NORTHRUP (W. P.). Gonococcal Peritonitis. Archives of Pediatrics, No. 12, p. 910. 1903. Two girls, sisters, aged nine and eleven years, acquired vulvo-vaginitis, developing one week later into peritonitis. Case A at the end of the week's indisposition, during which the vaginal discharge had been discovered, became rapidly prostrate. The temperature rose to 103°F., she vomited once, a death-like pallor supervened, and she complained of abdominal pain, especially in the right iliac fossa, where there was much tenderness. Micturition was painful, and the abdomen moderately distended. Laparotomy was performed, and a few drams of strawcoloured, clear fluid found deep in the pelvis, the peritoneum being red, and the vessels distended, forming a most striking example of arborescent infection." In case в also the onset of the peritonitic symptoms was sudden, abdominal pain of a colicky character coming on and lasting 17 days. The patient lay much of the time with her knees drawn up, vomiting large quantities for several days, the abdomen slightly distended and most tender over the spleen, though generally resistant. Micturition and defæcation were painful, and the respiration was rapid and thoracic. Dr. Northrup gives a short account of eight cases previously reported by Comby, and from these ten cases discusses the etiology and symptomatology. All the ten cases recovered, and though three fatal cases are recorded in young children, he suggests that when a young girl presents abdominal symptoms having an explosive beginning a vulvo-vaginal discharge should be examined for. If the gonococcus is identified he advises that operation should be deferred. R. W. MARSDEN. DELILLE (M. ARTHUR). Symptomatic Intermittent Fevers. Gazette des Hôpitaux, 1903. No. 138, p. 1357. THE writer deals with the very numerous conditions under which intermittent fever occurs, describing its characters in association with various local causes (the affections of the organs being separately referred to), and also in connection with blood infections (e.g., septicæmias), infective diseases, affections of the nervous system (e.g., hysteria, etc.), and the arthritic diathesis. R. W. MARSDEN. PILSBURY (LAWRENCE B.). Agglutination of Dysentery Bacilli by the Blood of Non-Infected Persons. Medical News, 1903. Vol. lxxxiii., p. 1078. FROM his study of the subject. Dr. Pilsbury comes to the following conclusions: 1. That the serum of non-dysenteric adult patients does agglutinate the Shiga and acid type (Flexner) bacilli frequently in a 1 to 20 dilution and occasionally in a dilution as high as 1 to 100. 2. That this agglutinating power is wanting in the blood of nondysenteric young infants (under one year), rarely being present in a 1 to 10 dilution. 3. That there are certain differences in agglutinating capability between the Shiga and acid type (Flexner) bacilli, the former clumping more readily than the latter. 4. That a decided and prompt reaction, under two hours, with the bacillus dysenteria in dilutions of 1 to 20 or higher in young subjects (under one year), and 1 to 50 or higher in older persons who have not recently suffered from chronic or subacute intestinal disease, is probably pathognomonic of acute epidemic dysentery. R. W. MARSDEN. AUCHÉ (B.). Diffuse Parenchymatous Hepatitis in the Acute Sporadic Dysentery of Infants. Journal de Méd. de Bord, 1903. No. 48, p. 773. DR. AUCHÉ states that if one excepts abscess and congestion of the liver, the hepatic affections caused by acute dysentery appear to have attracted very little attention, and he quotes from several recent writers on the subject in support of his contention. From an examination of the liver in these cases Dr. Auché finds a diffuse parenchymatous hepatitis characterised by cellular necrosis which may pass on to disintegration and complete disappearance of the cell. Though generally diffuse, these changes may group themselves in small islands, and give to the hepatic parenchyma the appearance of an areolar tissue owing to the more or less complete disappearance of the gland cells. With these lesions there exist a centro-lobular congestion unequally distributed, and a very slight degree of fatty infiltration of the hepatic cells. The portal and supra-hepatic venous systems, the biliary canals, and the connective tissue surrounding the portal veins and bile ducts are not altered. Dr. Auché was unable to find a micro-organism in the hepatic parenchyma in any case, and therefore thinks it probable that the lesions must be attributed to the action of a dysenteric toxin. R. W. MARSDEN. EARL (H. C.). The Cytology of Serous and Serofibrinous Effusions of the Pleural and other Serous Cavities, and of the Cerebro-Spinal Fluid. The Dublin Journal of Med. Science, 1903. Vol. cxvi., p. 409. AFTER referring to the frequency with which indefinite or inadequate results are obtained by the chemical and bacteriological examinations, Dr. Earl deals with their cytology, mentioning particularly the work of Widal and Ravaut in Paris, and Alfred Wolff in Berlin, the former of whom expressed the opinion that a predominance of lymphocytes denotes a tuberculous effusion, a predominance of polynuclear cells an acute infectious effusion, while mechanical effusions are characterised by a predominance of endothelial cells. Dr. Earl then mentions various points which must be observed in the methods of investigation, viz., the prevention of coagulation in the fluid, the replacement of the albuminous fluid by normal saline solution, so that the staining of the groundwork will not obscure the details of the cells, and in addition gives the points to be observed in distinguishing degenerated polynuclear neutrophile cells or "pseudo-lymphocytes" met with in serous effusions from lymphocytes. In primary tuberculous pleural effusions it would seem that endothelial cells are often present in the early stage. They soon diminish and finally disappear, desquamation no longer occurring after a fibrinous membrane covers the pleura. Moreover polynuclear cells are always present during the first ten days, and subsequently gradually disappear, so that it becomes necessary to know the date of onset. Generally the cell formula of secondary pleural effusions in the course of phthisis is very mixed, and this has been attributed to mixed infection. Of the acute infectious pleural effusions, though the cell formula varies somewhat with the nature of the infective agent, yet it may be said that Widal and Ravaut's formula has been in the main confirmed. As regards pericardial and peritoneal effusions and hydrocele, though the observations made are insufficient to warrant definite conclusions, the results obtained agree with the formula cited. In hydrocele Julliard pointed out that the appearance of lymphocytes, or even of polynuclear cells, may depend on irritation, such as puncture without the existence of any bacterial process, whilst the presence of endothelium alone in a fluid is not sufficient to stamp the case as essential hydrocele, since any very chronic affection may be accompanied by this condition. Further, the same observer showed in articular effusions that the presence of polynuclear cells in a fluid is not a sign of a bacterial origin, but of the acuteness of the morbid process whether its origin is infective, toxic or traumatic. Widal and Ravaut's formulæ may also be extended to cerebro-spinal fluids, but it must be noted that in tuberculous meningitis the lymphocytes, instead of being, as they are in tuberculous pleural effusions, 90 to 98 per cent., are sometimes not much above 50 per cent. In addition consideration must be given to the acuteness of the process, to the presence of caseating nodules, or the occurrence of secondary infection, as under these circumstances the polynuclear cells have been generally found to predominate. Finally, it must be mentioned that in tabes, general paralysis, and syphilitic meningo-myelitis there is a predominance of leucocytes even in the early stages. R. W. MARSDEN. SERGENT (EMILE) and LEMAIRE (HENRI). Staphylococcal Cerebro-Spinal Meningitis. Arch. Génér. de Méd., 1903. Vol. cxcii., p. 3073. THE writers give a clinical account, with post-mortem report, of two cases of typhoid fever complicated by meningitic symptoms, in both of which examination of the cerebro-spinal fluid after death revealed the presence of the staphylococcus citreus. One of the cases had in addition an abscess which had invaded almost the whole of the lower lobe of the right lung, and suppurative lymphangitis in the right upper extremity. According to the clinical account, however, the meningitic symptoms were antecedent to these two complications. As the patients were in adjoining beds the writers suggest the possibility of contagion. R. W. MARSDEN. LÉPINE (JEAN). Typhoidal Myelitis. Revue de Médicine, 1903. Vol. xxiii., p. 930. DR. LÉPINE gives a detailed description of a case of typhoid fever in a young man, 19 years of age, in whom the following unusual nervous symptoms developed :-Increased sensibility to touch and to the point of a pin especially affecting the lower extremities and the abdomen up to the level of the umbilicus. Tendon reflexes of the lower extremities increased, most markedly on the right side. The presence of Babinski's reflex. General diminution of muscular power in the limbs, again most marked in the lower. Nevertheless voluntary movements possible, though slow and showing slight inco-ordination. Gradually complete flaccid paraplegia developed, the cutaneous and tendon reflexes on both sides disappeared, marked diminution to every form of sensibility and incontinence of urine and fæces supervened, and, despite the greatest care, bed sores formed. Post-mortem examination showed the presence of an acute anterior poliomyelitis, attaining its maximum development in the lumbo-sacral region, with central myelitis, extension of the lesion into the white columns (antero-lateral), and concomitant leptomeningitis. Other parts of the central nervous system showed only slight changes, there being very moderate implication of the motor roots and relative integrity of the sensory paths. Dr. Lépine then reviews previous accounts of paralysis in association with typhoid fever, and concludes that one may meet with a neuritis or a myelitis. All degrees of acute inflammation may occur, the lesions being without doubt primarily vascular (e.g., hyperemia, diapedesis, extravasation, hæmorrhages), with subsequent affection of the cells, interstitial inflammation and degeneration, with a tendency to an upward propagation, thus assuming the type of acute ascending paralysis. Apparently the typhoid toxin is sufficient for the production of the lesion, the presence of the bacillus not being indispensable. Though some observers have been able to cultivate the bacillus from the spinal cord, Dr. Lépine obtained negative results in his case. As regards the path taken by the poison, the vascular channels must first be mentioned. Nevertheless this is not the only way. The permeability of the arachnoid membrane in inflammatory affections must be taken into consideration, thus permitting the entrance of toxins into the cerebro-spinal fluid, and in this connection the evident implication of the pia mater, the neuroglia and the ependyma lining the central canal, i.e., in each instance of the membrane enclosing the cavity occupied by this fluid, offers important corroboration. Without doubt some cases of typhoidal myelitis recover, some being possibly undetected at the period of origin during the febrile attack. Thus it may happen that not only disseminated sclerosis, chronic myelitis or combined tabes may follow as shown by Pierre Marie, but that abortive syringomyelia and chronic affections of the spinal cord may owe their origin to a more or less distant infection. Usually myelitis occurs during the attack of typhoid fever, peripheral neuritis supervening in convalescence, but the rule is by no means absolute, and similarly, though met with most frequently in severe cases, the rule is not definite. It must not be assumed that in all cases a clear differentiation into one or the other of the above types of nervous lesion can be made. Occasionally a combination of the symptoms of myelitis and of polyneuritis occurs, the lesion being then referred to the whole of the peripheral motor neuron. In addition also the symptoms may assume the character of a meningo-myelitis. Nevertheless it is important to differentiate the two conditions of myelitis and peripheral neuritis, since in the latter recovery is the rule, whereas in the former death, sometimes even very rapid, is not uncommon, and recovery when it occurs is slow and incomplete. R. W. MARSDEN. SAILER (JOSEPH) and FRAZIER (CHAS. H.). Strangulated Meckel's Diverticulum Complicating Typhoid Fever. Univ. of Pennsylvania Med. Bulletin, 1903. Vol. xvi., p. 314. ALTHOUGH ulcers in Meckel's diverticulum have been found occasionally in typhoid fever, the writers have not found any record of its rotation and strangulation during that disease. The patient was a man, 26 years of age, who gave a history of having suffered from an attack that had been diagnosed as gall-stores one year before admission, there being pain in the right hypochondriac region which lasted for several weeks. Symptoms of typhoid fever were present when he was seen on the second occasion, the diagnosis being confirmed by the sero-reaction. Of unusual symptoms, must be noted the absence of diarrhoea, temporary difficulty in micturition and continued pain and discomfort in the abdomen, with tenderness sometimes situated about one inch above the symphysis pubis, sometimes just below the xiphoid cartilage. Three weeks after admission there was sudden severe pain in the abdomen with some collapse. The pain rapidly diminished, and examination showed a prominence just to the right of the umbilicus, which gave a slight sense of resistance, some tenderness and normal |