Gonococcus Differential Stain. Leszcynski (Arch. f. Derm., Vol. 71, No. 3) describes the following clinical method of differentiating the gonococcus :— R Thionin sol. aq. sat., 10.0. Ac. carbol., 95 per cent., 2.0. Stain with the above for one minute, wash and then stain also for one minute with: B Ac. picric sat., sol., Kali caustic, 1 to 1000, aq. sol., of each, 0.50. Alcohol absolute five seconds, wash and dry. Pus and epithelial cells on examination show yellow protoplasm and reddish-blue nucleus, the former somewhat darker than the latter. The gonococci are intense black, and possess a distinctive plastic sharpness when intracellular. Extracellular micrococci and a few bacilli are also jet black, but are easily differentiated. - LancetClinic. Phlegmasia of the Four Limbs. At a meeting of the Society of Obstetrics, Gynæcology and Pædiatrics M. Pinard spoke of a case, the details of which had been communicated to him by Dr. Coquard, of Angers, in which there was arthritis of the knees, of the left shoulder, of both temporo-maxillary joints, embolism, and pulmonary gangrene. The patient recovered. A tripara of 35 years, whose preceding labors had been normal, was brought to bed at term on September 10, 1904, after an irregular labor of twentyseven hours and a stage of expulsion which lasted three hours. The child was extracted by the forceps. The perineum was completely torn and the recto-vaginal wall was involved. On the following day, September 11th, the perineum was repaired. On the 11th, 12th and 13th of September the average temperature was 38.2° C. (100.7° F.). The process of involution seemed to be normal. From the 14th to the 17th the temperature and lochia were normal. On the 18th occurred a chill and the temperature rose to 39.5° C. (103.1° F.) and the lochia diminished. A uterine injection was made and the liquid returned somewhat turbid. By the 20th the temperature had fallen more than two degrees and another uterine injection was given. On the 21st the evening temperature had risen above 103° F. The uterus was curetted. Only mucous débris without odor was obtained. On the 22d there was a chill and a temperature of nearly 103° F. On the 24th another chill and uterine injection. A severe chill occurred on the 25th. On the 27th phlegmasia began in the right leg. On October 1st the temperature exceeded 103° F. On the 6th it was On the 8th it again rose and normal. phlegmasia occurred in the left leg. On the 11th there was a severe chill and a temperature of 106.7° F. The same temperature endured for several days. On the 18th there was phlebitis of the right arm. On the 21st the left arm was similarly affected. There was also inflammation of the left shoulder. Some days later the patient experienced a sudden pain in the breast and at the apex of the left scapula. The patient had a dry cough, pleural friction sounds and dyspnoea for twenty-four hours. Arthritis of the left knee began on November 5th, the temperature remaining very high. On the 11th there was suppuration of the right knee; the joint was opened and drained. Chills were repeated for three days. Cough returned on the 21st of November. Upon auscultation bronchophony was recognized with bronchial murmur and subcrepitant râles at the left base. There was a characteristic expectoration of a gangrenous odor. An elimination by spacelus of an embolus was suspected. During all the progress of these events the heart acted well and regularly. There was no delirium and only a moderate excitement attended the highest ascents of the temperature. Digestion remained good with the exception of some diarrhoeal attacks. The tongue continued moist. M. Pinard, who was called in consultation on October 29th, was able, notwithstanding the four sites of phlebitis and the embolism, to make a favorable prognosis. On February 5, 1905, there remained of this long illness, after eighty days of fever and multiple localizations, nothing but a little stiffness of the right knee. The uterus had not been involved in the disease. To the history of the case M. Pinard appended some remarks: When he saw the patient he was impressed by the force, regularity and absence of rapidity of the pulse (96). In seven cases of phlegmasia alba dolens of all the limbs which he had observed, and accompanied by œdema of the entire trunk, basing his judgment upon the analogous characters of the pulse, he was able to formulate a comparatively hopeful prognosis. Out of the seven pa tients but one died, in consequence of a phlebitis of the ophthalmic vein. In the case just described M. Pinard advised against any uterine treatment. He recalled the fact that in six cases he witnessed the generalization of the phlegmasia was consecutive to a late uterine intervention. These procedures later than the eighth day after delivery tend to generalization. He emphasizes the idea that in consequence of a pathological puerperium, unseasonable local treatment is particularly dangerous.-La Tribune Médicale. Typhoid Peritonitis Without Perforation. At a meeting of the Medical Society of the Hospitals MM. Courtois-Suffit and Beaufumé reported the case of a patient who, on the twenty-first day of a typhoid fever, had a generalized peritonitis. This peritonitis, which began suddenly like one due to an intestinal perforation, and developed also in the same manner, except that the abdomen was not swollen and the hepatic dullness was preserved, was operated upon six hours after its advent. The peritoneum contained two liters of a yellowishbrown, inodorous fluid, and numerous false membranes covered the lower third of the ileum, cæcum, and ascending colon, lesions in an advanced stage, and which no doubt had progressed in a latent form for a considerable period prior to the apparent beginning of the peritoneal infection. There was no intestinal perforation. The appendix was absolutely healthy and there was no appreciable lesion to explain the occurrence of the peritonitis. It could only be related to the typhoid intestinal lesions. This was a most interesting case from the clinical point of view as well as from that of the pathogenesis, still under debate and obscure, of typhoidal peritonitis withcut perforation, commonly called by propagation. Such cases undeniably occur, and it seems logical to explain them, with the classical authorities, by infection through contiguity of the intestinal tunics to the peritoneum, rather than to admit that hypothesis which, in order to explain the cases, invokes a peritoneal invasion by the bacillus of Eberth, independent of that of the intestine, the peritoneum being infected on its own account, as the pleura and the bones.-La Tribune Médicale. Acute Syphilitic Meningitis. H. Drouet has published in a Thése de Paris a description of a rather rare affection, and yet which is more frequent than is usually supposed. Prior to 1900, moreover, only two undoubted cases were known. Since that date the author has been able to collect six additional cases. It occurs preferentially in males from 18 to 40 years of age. The disease is ushered in by headache, vertigo, vomiting, neurasthenic troubles, and fever, which is sometimes high. Subsequently there is agitation or somnolence, epileptiform attacks or coma; above all, ocular and facial paralyses. Finally, there is lymphocytosis and hypertension of the encephalo-rachidean fluid. Sometimes its evolution is inter rupted by alternations of amelioration and aggravation. It lasts, on an average, from twenty-five to thirty-five days. The habitual termination is recovery, nearly always complete. Acute syphilitic meningitis is the least dangerous form of acute meningitis, and the most benign variety of cerebral syphilis. It yields readily to specific treatment. The prognosis is not serious in itself; the syphilitic background remains, however, and return is possible. The diagnosis is easy between syphilitic and tuberculous meningitis, as well as saturnine encephalopathy. In all these forms there is rachidian lymphocytosis. The sole rational treatment is specific and the course should be prolonged.—La Tribune Médicale. tients have childish ideas, sometimes childish gestures. They weep without cause, and sometimes have fits of laughter for trivial reasons. It is often when they are. refused something which they wish to eat that they exhibit their puerilism by tears and pouts. Other patients subjected, like typhoid, to a milk diet and experiencing hunger call lustily for food. Instead of crying like children, however, they argue, talk and gesticulate. It is not surprising that typhoid fever, which attacks the brain by predilection, should include puerilism among the psychical troubles which it engenders. redity and neuropathic predisposition play, no doubt, a great part in its production. He It is not ordinarily at the height of the disease, when stupor predominates, that mental puerilism occurs, but rather during the period of decline. It appears that the brain, in regaining little by little its activity, passes through a short infantile phase. La Tribune Médicale. Infectious Optic Neuritis. Dr. Henri Bichelonne has studied a particular group of cases of optic neuritis following infection and due to angina. He reports a new and detailed case of a robust artilleryman, formerly of good health, without adequate morbid antecedents, who, fifteen days after the outbreak of an angina, was attacked by amblyopia followed by amaurosis. The papilla was hyperæmic and oedematous. The patient remained blind for eight months and then the symptoms progressively amended. The objective lesions disappeared and in the ninth month sight was regained, the visual acuity equal to 1, and restitutio ad integrum was complete. The author has found four similar cases recorded in medical literature, those of von Graefe, Menacho, Nathouson, and Parinaud. In these cases, as in his own, he remarked that the ocular accidents are somewhat distant from the angina which produced them (about fifteen days). This is not surprising, as the microbian toxins are capable of acting after a long interval. He asks, on the other hand, is there an inflammatory compression of the optic nerve by an inflammatory cedema of their sheaths. The author doubts this hypothesis, at least in his own case, for he finds it difficult to believe that such compression could last for six months. tions.-Revue Hebdomadaire de Laryngologie, etc. Neuritis of the Abducens, Accessory, and M. Negro says after an attack of grippe there followed paralysis of the right adducens, with diplopia, lingual hemiatrophy, paralysis of the vocal cord, of the anterior pillar of the fauces of the right side; the uvula was unaffected as well as the constrictor of the pharynx; finally, there was paresis and atrophy of the right sternomastoid muscle. These accidents have persisted without change for twelve years, probably under the dependence of an encephalic polyneuritis. The localization of the process attacking the vocal cord, the soft palate, the sternomastoid muscle, shows that the superior laryngeal nerve is not a branch of the pneumogastric nerve, but of the accessory, and that, except the uvula, the innervation of the velum palati is furnished by the same nervous branch.-Revue Hebdo The theory of impregnation of the perineurium by microbian toxins appears to him more admissible. The troubles of the papillary stasis also may be vasomotor disturbances of the retinal vessels due to the infectious poisons. M. Bichelonne furthermore inquires whether the disorders of vision may not be related to a renal lesion madaire de Laryngologie, etc. due to the angina. Angina, in fact, is often followed by kidney disease, and when there is nephritis there is œdema. As regards the nature of the angina, it is to be regretted that a bacteriological examination was not performed. It was probably due, however, to insignificant germs, as the streptococcus, which is the most frequent cause of catarrhal angina, and which, nevertheless, profoundly affects the organism; for, as Pitres and Vaillant have stated, a simple streptococcus angina may be the cause of polyneuritis or of psychoses. Lemoine looks upon the streptococcus as the infectious agent of scarlatinal nephritis, and Basquet attributes to it the cardiac sequels of angina. The streptococcus, therefore, of all the microbes of the mouth is the most capable of producing grave and distant complica Post-traumatic Nervous Accidents. For M. Quénu At a meeting of the Surgical Society M. Quénu divided post-traumatic nervous accidents into two classes: one of infectious origin, the others of toxic source. Both are very much influenced by the anterior alcoholism of the subject. The pathogenesis of the accidents is not yet completely explained. there is an auto-intoxication due to insufficiencies arising from shock. From this part of view he modifies the treatment and considers the position of Todd and the opiated wine as inefficacious. Trousseau and Vulpian also were opposed to this course and employed digitalis. In order to facilitate the elimination of toxins M. Quénu makes use of the physiological serum. He also recommends cold lave ments and baths advised by M. Letulle. He combats the cardiac manifestations by means of hypodermic injections of strychnine sulphate in small doses.-La Tribune Médicale. Poisoning by Orangeine. J. L. Miller, Chicago, reports in the Journal of the American Medical Associa tion, June 24, a death from orangeine poisoning. The patient had been warned of the danger, but persisted in the use of the powders. Miller calls attention to the danger to the public from having free access to such a remedy, which is advertised as harmless. The public will use it without the careful dosage which a physician would require, if he gave acetanilid. Analyses of orangeine show it to contain a large proportion of acetanilid. Bright's Disease. Bright's disease, according to A. C. Croftan, Chicago (Journal of the American. Medical Association, June 24), is a toxæmia presumably of intestinal, and, by implication, of hepatic origin, involving, primarily, the cardio-vascular apparatus, and secondly, many organs of the body, including the kidneys. Causal treatment, therefore, in his opinion, must be directed toward the digestive disorders that underlie most causes of the disease. In some cases, however, there are, he believes, obscure metabolic perversions, hereditary or neurotic, it may be, that we do not understand, and this class is less manageable, and its treatment is necessarily only symptomatic. Symptomatic treatment is not, however, the conventional treatment of the kidneys, but the treatment of the heart and arteries. When nephritis is established, it of course calls for treatment, but nephritis may not occur till late in the disease. The · general measures of maintenance of the nutrition by regulated diet and the avoidance of nervousness, care, worry, and fear are naturally of paramount importance. Croftan advises the use of intestinal antiseptics, sulphocarbolate of zinc, sodium glycocholate, and organic peroxides, a number of which are sold under various trade names, and which, he thinks, are useful in small doses, together with bismuth as a test for the presence of sulphur comWhen the stools are pounds in the fæces. not colored black by bismuth sulphide, it is an indication that the intestinal antiseptic is given in sufficient amount to check the putrefaction of albumin, and in most cases the indican and other aromatic urinary ingredients will have disappeared. Small doses of digitalis, 1 drop of the tincture, t. i. d., are useful in rendering the heart less susceptible to the disturbing stimulation of circulating toxins, and may be given without danger of impairing the power of the heart to respond to larger doses in emergency. Schott's exercise treatment is very useful for strengthening the heart in Bright's when myocardial changes. threaten, and far better than large doses. of digitalis or other cardiac tonics. For reducing blood pressure, nitroglycerine or, better, erythrol tetranitrate, is the orthodox remedy and can be kept up for a long time. Continuous vasodilatation, lowering blood pressure in the kidneys, reduces the albuminuria and enables the renal epithelium to regain its tone and to resume its functions. Other measures that aid are hot baths, rest in a warm bed and judicious life in a warm, dry climate, all favoring relief of arterial tension and rest to the heart. Croftan condemns kidney decapsulation as irrational in Bright's disease. In acute nephritis underfeeding is advisable, but in chronic cases the daily amount of feeding, expressed in caloric values, should be inversely proportionate to the presumed duration of the nephritis. There is also no reason why a mixed diet may not be |