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Speech returned with power in the right side, and he gradually regained his strength, being in October the picture of health.

Case II.-A boy, aged in, was admitted to hospital with a right apical pneumonia, which cleared up in five days. A fortnight later the temperature was slightly raised, and a systolic blowing bruit developed in the left fifth space. It gradually became louder and the temperature oscillated up to 100° F. for a month, when it became normal. Injections of Pané's antipneumococcic serum were given, and he left the hospital in perfect health and remained so when last heard of. Some months later the bruit was still audible.

That cases of malignant endocarditis may run a course of some months is well known, but comparatively few cases are recorded in which the patients regained health. In both these cases the boys enjoy perfect health, although the valves were permanently damaged. The beneficial effects of the antistreptococcic serum were very striking, and recovery was certainly due to its use.

The Cardiac Complications of Diphtheria.-F. W. WHITE, M.D., and H. M. SMITH, M.D. (Boston Med. and Surg. Jour., Nov. 12, p. 433) have analyzed 1,000 cases of diphtheria treated in the Boston City Hospital in which the condition of the heart was particularly observed. Their results show a much higher proportion of murmurs (94 per cent.) than has been found by others. The patients were principally children. All the murmurs were systolic except those in a few cases of chronic heart disease. They were loud and sometiines musical. They were usually heard at the apex, frequently transmitted to the axilla, and generally associated with accentuation of the pulmonic second sound. The majority were associated with irregular action of the heart and outlasted the fever. It was therefore concluded that they were not functional. They developed in the first few days of the illness and they lasted several weeks at least. Five of the six patients were examined eight or ten months after leaving hospital. All had murmurs, and two had cardiac enlargement and irregularity with a weak first sound, indicating probably chronic myocarditis. In about 35 per cent of the cases the heart was irregular at the time of discharge. Pathological researches have shown that such murmurs are due to mitral insufficiency from changes in the heart muscle of its innervation. Endocarditis and pericarditis are very rare complications of diphtheria. Cardiac enlargement was frequently found, contrasting with the cbservations of Dr. D. B. Lees. The writers also do not confirm his views as to the frequency and importance of acute

cardiac dilatation and syncope.

In almost all the fatal cases there was gradual cardiac failure.

There were three types of cases. In the first and most serious there were gallop rhythm, vomiting, epigastric pain and tenderness, and the majority were fatal in two or three weeks. The second type lasted weeks or months, with a rapid regular or irregular heart, which gradually became normal. The third type was very rare. Its main feature was a slow pulse at the end of the second or the beginning of the third week. There were three cases of this type, which were all fatal.

Treatment.- Prolonged rest in bed was ordered in all severe cases, but all the patients who had murmurs and a somewhat irregular pulse increased in rate were not kept in bed. Digitalis and alcohol rarely did any good. Strychnia was found to be the best drug, and was given in doses of 1-60 gr. every four hours to a child aged from 5 to 10. In many cases larger doses seemed to be useful.

Relation of the Index of Alkalinity to the Production of Diphtheria Toxin.-A. P. Hitchens, Glenolden, Pa. (Science, March 31, 1905). A study of the reaction of bouillon before and after sterilization shows that in media containing carbohydrate the rise in acidity after sterilization varies according to the temperature of the sterilizer. This is most important in the production of diphtheria toxin. Bouillon prepared according to the method of Smith, and sterilized in the autoclave, showed after sterilization varying indices of alkalinity. The reaction after sterilization of sugar-free bouillon is very uniform. And as the reaction of bouillon for the production of diphtheria toxin must be very exact, it is advantageous to add the dextrose after sterilization. The meat juice is neutralized to litmus, planted with the colon bacillus and incubated over night to destroy the muscle sugar. The bouillon is made from this in the ordinary way, two per cent. of Witte's peptone being added. It is dispensed into Fernbach fasks, one liter in each, and sterilized in the autoclave. Little attention need be paid to the temperature, it may vary anywhere from 115° to 120°, 0.2 per cent. of dextrose is added after sterilization. The cultures are incubated six days at 350-36° C. The reaction of the bouillon before sterilization is made +.45, so that after sterilization it may be +-75. Toxin made by this method has been very uniform, rarely being below .005 c.c. for a 250-gram guinea-pig.

The Viability of B. Dysenterioe Shiga.-W. D. Frost and R. Whitman, University of Wisconsin in Science, March 31,

1905:—Four strains of this organism were tested. One was the Shiga type. The others belonged to the Flexner-Harris type. Of these one was the Harris culture and the others were from Duval and Bassett's series of summer diarrhoea cases. The viability was tested by drying the organisms on articles of merchandise, dried food substances and in sterile distilled water and milk, under various conditions. A summary of the conclusions reached follows: the B. dysenterioe when dried on articles of merchandise, as paper, cloth and wood dries rapidly in from four to nine days at the temperature of 17-20° C. On dried food substances, as bread, rice and albumin balls, this germ may live for days. In some cases it is able to live over a month. In sterile water the life of the germ is very short, rarely maintaining itself more than a week. In sterile milk the germ can live until the medium is dried up. The different strains vary in their viability under given conditions, the Shiga type culture being distinctly more frail than cultures of the Flexner-Harris type, the effect of temperature in modifying the viability of the germ being important. At a temperature of 38° C. it will live from only one half to one fourth of the time that it will live at a temperature of 17-20° C.

Treatment of Gastro-enteritis with Buttermilk.—During a severe epidemic of gastro-enteritis and of cholera-infantum in the north of France, buttermilk was largely employed as a medicament. The conclusions which have been drawn by Dr. Floquet from the results of his experiences are reported by E. Decherf (Arch. de Med. des. Enfants, January, 1905) as follows: Buttermilk is generally well taken by infants, who prefer it to sweetened boiled water. Its use was followed by good results, while in parallel cases, treated by other means, no improvement was observed, while acting in these cases as a specific, buttermilk is also a food and causes an increase in weight. It is indicated in both chronic and acute cases. It produces excellent results in rickets; it combats the intestinal fermentations which give rise to chronic auto-infection. Some practitioners have administered the buttermilk raw, but the majority who have used it prefer to give it boiled. The following is the method of preparing the buttermilk: One tablespoonful of farina to a liter of buttermilk, which is then slowly boiled in an enamelled or porcelain vessel, at the same time that it is constantly stirred. The mixture is kept boiling for several minutes, at the end of which 75 grams of sugar are added. It is then ready to be fed to the infant, either in the bottle or with a spoon or cup. In cases of acute or chronic gastro-enteritis, it is given in the same doses as milk, every three hours. In the beginning it is best to give it in fractional doses of a tablespoonful every fifteen minutes. Although during the first few days the child may vomit after taking the buttermilk, the stomach soon gets used to its acid food. In children over a year old, sometimes large doses are necessary. The good effects of buttermilk are to be attributed to the large amount of lactic acid present, which counteracts intestinal fermentation. The small amount of fat contained, and the fine division of the casein, thanks to churning, render the preparation very digestible.

Associative Action of Bacteria on the Souring of Milk.C. E. Marshall, Michigan Agricultural College (Science, March 31, 1905. The author, working with cultures of associated bacteria, consisting of B. acidi lactici, and a bacillus obtained from milk and not yet described, possessing marked proteolytic action in its growth upon milk, and producing alkaline reaction, decidedly marked in old cultures, has been able to demonstrate that loppering is hastened by the presence of this proteolytic germ over that of the lactic acid germ, by as many as ninety-six hours at times, temperature 20° C.; that the acidity rises high above that of the lactic germ; that these changes may be noted by the naked eye appearances of the cultures; and, further, that the lactic acid germ develops much more rapidly when associated with these proteolytic germs than when existing in pure cultures. He has also found that the products produced by the proteolytic germ are stable and that they may exert the same influence as the presence of the living germ. Analyses of cultures at various ages indicate that the products influencing the growth of the lactic acid germ are either amido or ammonia compounds. Synthetic cultural media have been attempted, but without satisfactory results so far.

It may also be said that peculiar curdling effects have been obtained with fresh milk from the cow and of various ages thereafter. This may account for certain peculiar cultural results secured in cultivating germs in various samples of milk.

A Case of Noma Cured by Means of Red Rays.-Another triumph of phototheraphy is recorded in the successful treatment of that dread malady, cancrum iris, by W. O. Motshan (Arch. f. Kinderheilk., Vol. 40, Nos 4 to 6). The patient was a nine-year-old boy, who after having passed successively through scarlatina, varicella and measles, developed noma of one cheek, which went on to perforation. Immediately upon the admission of the case to the hospital, the local use of red rays by means of a 16-candle power incandescent lamp with


a red globe, was resorted to. The wound alone was exposed to the rays. The results of this treatment were soon apparent. On the third day pain disappeared. Seven days later the anterior half of the wound was filled with granulations. The necrotic areas gradually diminished. Two months later the patient was presented before the Pediatric Society of St. Petersburg, entirely cured.

Researches in Dementia Praecox.-A. D. Ormea and F. Maggiotto (Gazz. deg. Osped., January 22, 1905) report the following observations on the urine of cases of dementia praecox. They believe a definite relation may be established between the limination of methylene blue and the clinical symptoms of depression and excitement. They arrive at the following conclusions: (1) In dementia praecox there is a special and characteristic alteration of the process of excretion, which shows (a) by means of the elimination of methylene blue through the kidneys, which begins and reaches its maximum intensity with great delay and is prolonged far beyond the time customary in normal individuals; (b) by the character and composition of the urine, in which the total quantity is diminished and the specific gravity is reduced; with a great reduction of area, uric acid, phosphates, sulphates, nitrogen, and total acidity, with a slight increase of chlorides. (2) The elimination of methylene blue in other psychoret, manicdepressive insanity, hysteria, phrenasthenia, melancholia, of involution and dementia paralytica, is always more rapid than in normal individuals. (3) These types of mental disease do not show the same variation in the urine corresponding to the symptoms of depression and excitement. (4) These observations suggest that dementia praecox is an idiopathic form of disease, quite distinct from other kinds of psychoses, and based on the alteration of the excreted materials, probably produced by the blood vesels in the sexual organs-resulting eventually in a systemic and partial degeneration of the brain. (5) The elimination of methylene blue in this characteristic way shown in dementia praecox can be used to diagnose this disease.

Fresh Cold Air Treatment of Pneumonia in Infants.-W. P. Northrup (Med. Rec., February 18, 1905) reports two cases of pneumonia in infants in which the windows of the sickroom were kept open day and night; both children recovered. He believes it will become more and more the rule to treat pneumonia in this way. Cool, pure air, he says reddens the blood, stimulates the heart, improves digestion, quiets restlessness, and aids in overcoming toxemia. He concludes with the following prescription for killing a baby with pneumonia:

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