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The test paper here described makes it relatively easy to choose the antibiotic best suited for treatment of a given bacterial infection. Each type of test paper bears both a culture medium and an antibiotic and is supplied, dry and sterile, in a transparent envelope. For a given test, the paper is wetted and inoculated and the envelope with its contents is incubated. It is not necessary to wait for the appearance of visible colonies because the metabolic activity of the bacteria is detected by an indicator (triphenyltetrazolium chloride) which is colorless until reduced to a bright red dye by bacterial enzymes. The reliability of the new test was established by a comparative study with other methods in 100 clinical cases. The test paper is easily stored, and the entire unit can be incinerated after use. It is therefore useful in general office practice and should help to make sure that each patient receives the most effective antibiotic.

A p H test paper (Hydrion) was found to have the most favorable color scale over a p H range from 1 to 6, in comparison with many available indicator papers. Its use gives good correlation with the standard titration technique. Availability of a reliable, easily used indicator paper would encourage the physician to use gastric analysis more frequently and would stimulate patients to accept self-testing just as diabetics test for glycosuria.

To the Editor: —During the past six months we have been experimenting at the New York Orthopaedic Dispensary and Hospital with the use of paper as a surgical dressing, and our experiments there warrant me in making this preliminary report of its use in the hope that other surgeons may try it, that further experience may prove it to be a substitute for gauze, muslin, etc., and that its use will effect a great economy in the expense of our surgical work. Among our experiments we have used sterilized newspapers in the dressing of clean wounds, and have found them perfectly satisfactory, causing no irritation and no disturbance whatever. We have also used various forms of paper, such as those used in making towels, toilet paper, table cloths, napkins, etc., in the dressing of clean wounds, and have had no trouble whatever. We have used sterilized newspapers also in the

To the Editor: —Since the publication of my article entitled "A Delicate Test for Bile in the Gastric Contents," inThe Journal, May 20, 1909, p. 1758, my attention has been called to Rosenbach's test for bile in the urine. This consists in filtering the urine several times through the same filter paper and applying nitrous acid to the filter paper after drying, to obtain the reaction for bile. I have never used the Rosenbach test for bile in the urine, but, working entirely independently of that method or other methods, I have found that the filter paper test for bile in gastric contents as described by me, will detect the presence of bile, when no reaction for bile will be obtained when nitrous acid is applied to the filtered gastric contents themselves.

With the constantly increasing technological knowledge, we are almost daily presented with new materials and processes to facilitate all mechanical tasks. In this present era it is not unusual to find that plastic materials are used to replace wood products, leather, or cardboard, while fiberglass frequently does duty for steel and all rubber is not necessarily obtained from trees. The efficency required by contemporary industry has resulted in the introduction of the typewriter (which has an "inked" ribbon), carbon paper, and stencil papers (with which inks and correcting fluids are used), as well as the recently developed various types of photographic duplicating processes. In view of the fairly frequent use of these new materials and processes, the dermatologist must constantly be aware of the possibility that these agents may be a causative factor in contact dermatitis. We have observed two patients who developed contact dermatitis from paper used in one

Every physician should know how to prepare a paper for presentation at a medical meeting or publication in a medical journal. Perhaps the most convincing reason for this is an altruistic one. Since writing is the only means the medical profession has of universally disseminating knowledge concerning new therapeutic concepts, medical discoveries, or clinical experience, it is the moral obligation of every physician who has made an original scientific observation, or has formulated from his own experience a new medical theory, to publish it for the information of his colleagues, and the ultimate benefit of mankind. Another good motive for writing medical articles is a purely selfish one. In addition to the sheer joy derived from effective self-expression, the physician who prepares an article on a certain subject broadens his own knowledge of that subject, for, before he can present his material in a comprehensive manner, he must have a

Pure carbonic-acid gas which has been compressed into a liquid by enormous pressure evaporates so rapidly when liberated that a portion of the liquid freezes and takes the form of snow or ice according to the conditions under which it is collected. Frozen carbonic acid has a temperature of about 85 F. below zero and freezes any animal surface to which it is applied, a certain amount of pressure being required. The effect is one of superficial or deep destruction according to the length of application, thirty seconds usually being a full exposure. Frozen carbonic acid has been successfully used in treating port-wine stains, a type of nevus for which no other treatment is even partially satisfactory. Other lesions for which it is excellent are lupus, warts, condylomata, moles and epitheliomata. METHODS PREVIOUSLY IN USE The originality and simplicity of the method which I am about to describe is best

It is just make believe, this "war" in Europe last June, but to 40 physicians of the Calcasieu Parish Medical Society, meeting in a Lake Charles, La., restaurant, it might well be the start of World War III. They are getting ready in earnest for the fourth annual U. S. civil defense exercise—planning emergency procedures, reviewing assignments for the society's 98 members, and discussing aggressions of the paper enemy. Already, the "enemy" is supposed to have invaded a friendly nation abroad. In three days, according to the exercise blueprint, the President will call Congress into session. On July 12, some 165 nuclear bombs would rain on key American targets, and tens of millions would die—all on paper. Of course it is not going to happen, but this night of Tuesday, June 25, is the last time for the medical society to plan its role in the test because the next

A bacteriologist frequently finds occasion to demonstrate cultures of micro-organisms, either to student classes within or near the laboratory or at meetings at some distance. In such circumstances it would be desirable to have not only some light and compact receptacle for such cultures, but also one in which the cultures could be shown to the best advantage. It was for just such an occasion that, in looking about for a proper demonstrating case, I finally invented the form of folding paper display case shown in Figure 1. This case is easily made by using a No. 160 white card paper. The design is mapped out, cut and creased, as indicated in Figure 2. The holes are punched out with a ⅝-inch die. The case is then folded, fastened and put away until it is to be used. When the cultures to be demonstrated are ready they are placed in

To the Editor: —At the April meeting of the National Academy of Sciences, Dr. I. S. Kleiner and I presented a communication entitled "Retention in the Circulation of Dextrose in Normal and Depancreatized Animals, and the Effect of an Intravenous Injection of an Emulsion of Pancreas upon This Retention." This paper was published in the June issue of the Proceedings of the National Academy of Sciences , a publication which has only a small circulation. A few weeks ago we were surprised to find an article in the New York American stating that we have discovered the cause of diabetes and a cure for it. A day later a writer on foods published in an evening paper (in quotation marks) a statement, purporting to have been made by us: Glucose in its natural form may be detrimental, but when manufactured is often fatal. That article contains many other nonsensical remarks. I

Paper caps in place of linen caps for surgeons are becoming very popular for a number of reasons. They are cheap, costing less than the laundering and depreciation of linen caps, are cool and light, are automatically adjustable and are free from lint. While there are probably several types of paper hats on the market, the one which has an elastic crape paper insertion in the back is the one to be recommended because it adheres firmly to the head, preventing the dropping of dust on the wound. This hat is made over a block the shape of the head by pasting a paper band of glacine paper to a crown piece composed of any type of paper. In the back of the paper band is an elastic insert composed of crape paper which permits the hat to be stretched sufficiently to conform to heads of any size. A piece

To the Editor:— The feature paper on page 305 ofThe Journalof Jan. 22, 1955, "Critical Reevaluation of Antibiotic Therapy in Surgery," illustrates a point which deserves some comment. I scanned the headings and passed up the paper, because often, I have found, a paper without a summary is one with poorly organized material. Then, after reading the editorial on page 348, I turned back and read the paper. The material is practical and well written, but a proper summary would have served me well and saved some time. My plea is that all papers inThe Journalshould have good summaries. This will catch more general readers and give wider spread to the subject matter, which is important with a paper like the one mentioned above.

To the Editor:— The report on suspension cast for acromioclavicular separations and clavicular fractures, published in The Journal (169:672-675 [Feb. 14] 1959) and presented at the A. M. A. meeting in San Francisco last June, leaves much to be desired. The paper gives the impression that many patients have been treated this way and that the results were good. However, what we saw when the paper was given was most inconclusive. It appeared that the acromioclavicular joints were still separated in the cases shown and that the suspension cast gave no better results than did a posterior figure-of-eight support in bilateral clavicular fractures. It is unfortunate that the discussion of this paper was not also presented in The Journal. In it these points were clearly brought out and doubt was cast on the value of this method of treatment. Many papers published in various journals lose their value when

To the Editor:— At the hospital staff meeting we were informed that, owing to pressure from government boards controlling the use of raw materials, certain form sheets used in our case histories will no longer be furnished. For example, "progress" and "follow-up" notes will, for the duration, go on the same sheet. This may not be a vital change, but the hospital is making a definite sacrifice. The histories will be less easily digested and abstracted when somebody wishes to tabulate a number of them. Yet if this trifling change can be of the slightest use in the war effort, it has our wholehearted approval. Here is the rub. After that meeting, I visited my mail box in the hospital and abstracted sixteen pieces of mail that made a mass of paper weighing 1 pound 9 ounces. Many folders consisted of numerous pages, some printed in brilliant colors. Many, many

METHODS FOR DETECTING HEATED MILK Numerous methods have been proposed to test quickly and simply whether or not a given sample of milk has been heated. The methods suggested fall into three main groups: Those based on the changes which the protein undergoes when milk is heated. These have not proved applicable in practice. Those which depend on the presence of oxidizing enzymes in milk. Of these, Storch's test is generally regarded as most satisfactory. This, however, as is well known, can be used only on milk heated from 78 to 80 C. (172.4 to 176 F.). It cannot, therefore, be applied to milk heated to the temperatures employed for pasteurization in this country. A microscopic test devised by myself and described in a paper by Frost and Ravenel in 1911 (A Microscopic Test for Heated Milk, Proc. Am. Assn. Med. Milk Commissions, May, 1911, p. 127). Two features of

To the Editor: —There is no specialty in medicine that may be excused from its obligation to the bedside point of view. Administrative medicine as one of the more important public health activities has a clinical aspect which, in a peculiar sense, is the final reason for its existence as a specialty. The successful hospital constructionist is the man with the bedside point of view. Hospital equipment is more obviously related to the bedside. Professional and business staff organization, if it is not planned and later adjusted to the needs of the patient, defeats its own purposes. Hospital administration, which provides the experience on which construction, equipment and organization are finally based, must concern itself primarily with the bedside, for in the last analysis the hospital exists for the benefit of the patient, all other benefits that may be derived in connection with his care coming in the nature of

Dr. J. A. Stucky, Lexington: Any method which simplifies anesthesia diminishes the quantity of the drug used and the dangers that attend its administration is to be hailed as a great advance. I have contended, and still do contend, that the patient should be practically from under the influence of the anesthesia by the time the operation is finished to insure rapid recovery. This can be facilitated by the administration of a small dose of morphin hypodermieally—⅛ to ¼ gr. with from 1/150 to 1/200 gr. atropin. I raiely give more than ⅙ gr. of morphin. I am glad Dr. Miller used the term "charging the patient with ether;" I have used the word "soaking." Charging the patient with any anesthetic is dangerous. Chloroform is a dangerous anesthetic in any adenoid or tonsil operation, and especially when there is a tendency to the status lymphaticus.

During the past twelve years the writer has embraced every opportunity to test various means for the purpose of devising some method of treating these injuries successfully, without resort to operations. A very large proportion of females suffering from these afflictions have neither the means nor the opportunity of seeking the aid of the specialist. The writer believes that he has perfected a simple method which can be used by all practitioners of intelligence for the treatment of these cases successfully with time and care without the necessity of operation. The agents resorted to in this method are entirely of a local character. Concealed fissures are often found after labor in the mucous membrane of the cervical canal, and are the cause of an infinite amount of local disease in the form of endocervicitis, hypertrophy of the adjacent tissues, inflammation of the submucous fibrous tissue, leucorrhœa, and often painful menstruation.

Phenylketonuria is a disease characterized by the inability to metabolize an essential amino acid, phenylalanine, which is present in all proteins in average concentration of 4%. Phenylalanine, phenylpyruvic acid, ortho-hydroxyphenylacetic acid, and other unusual metabolites are excreted in the urine. This biochemical abnormality ordinarily leads to severe mental defect. Excellent reviews 1 have appeared recently. Results have been reported 2 indicating that treatment with diets low in phenylalanine has been successful in allowing normal physical and mental growth. It appears, therefore, increasingly important to detect phenylketonuria in early infancy. A routine diaper test 3 has been in use in southern California for some time. Collection of urine specimens from infants is always difficult. Urine containing phenylpyruvic acid that has been dried on filter paper gives a positive test with ferric chloride reagent even after several months. We have devised a simple method for collection of urine on filter paper which

Like other rare diseases, myohemoglobinuria1(myoglobinuria) is believed to occur more often than the sparse number of reported cases (about 35) would indicate. Even when the diagnosis of myohemoglobinuria is entertained, it is difficult to distinguish between myohemoglobinuria and hemoglobinuria, a much more frequent condition. This differentiation until recently has required the use of a highly precise and carefully calibrated spectrophotometer usually found only in research laboratories. Even with such an instrument, and with both pure myohemoglobin (myoglobin) and hemoglobin saturated with carbon monoxide available for control determinations, differentiation is difficult since it depends on small differences in the position of spectral bands.2It has recently been suggested that, with a fluorescent lamp as a source of light, the hand spectroscope may be used to identify myohemoglobin.3Also, in one case, paper electrophoresis has been used to diagnose myohemoglobinuria.4A simple chemical method for differentiating between

Although a diminution of serum gamma globulin or even its total absence electrophoretically not infrequently follows an infection in early childhood, it is much less common in adults. A persistent diminution or absence of serum gamma globulin as the cause of multiple infections is a concept that was introduced by Bruton 1 in 1952. The syndrome in adults seems to be very rare. Moncke, 2 using paper electrophoresis, found only one case of complete agammaglobulinemia, in a male aged 16, among 6,000 adults and adolescents above the age of 15. Because of the rarity of the condition, the following case in an adult is reported. A 53-year-old female was admitted to the Lenox Hill Hospital on Oct. 28, 1954, with a pneumonitis of both lower lobes. This was her ninth hospital admission. The patient had been well until January, 1949, when she was operated upon for internal hemorrhoids and a

The extensive subject of cardiology is not amenable to detailed presentation in a short paper. Because of the relatively extensive experimental and clinical activity in this field, a summary of the current state of selected aspects of cardiology might be of interest. ANTIBIOTICS The most important single therapeutic development in the field of cardiology has been the advent of antibiotics. These drugs have not only made it possible to convert almost all fatal diseases, such as bacterial endocarditis and endarteritis, to almost nonfatal ones but have played an important role in control of infections in all cardiovascular disease states. Until the introduction of these drugs, the physician was often able to manage satisfactorily the cardiac disturbances, such as congestive failure, only to have the patient die of bronchopneumonia or urinary tract infection. The fear of secondary infection as a threat to life was constantly present, and the more chronic or

The magnitude of the literature that has been published concerning the metabolism of different forms of iron makes it impossible to attempt a complete review of the subject in this short paper. A discussion of much of the early work is also unnecessary in light of the more recently established facts, which lead to an explanation of much of the contradictory evidence presented in the earlier papers on hemoglobin formation. Those who believe that inorganic iron cannot be utilized and that only organic iron is available for hemoglobin formation find little support for their view in the recent work. Experimental work in both laboratories and clinics has shown that inorganic iron salts when fed under proper conditions can be utilized for the synthesis of hemoglobin. In 1928 Hart, Steenbock, Waddell and Elvehjem1demonstrated that inorganic iron, such as ferric chloride, when accompanied by traces of copper can be used

I have not attempted an academic paper on the treatment of interstitial keratitis, but have rather endeavored to give a paper based on clinical observations; and in order to get the conclusions and opinions of others, the following questions were addressed to thirty representative ophthalmologists in as many different sections of the country: What local measures other than those for the alleviation of symptoms have you used in the treatment of interstitial keratitis? To what extent have any of them contributed to the shortening of the inflammatory stage? Do you administer iodids during the inflammatory stage? In your opinion do iodids, given during the inflammatory stage, aid or retard recovery? What, in your opinion, is the best method of administering mercury? What is the average duration of the inflammatory stage in your practice? The answers to questions one and two were surprisingly uniform. Subconjunctival injections, cold water dropping, massage, ointment

At the close of the last meeting of the Association, held in St. Louis, I promised Dr. Miller, the Chairman-elect of this Section, to write a short paper on this subject, which had been pressing itself upon my mind for several years, and with growing force since the discussion in the Academy of Medicine, of Paris, of Gautier's paper on the result of the very important—not to say startling—investigations of Selmi in 1877, including much original matter as presented by himself. Continued researches in this direction have only confirmed the principles enunciated by earlier workers. The discovery of tyrotoxicon by Prof. Vaughan, with the increasing number of suggestive cases and reports, seemed to me to justify the contribution I proposed to offer to this Section. Since commencing the preparation of this paper Dr. Emmet Holt has given us a valuable article on the same subject published in the New York

A paper based on practical experience with small-pox and giving further striking evidence of the remarkable protective value of vaccination is never untimely. This is especially true in these days when common ignorance of the disgusting horror of the ravages of small-pox has caused so much ill-advised and even fanatical opposition to the one essential weapon against it, vaccination. This paper is also timely in that it offers some corollaries on frequent Mexican medical abuses, the results of which may be brought forcibly to our notice in case of intervention by our country in the internal affairs of Mexico. In October, 1912, I was in the Yaqui Valley, Sonora, engaged in making a climatic and hygienic survey of the region for a large irrigation project. In the spring of 1912 small-pox had become epidemic in a group of towns about eighty miles to our south, but the spread had been

While refraction is a science based on mathematical principles and theoretically very exact, yet there are other questions involved besides that of measuring the radius of curvature, finding the far and near points, range of accommodation, etc. What I shall have to say in this short paper will not be new to many, but it is a phase of refraction about which very little has been said or written. Hence my excuse for presenting this paper. Has psychology any practical bearing on the subject of refraction? In many cases perhaps very little, while in other cases quite a good deal. If all brains were of the same quality, all minds trained to think alike, all nervous systems equally well balanced, every individual reared in a pure atmosphere with proper and healthful environments, refraction would in a measure be reduced to the simple question of accurate observation and correct measurements. It

The use of lantern slides showing tables, classifications and sketches, during scientific presentations, lends much to the clarity of a paper and has had an increasing vogue. The following method was worked out to obviate the expense of the photographic method of making such lantern slides : A sheet of cellophane, the size of a standard lantern slide, is placed between two sheets of heavy carbon paper, the carbon side toward the cellophane. These are then placed between two sheets of thin white paper, folded into an envelope of the same size. The material to appear on the slide is typed in the usual manner, a three-fourths inch blank border being left. A clear carbon copy is thus produced on the cellophane, which is then removed and mounted between two lantern slide coverslips, the edges being taped with standard lantern slide binding tape. Free-hand sketches can be made directly on

At a meeting of the Indiana State Medical Society in May, 1882, I read a very short paper on the above subject, in which I cited five cases in support of the position therein assumed, that the deferred operation was preferable to the immediate, and that neither was as frequently required as the profession generally supposed. In consequence of the very unpopular stand I took upon this subject, I was quite surprised, though agreeably, at the favor with which my paper was received by the Society. I must mention, however, one notable exception, a leading gynecologist of Indianapolis, and a prominent member of the Society, who was absent at the time it was read. This gentleman, a year later, while reading a paper on "Laceration of the Cervix Uteri," took occasion to refer to my paper of the previous year, and to express his regret that he was not present

To the Editor:— In the Feb. 26, 1955 issue ofThe Journal, page 719, W. T. Caraway describes a "Rapid Turbidity Test for Diagnosis of Uremia" and refers to the spot test by Patterson (Lancet1:1061, 1934) that was found unsatisfactory. In 1942, with Plotz and Reich, I devised (J. Lab. & Clin. Med.28:335, 1942) a modification of the Patterson spot test performed by dropping Ehrlich's aldehyde reagent (p-dimethylaminobenzaldehyde "Kodak" 0.5 gm., trichloracetic acid 100 gm., distilled water up to 100 ml.) on filter paper, placing a drop of blood on the still wet surface, and drying the paper over a desk or microscope lamp. A positive reaction in the presence of blood urea nitrogen levels of more than about 50 mg. per 100 cc. is indicated by a distinct yellow zone diffusing around the brown spot of coagulated blood. This test proved simple, speedy, and

Since Papanicolaou 1 first described a procedure of preparing smears for cytological examination numerous investigators have attempted to improve the method of fixation. Their principal purpose was to achieve good preservation of cells with a minimum time spent in fixing the slides and a convenient and safe means of transporting these slides to the laboratory. The original method consisted of placing freshly prepared smears into a bottle containing a mixture of equal parts of alcohol and ether. The cellular fixation resulting from this method is excellent, and it is still being widely used even though the bottles are bulky, subject to breakage, and not suitable for mailing. Several workers have made innovations principally in order to render the slides amenable to transportation in a dry state. Ayre and Dakin 2 suggested fixing slides in alcohol-ether and then covering them with glycerine and another clean slide. Sagi and Mackenzie 3 described

The desirability of excluding all types of vacuum cleaners from hospitals is disputed. The efficiency of one type of machine was tested by a variety of physical and bacteriological procedures, including the use of freshly generated aerosols of a standard strain of staphylococci. When fresh paper filter cones were used in the machine, penetration by the cocci never exceeded 0.49%, and when dust-coated filter cones were used, apparent arrestment of bacterial droplet nuclei rose to more than 99.99% The evidence did not justify an indiscriminate condemnation of vacuum cleaners as unfit for use in hospitals. It indicated, rather, that the machine tested was very efficient in many hospital situations when used by welltrained personnel. The observations also suggested various improvements in design (such as disposable containers for dirt) and operation (such as heat sterilization of dustladen canisters) that should be explored further.

To the Editor: —An ultrafiltrable preparation of adrenocorticotropic hormone, effective clinically in daily doses of only 3.5 to 7 mg., has been prepared. This preparation has been used successfully in total doses not exceeding 60 to 80 mg. in the treatment of rheumatoid arthritis, purpura annularis telangiectodes (Majocchi's disease), lupus erythematosus and certain ophthalmologic conditions. No toxic manifestations have as yet been noted. A dose of 3 mg. induces a fall in eosinophils in persons with normal adrenal functions, according to Thorn's technique. The preparation is obtained by ultrafiltration of an aqueous solution of anterior pituitary powder buffered at pH 5.2. It is slightly yellow and thermostable and contains about 2.5 mg. of solid substance per milliliter. The nitrogen content is about 5 per cent of the organic substance. Amino acid analysis by paper chromatography reveals a limited number of amino acids, including aspartic acid, glutamic acid, tyrosine, glycine and

To the Editor: —In the name of economy let us have some editorial regulation as to the form and manner of reporting cases and clinical statistics. System, uniformity, conciseness and graphic contrasts make for saving of comprehension, of patience, of time, of space, of printing, of white paper, and, above all, for the securing of attention to invaluable data which, under the most favorable circumstances, are tedious reading. The symptoms of a case, I would urge, should be uniformily contrasted thus; ( a ) positive findings; ( b ) negative findings, and ( c ) dubious, uncertain or debatable points which an author finds it necessary to mention. There should be no difficulty and no objection in adopting a uniform method of recording, such as the following: (1) positive data, which the reader needs to note and bear in mind: (2) negative data for purposes of knowing what might have been expected but did not appear

The object of this short paper is to call attention to the course and prognosis of syphilis in certain patients who may present many of the physical and mental characteristics of general paresis, and yet, unlike sufferers from paresis, are to a certain extent amenable to antisyphilitic treatment. These cases are more common now than they were a decade ago. This is probably due to the ever-changing character of the two factors which cause their development—"syphilization and civilization." Secondly, this increased frequency is also doubtless due to our ever-increasing skill in diagnosis. There can be but little doubt that the specific case of to-day differs from the one of twenty years ago. The following case is a typical one. Case 1. —History. —J. A. G., came into my office with the story that for the previous six months his business associates and the employees in his office had noticed

Crystalline proteins have been isolated from the urine up to the present time in only eight cases.1In the course of work on human blood proteins, difficulty was experienced in obtaining blood for the preparation of sufficient quantities of albumin. This led to an attempt to separate this protein from the urine of patients with nephritis that were eliminating large quantities of protein. In the course of this work it was discovered that, under certain conditions, proteins in the cases studied tended to become crystalline. As a preliminary treatment, the urine was saturated to 25 per cent with ammonium sulphate, left standing for a few minutes until flocculation had taken place, and then filtered. The filtrate was placed back on the filter paper until a clear fluid was obtained, which was completely saturated with ammonium sulphate. The precipitate was dissolved with the requisite amount of distilled water giving a

The pendular movement of the arm in walking is frequently found to be reduced or absent in patients with pyramidal or extrapyramidal disease. My purpose in this article is to point out that unilateral decrease or cessation of the arm-swinging movement in walking may be due also to disease of the cerebellum. This finding may constitute a fine and early sign of the involvement of the homolateral cerebellar hemisphere. When in 1930 I reported this clinical observation to my former teacher, the late Dr. Kinnier Wilson, he said that he considered it of great interest and worthy of further study. In the same year I read a short paper 1 on this cerebellar sign at the Congress of the German Neurologists in Dresden. In an article in 1931 Mann 2 concluded from his own experience that this sign deserves "marked attention." Marburg 3 referred to my first observation as extremely

The presentation of a paper based on the observation of a small number of cases must justify itself by dealing with a rare condition or by demonstrating new facts concerning a well known subject. With the advance of intestinal surgery, and the increasing number of "developmental reconstructions" and other operations which involve removal of the cecum and part or all of the first portion of the hind-gut, we are able to note with more frequency a pigmentation or melanosis of the mucosa of both organs. This pigmentation may or may not be transitory; but the rarity of its observation at the necropsy table, and the fact that at times a fading of color may be noted through the proctoscope, lead to the supposition that, in not all cases at least, is it macroscopically permanent. PATHOLOGY Gross Pathology. —Both the gross pathology and the histopathology of pigmentation of the hind-gut have

The object of this short paper is to bring to your notice an operation, which though described in several works on surgery in the German1is not mentioned (so far as I have been able to investigate) in any English or American text-book on surgery, with the exception of the English translation of Kocher's "Operative Surgery" recently published. I do not believe that the technique of this operation as practiced by Trendelenburg, Tillman, Kocher and other Continental surgeons is generally known or practiced in this country. The operation I have reference to is the operation of supra-pubic cystotomy, by a transverse incision through the skin and abdominal muscles, without previous inflation of the rectum or injection of the bladder. This operation is known as Trendelenburg's method of supra-pubic cystotqmy (sectio alta) by means of the transverse incision. This method was first suggested by Gunther and carried out afterward by

To the Editor: —InThe Journal, June 22, there was an editorial notice of investigations conducted in the Harvard Physiological Laboratory on the effects of complete removal of sympathetic nerve impulses. It is pleasant to know that the work is of sufficient interest to warrant such notice. In this instance, the writer took as a subject for comment a brief summary in a report of the proceedings of the National Academy of Sciences. The full paper on the subject, with photographic illustrations of animals deprived of half or all of their sympathetic impulses, appeared in the American Journal of Physiology ( 89: 84 [May] 1929). The reader will find it a much more interesting and intelligible account of the observations on sympathectomized animals than the brief summary referred to in the editorial notice. The full article also is published under the names of all the collaborators in the complex research—H. F.

The purport of this short paper is to describe in as few words as possible the technic of a nephropexy which has satisfactorily suited my cases for more than three years. In the multiplicity of procedures practiced by surgeons and in the many relapses that occur some prominent internists find reasons to discontinue altogether operations for the relief of floating kidney. It is safe to assert that there is no drug or external support that cures a case of this order, while even the simplest fixation by operation relieves many of them. Since applying the technic here described there have been no recurrences. Floating kidney is no longer a border line disease; it belongs to the field of surgery. A brief survey of its pathology is overwhelmingly convincing of the demands on surgery for its treatment. Let me make it clear that a kidney should not be insulted by an

The bacteriology of most infections as worked out heretofore is largely the bacteriology of the fluids of the body and semifluid exudates. In acute infections a bacteriologic study of the fluids commonly yields trustworthy results, but in many chronic conditions the cultures are usually sterile and demonstration of bacteria in the tissues usually fails. In this short paper I wish to describe methods for making cultures particularly from excised tissues and from the blood and other fluids in which due regard is paid to the question of oxygen pressure, particularly in the primary culture, and to detail very briefly the results obtained by their use in various infections. PREPARATION OF THE EMULSION FROM THE TISSUES The tissues are excised with strict aseptic precautions usually under local anesthesia and cultures made at once, a portion being reserved for microscopic study. In addition to the great care used to avoid contamination from

The problem of a sanitary receptacle for waste cotton for ear, nose and throat treatments has been a puzzle. Most of the receptacles on the market have to be cleaned out and are in an awkward position. I have taken an iron ring clamp from an ordinary laboratory ring stand and clamped it to the standard of my fountain cuspidor. I then place a manila paper sack, like those grocers use for sugar, etc., in this ring with the open end projecting about ½ inch above the ring and crushed over it. Waste cotton is simply thrown into this sack. As often as need be the bag is taken out, the open end twisted shut and it is ready for disposal, a new clean sack being placed in the ring. There is nothing that has to be cleaned, and after once taking the cotton from the applicator it does not

It is seldom possible in medicine or surgery to say "always" or "never." As far as it is possible to use either word medically, it seems reasonable to state that any patient seeking medical advice about an undesirable facial scar always wants it completely removed, and every surgeon making a facial incision, suturing a facial laceration, or removing an unsightly facial scar never wants to produce anything but an invisible scar. The surgical approach to facial scarring is a vast topic, and, since it cannot be completely discussed in a short paper, only some of the basic factors involved in both the formation and surgical treatment of facial scars will be considered here. A basic principle frequently unknown to most patients, especially those who read about the wonders of plastic surgery in the lay press, and a basic principle frequently forgotten or ignored by some physicians, is that each cut

In offering a short paper to the Association I assume that knowledge independently acquired in a special department of practice may be a useful contribution to the general store; especially if illustrating the importance of an adequate theoretical and clinical training in order that the value of local phenomena, and their relation to coexisting conditions of other organs and of the general system, may receive due estimation. Much of our information, on points to which I am to refer, is of so recent date, that I trust a brief epitome of some personal observations may not be unacceptable. INTRA-CRANIAL GROWTHS. When we remember that less than forty years ago the existence of intra-cranial growths was usually but dimly suspected from the existing symptoms, and only rarely demonstrated at autopsy; and that we are mainly indebted for the first and most positive recognition of their presence, to the disclosures revealed through

In this report we describe briefly a method for the culture of human marrow in quantities permitting hematologic and metabolic studies. We also outline some of the problems under investigation by this method. The apparatus supplies a lung, kidney and circulation for the marrow, as it provides for the control of oxygen and carbon dioxide tension, ofpH, and of the composition of the medium; for elimination of waste products, for supply of nutrients, for removal of part or all of the culture for study, and for maintenance of sterility. The most important feature of the apparatus is a semipermeable membrane, separating the culture from the main volume of medium. This membrane allows nutrient materials from the surrounding medium to diffuse into the culture as needed and allows waste products to diffuse out as they accumulate. Because of this equilibrium, analysis of the outflowing medium gives a good indication of

The Golds l have recently supplied data controverting the tradition that U. S. P. ether undergoes rapid deterioration when exposed to the air. More recently, Hediger and Gold 2 have secured data from 702 clinical anesthesias substantiating the earlier laboratory results. These were given in routine manner except that the anesthetists were unaware of the type of ether given ("blind test"). Bulk (drum) ether U. S. P., freshly opened quarter pound cans of ether U. S. P. and quarter pound can "special" ethers from different manufacturers were used. The only assurance the anesthetists had was that the presence of the supposedly deleterious substances (acids, aldehydes and peroxides) were always within the limits of tolerance of the U. S. P. X. Such assurance was based on U. S. P. and other tests (Nessler and potassium iodide) on each lot on the day used. These results were of interest to us because our own

The use of solvents and cutting oils is so widespread that it is not possible to inspect any large manufacturing plant without encountering some department where one or the other is used. All operations in which cutting tools are used are literally bathed in oil of one type or another. It is almost impossible under ordinary conditions and much more so under the pressure of war production for the workers to avoid intimate contact with either the solvents or the cutting oils used in their operations. Dermatitis from cutting oils, especially those of the insoluble type, occurs more frequently than any other occupational disease of the skin. If its incidence could be decreased, one of the most vexing problems of the industrial physician would be solved. The use of the dielectrics, especially the chlorinated hydrocarbons, is rapidly increasing. The latter give rise to a characteristic cutaneous eruption, known popularly as

The increasing prominence of volatile solvents in modern industrial processes emphasizes the need of early recognition of any toxic action on exposed workers which, if recognized, may lead to corrective measures being adopted. Within the past few years the number of newly perfected solvents has steadily mounted, until today well in excess of 300 are in common use, contrasted with a bare half dozen used twenty years ago. One or more of the solvents are used in ever increasing quantity and variety in nearly every manufacturing industry today either as a solvent or as a diluent. They are employed as cleaning or degreasing agents, in lacquer coatings, in dyes and cement, as plasticizers, and as solvents of cellulose and gums of various kinds in a myriad of synthetic finishing materials. The volatile solvent vapors enter the body chiefly through the respiratory passages, but appreciable quantities may either be ingested or

As exfoliative cytology has become more widely used, the need for an adequate technique for mailing fresh, unstained smears to a cytology laboratory without exposing them to drying, which is known to distort the structural characteristics of the cells and their nuclei, has been more keenly felt. Several techniques for mailing fresh, unstained smears have already been suggested. Ayre's glycerin method 1 has found, thus far, the widest application. Other methods proposed more recently are the propylene glycol and the rehydration techniques. 2 The method presented in this report was described by one of us (G. N. P.) in 1954. 3 Since then it has been intermittently used in our laboratory with gratifying results. It provides a preliminary fixation of the smears and the formation of a film which protects the smear surface during mailing. The staining reaction of the cells shows no appreciable change. In recent months, the technical