 cm. ; length from umbilicus to symphysis 3 cm.; circumference of head 29 cm. ; circumference of chest 21 cm.; pelvis 19 cm.; length of arms from axillae 9.5 cm. ; from axilla to elbow 3 cm.; from elbow to wrist 3.5c m.; from wrist to end of finger 3 cm. ; from trochanter to ankle 6 cm. ; from knee to ankle 2 cm. The entire top of skull consists of a hard membrane; on the inside of this membrane is a mass of fluid blood. A few bony plates were found in the region of the frontal and occipital bones. These plates were found in the region of the frontal and occipital bones. These plates were very brittle. Their thickness corresponded to that of a three months' embryo. Cerebral tissue was soft. The entire form of the face was lost; it assumed a flat appearance. The synchondrosis sphenooccipitalis is 3 mm. wide and hangs in a straight line with the cartilaginous dorsum ephippii. The foramen magnum had a diameter of 7 mm. While the squamae osseae temporalis showed a membranous structure, the os petrosum and the partes condyloides, as well as the processus mastoideus showed beignning bone formation which could be cut with a knife. The os vomer and ethmoidale were cartilaginous. spinal column was movable and showed beginning bone formation. The bones of the extremities showed innumerable fractures. Microscopic examination of the bones after decalcification, showed widespread retardation of endochondral and periosteal bone-formation. The cartilage in general was of good consistence. The vascularization of the cartilaginous parts of the femur and tibeal epiphysis was rich. Enchondral boneformation scarcely had begun. At the points of fracture in the long bones, the periosteum showed marked thickening. As in post-embryonic life, the fractures showed signs of repair in the pouring out of blood and serum and infiltration with round cells. Giant cells and periosteal cells in the form of fibroblasts were seen in these fractured situations, with bony placques. The bone marrow at the site of the fractures showed numerous fibrous material, but few cells. These fractures were due either to outside pressure, or pressure of the embryonic body against the enveloping sac, or pressure of the legs against the back, or by muscular contractions. The fracture of the lower jaw was due to direct pressure of the head against the breast or to muscular contraction. Twelve cases of oseteogenesis imperfecta have previous been described, notably by J. Schmidt in 1859, Bidder in 1866, Stilling in 1889, Scholz in 1892, S. Mueller in 1893, Buday in 1895, v. Gelden-Egmond in 1897, Hildeband in 1899, Scheib in 1900, Harbitz in 1901, and two cases by Paltauf 1891. The etiology of this affection has been much discussed, and no light so far has seemingly been thrown upon it. Virchow was of the opinion that it was a fetal rachitis or

The

osteosclerosis. He differentiated this from extra-uterine rachitis by stating that "it was not a cartilaginous overgrowth with delayed bone forma. tion, but an accelerated bone-formation with poor cartilaginous growth. Some have claimed that this is a syphilitic manifestation. Kaufman has called this affection "chondrodystrophia foetalis," although some have denied the identity of these two affections. Michel states that the name chondrodystrophia foetalis is not as suitable as osteogenesis imperfecta, micromelia chondromalacia (Marchand), osteosclerosis congenita and osteopsathyrosis, as it has been variously named. Klebs has called it fragilitas ossium. It is a different affection from osteochondritis syphilitica where calification takes place in the bones.

DEPARTMENT OF INTERNAL MEDICINE.

BY O. E. LADEMANN, M. D.

ST LOUIS.

The Detection of Gall Stones by Means of the X-Ray.-(Coen, Ll. Policlinico.)-Numerous patients with gall-stones in the hospital of Livorno were exposed to the X-rays with negative results leading the author to believe that in colclitheasis the Rontgen rays are of little value.

A Traumatic Aortic Insufficiency. (F. Jessen, Vereins Hospital in Hamburg, Wiener Med. Wochenschrift No. 17, 1903.)-A fisherman 40 years old, with a previous absolutely normal heart no murmurs, accentuated second sounds or dilatation, after one and one-half hours of hard labor, the signs of an aortic insufficiency manifested themselves. The writer was inclined to believe that a tear in one of the pulmonary segments occurred.

Hereditary Icterus. (Pick, Wiener med. Wochenschrift, No. 17, 1903.)-Pick reports the mother and three members of the family between the ages 17-26 with icterus since birth. In each of these cases there was a distinct icteric discoloration of the skin and sclera, the urine containing. urobilin, but no bile pigment, stools of a normal color. The author found a number of such cases reported and gives as cause a congenital insufficiency of the liver, or possibly an abnormal communication between the lymph vessels and the bile ducts or capillaries.

Bradycardia as a Symptom.-(R. G. Curtin, American Medicine, August 1, 1903.)—The author cites several cases with an abnormally slow pulse rate among them influenza, and other intoxications, as lead and tobacco. In regards to a prognostic sign, he states, "that a given constitution, not undermined by disease with a gradual subsidence of the primary cause of a slow pulse, bradycardia need not necessarily be regarded as a particularly grave symptom. On the other hand, however, if it is associated with or caused by depressing chronic condition especially of the cardio-vascular system it becomes a most serious symptom. When accompanied by anginose symptoms it is frequently followed by sudden death.

Albuminuria. (M. Cloetta, Correspondenz blatt fur Schweiz Arzte, 33 Yahrg. No. 8.)-The author, from a large number of examination, concludes that in an acute nephritis there is a predominence of serum albumin and globulin with nucleo-albumin, in a chronic indurative nephritis, serum albumin. This does not depend on a difference in the composition of the blood, or a difference in the blood pressure, but the change in the kidneys. themselves. The author has experimentally proven, that in acute nephri tis there is a disturbance in the epithelial cells of the excreting membranes allowing a transudation of both serum albumin and globulin, whereas in a chronic indurative nephritis the membranes are in a thickened and hardened condition, thereby preventing a transudation of globulin. The amount of nucleo-albumin depends on the desquamation of the kidney epithelium and indicates the degree of disturbance in the epithelial cells, whereas the serum albumin does not run parallel with the disturbed function.

Olei. caryophylli.

aa gr. 15

aa gr. 3

gtt. 5

Mix. Divide into twelve pills. Dose: One pill mornings and evenings.

PRESCRIBING TERPIN HYDRATE.-The Rev. franc. de Med. et de Chir. gives the following formulas for the adminstration of terpin hydrate in chronic bronchitis and affections of the urinary tract:

Distilled water, to make..

30 grn.

3 oz.

75 min.

5 dr.

aa

3 oz.

11 oz.

Dose: Tablespoonful two to four times daily.-Merck's Archiv.