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Cernik, A. A., and Sayers, M. H. P. (1971). Brit. J. industr. Med., 28, 392-398. Determination of lead in capillary blood using a paper punched disc atomic absorption technique. Application to the supervision of lead workers. The presence of lead in blood is the most incontrovertible evidence of absorption but hitherto the need for venepuncture has limited its determination in the supervision of industrial workers. Micro-methods using atomic absorption spectrophotometry (AAS) have, however, made possible the development of a sufficiently reliable test using a drop of blood obtainable by ear prick for use in the field for screening purposes. A micro-sampling method by AAS is compared with a routine polarographic procedure (POL) using venous blood (corr. coeff. = 0·990). The pipetting of microlitres of blood can be eliminated by spotting the blood onto filter paper, allowing it to dry in air, and then using a punched-out standard disc of dried blood for analysis instead. Correlation of this method (PD) with the micro-sampling technique (AAS) is good (r=0·981). The PD method using capillary blood also correlates acceptably with the micromethod using venous blood (r = 0·913). A pilot field study using capillary blood estimated by the PD technique showed that with this method blood can be collected by ear prick in factories for monitoring workers in the lead industry, thus eliminating the need for routine venepuncture.

A sample of 147 men drawn from the workers in a pulp mill was compared with one of 124 men from a paper mill. The former included those exposed to chlorine and to sulphur dioxide. No significant differences were found in respiratory symptoms or in simple tests of ventilatory function in the two samples, but men working in chlorine had a somewhat poorer respiratory function and more shortness of breath than those working in sulphur dioxide. The working population of both mills together had a lower prevalence of respiratory disease than that of the male population of Berlin, N.H., previously studied, suggesting that working populations may not be representative of the general population. Further, a low prevalence of disease in a working population exposed to pollutants may not indicate their `safety9 in general populations.

Summary The electrophoretic pattern of serum proteins has been studied in 30 infants suffering from toxicosis. During the stage of acute dehydration the main changes were a moderate or marked increase of alpha globulin, particularly of the α2 fraction and a decrease of albumin. In some cases there was also an increase of the gamma globulin. During recovery the alpha globulin decreases while albumin increases. However, the return to normal of the electrophoretic pattern is not always achieved when clinical recovery occurs. The absolute amounts of total serum proteins have also been estimated and their significance has been discussed. Electrophorese sur papier des proteines du serum au cours de la toxicose. L'aspect electrophoretique des proteines du serum a eteetudie chez 30 ehfants presentant une toxicose. Au cours de la periode de deshydratation aigue, on a pu noter une augmentation nette des alphaglobulines (en particulier la fraction alpha 2), et une diminution de l'albumine. Dans quelques cas, on a pu noter aussi une augmentation des gammaglobulines. La diminution des alphaglobulines, et l'augmentation de l'albumine est survenue avec la guerison. Neanmoins, le retour a la normale de la courbe d'electrophorese n'est pas toujours acheve au moment de la guerison elinique. Papierelektrophorese von Serum-Protein bei Sauglingstoxikose. Die Elektrophoresebefunde von Serumproteinen sind bei 30 an Toxikose leidenden Sauglingen untersucht worden. Wahrend des Stadiums der akuten Dehydration waren die Hauptveranderungen eine massige oder ausgepragte Zunahme des Alpha-Globulins, insbesondere der α2-Fraktion und eine Abnahme des Albumins. In einigen Fallen be-stand auch eine Zunahme des Gamma-Globulins. Wahrend der Genesung nimmt das Alpha-Globulin ab, wahrend das Albumin ansteigt. Jedoch ist der Ruckgang zum nor-malen elektrophoretischen Bild nicht immer vollendet wenn die klinische Genesung eintritt. Electroforesis en papel de las proteinas sericas en la toxicosis. Se estudiaron las imagenes electroforeticas de las proteinas sericas en 30 lactantes afectos de toxicosis. Durante el periodo de deshidratacion aguda, los cambios mas notables fueron un moderado o marcado aumento de la alfa globulina, especialmente de alfa 2. Durante la convalecencia, la fraecion alfa globulina disminuyo mientras au-mentaba la albumina. Sin embargo, la vuelta a la imagen electroforetica normal no siempre es completa al ocurrir, la mejoria clinica.

(1960). The Paper Disc Method for Determination of Bacterial Sensitivity to Antibiotics Studies on the Accuracy of the Technique. Scandinavian Journal of Clinical and Laboratory Investigation: Vol. 12, No. 4, pp. 408-413.

According to the result of totally 10 time mass-screening examinations of pulmonary tuberculosis carried out annualy twice spring and fall during five years, the following conclusions were obtained.1) Both the roentogenographically positive finding rate and prevalence rate of actual case had been decreased over a period of five years.2) Cases of mixed form with exsudative and fibroid lesions, according the Oka roentonographic classification, was most apparently decreased in five years. In the forms of the hardnodular and calcified-scar lesions the rates did not any significant changes, and the form with the deformation by surgical operations increased by the spring 1957 and no change was observed after that. Occurrence of exsudative pleurisy was very seldom.3) In the classification of guide standard, number of the patients with the A calss (off work required) and the class B (limitted working hour) remarkably decreased, and those of the class C (under supervision) relatively increased.4) According to the classification by the Japan Society of Tuberculosis, no case with extensively advanced cavity form was found through the observation, and cases with not-advanced cavity form disappeard by the end of the observation. Also cases with the varied non-cavity form was obviously decreased. No apparent changes were shown in the unmber of cases with the stable non-cavity form and the recovered form.5) The decrease of the number of cases with exsudative form seemed to be more apparent in the group of workers with medium physical work, compared with that group of desk workers. The increase of both the roentogenographically positive finding rate and prevalence of actual case was observed by the older years of age, and the trend was not so much varied through the five year observation.

Frozen sections are cut from the specimen until the level of interest is reached. A strip of paper (bond or similar writing paper) 5 cm long and about 1 cm wider than the specimen is moistened with water, closely applied to the surface of the specimen and frozen onto it. As the section is cut, the end of the paper strip above the knife is grasped and turned backward toward the other end of the strip. The section is then applied to an albumenized glass slide, firmed and thawed by finger pressure, and the paper removed. After thorough drying, the preparation is ready for further processing. When properly performed, mounted sections whose details coincide to those of the uncut block can be obtained. If thawing on the knife is prevented by cooling the knife, the technic can be performed without a cryostat, but it is also feasible to use a cryostat if a favorable temperature is maintained. The authors obtained 30 μ serial sections, suitable for stereotaxic mapping, from rabbit brain by this method.

A N u M B E R of -decisions are involved in the selection and administration of a pharmacologic agent to a patient: (1) establishing diagnosis, (2) determination of the necessity for treating with a pharmacologic agent, (3) selection of an appropriate agent, (4) selection of the safest and most efficient route of drug administration, (5) determination of the dosage to be administered, and (6) selection of the appropriate time intervals for administration. An additional and occasionaliy overlooked factor is the accuracy of the measuring deyice used for administration of liquid medications. Teaspoons, the most commonly utilized measuring devices in the home, have been shown to vary greatly in capacity? In addition, there can be significant variation in the amount of medication administered by dif ferent individuals using the same teaspoon. 2, Shirkey 3 has commented on the use of medicine glasses and paper and plastic medicine cups. He states that disposable cups are used widely in the hos

On account of the small supply and high cost of gauze, paraffin tissue paper will be found an excellent dressing for burns or any other condition in which a nonadherent dressing is desirable. It is far superior to the paraffin dressing of burns by the spray method, is much more easily and rapidly applied, results in more rapid healing of the burned surface, and is more easily removed. In the first stage of burns, when there is great pain, the various ointments now in use can be applied directly to the paraffin paper and this applied to the burned area after all vesicles have been opened. It has the advantage of excluding the air, which relieves the pain of the burns, and it is readily removed at the time of redressing, leaving the developing granulations unaltered. The first dressing, of pure petrolatum on paraffin paper, is applied directly to the

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.

Experiments show that kraft paper in wet dressings far from preventing evaporation instead promotes it and that this is a consequence of slightly raised temperature in the gauze sponges.

Materials for wrapping surgical dressings were studied by a method which measured the recontamination rate in packs stored for periods of up to several weeks. Of the materials tested a thick crepe paper was better than calico and balloon cloth fabrics. Dressings wrapped in paper were not significantly contaminated after storage in dusty places for periods of up to three weeks. For added protection during handling and for convenience in transport and storage, paper packs may be sterilized and kept in paper-lined cartons. The shelf life in good storage conditions would be many weeks at least.

Os caracteres gerais do método eletroforético são apresentados de modo sumário, especialmente aquêles referentes à eletroforese em papel, no sentido de familiarizar o neurologista quanto aos seus aspectos principais e sua utilização no estudo das frações proteicas do liqüido cefalorraquidiano cujos aspectos particulares são discutidos. The main aspects of electrophoresis are summarised, specially those concerning paper electrophoresis, as a practical guide for neurologists, in its appliance to the study of cerebrospinal fluid protein fractions.

Proteinuria, edema, and an increase in the diastolic pressure, which occurs in the latter months of pregnancy, are well-established indications of preeclampsia. Of these findings, consistent proteinuria is considered most important because it is usually detectable before other signs of preeclampsia appear and because the quantity of protein excreted generally parallels the severity of the condition. Success in the management of the preeclamptic patient is markedly enhanced by its earliest possible diagnosis. Consequently, it is clinically essential to test for proteinuria frequently. It is our routine practice to see all uncomplicated obstetrical patients in the office or the clinic at monthly intervals during the first two trimesters, every three weeks during the seventh month, every two weeks during the eighth month, and weekly during the final month. Testing for proteinuria during these visits is done routinely. However, patients do develop toxemia, sometimes to a marked degree, between visits. For about

Tests suggest that a paper sack, the mouth of which is turned over three times and firmly fastened together, will not allow the escape of organisms from contaminated towels within it. If these results are confirmed, doubt is cast on the necessity for separate disposal corridors for contaminated material from operating-rooms.

In the Blood Plasma Corporation of Japan we have tested the blood group of 279, 841 blood samples in the past two years.ABO blood grouping performed on the paper is not only very efficient as a routine work in the blood bank, but also very reliable, as we are able to avoid clerical errors by this method.In addition, we easily detect the errors of the direct method performed on the donor history card or the errors of nurses at the time of blood collection by this indirect method, i. e. back grouping performed on the paper.

Note. The field of otolaryngology has become so broad, that the man doing this work finds it difficult to follow as he would like the important contributions that are being made along the several lines. For his convenience, theArchiveshas undertaken to prepare a series of critical annual summaries which will epitomize the important contributions that appear covering the more important phases of this special field. So far as practical, the reviews on a particular subject are to appear each year in the same month.—The Editor. Because it is impossible to have the review of the literature for the current year ready for theArchivesby the end of that year, it was thought best to cover the period from about October, 1923, to October, 1924, and similarly for any succeeding years. At the suggestion of the Editor a few papers on the treatment of deafness, and so forth

(1972). Amputations with and Without Myoplasty on Rabbits with Special Reference to the Vascularization (Paper read in Dansk Ortopaedisk Selskab on April 30th, 1971) Acta Orthopaedica Scandinavica: Vol. 43, No. 1, pp. 68-77.

Arthroplasty is a surgical procedure which provides an artificial joint. The operation should give ( a) relief from pain; ( b) a stable joint; and ( c) an improvement in function. The loss of function of a joint may be caused by injury or disease. Since 1894 there have been many attempts to restore function using various artificial materials either to separate or replace the joint surfaces, and the following is a list of the ‘milestones’ in this field: (1) The use of foils to cover the femoral head. (2) Floating joint interposition. (3) The introduction of cobalt–chromium alloy. (4) The replacement of the femoral head. (5) The use of acrylic and other plastics for implants. (6) The replacement of the acetabulum. (7) Total hip replacement. (8) The introduction of acrylic dental polymer to anchor components in bone. This paper will discuss the various materials and devices which have been used, and some of the complications which consequently have occurred.

This I write not to contradict but to support, to the best of my power, the idea for which the author tries to make propaganda. I have myself done something of that kind already in 1911 by my article «Eine Methode, die Nabelabklemmung mit der Unterbindung zu kombinieren« appearing in Zentralbl. f. Gynak. 35. Jahrg. No. 31. — I have besides published papers on this subject in medical journals of my own country and already in those days I was far from the first one who dealt with the said topic.

The first model of a multifunctional externally powered hand prosthesis known as the ‘Belgrade Hand Prosthesis’ was developed in the Institute ‘Mihailo Pupin’ in Belgrade in 1964, and in the course of 1966–67 an improved model was developed. The further programme of work envisages a two-year engineering and functional evaluation of the prosthesis on the patients. A detailed description of the improved mechanical solution of the ‘Belgrade Hand Prosthesis’ is given in this paper, and two variants of control logic are described.

Summary Attention has been directed to the need for constant vigilance in safeguarding young infants from accidentally ingesting small foreign objects that may become lodged in the esophagus. Prompt dislodgment and removal of these objects may avoid dire complications. If undiagnosed, their lodgment in the esophagus may give rise to respiratory symptoms and findings of a bronchitis unresponsive to any medication. This pulmonary involvement is dissipated after removal of the foreign body. The essentiality of roentgen-ray examination of the chest even in young infants with unexplained respiratory symptoms cannot be under estimated in the early detection of a foreign body arrested in the esophagus. In our case it was conjectured that the accidental ingestion of the foreign body (paper clip) that became lodged in the esophagus might have occurred during the neonatal period, whence the respiratory symptoms had their onset.

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

1. The three leading surgical approaches to the revascularization of an ischemic myocardium are those of: a.) Beck: heart surface abrasion; insertion of coarsely ground asbestos; occlusion of the coronary sinus to 3 mm.; and application of the pericardium and mediastinal fat pad to the surface of the heart; b.) Thompson: insertion of magnesium silicate, a non-absorbable and irritating substance into the pericardial sac. c.) Vineberg: implantation of the left internal mammary artery into the left ventricle via a myocardial tunnel. 2. Noteworthy and provocative animal experiments to show the validity of revascularization procedures have been carried out by: a.) Beck, who has shown that his technique adds a flow of 4.7 c.c. of blood per minute to an ischemic area of myocardium, and that the quantity of backflow decreases the mortality in dogs whose coronaries were subsequently ligated; b.) Vineberg, who has demonstrated anatomically functioning vessels of arteriolar size between the coronary circulation and the extracardiac source, these anastomoses protecting the animal from a myocardial infarction post ligation of one of the major coronaries. He has also artificially recreated the gradual occlusive process of atherosclerosis, and by exercise tolerance tests has shown that animals receiving his procedure midway in their ischemic decline from normal tolerance regain most of their exercise potential, whereas the controls continue to lose their original exercise tolerance. 3. The human results of coronary heart disease surgery are promising: there has been a substantial decrease in the pain of angina pectoris, and an increase in the work capacity of the coronary heart disease patient; and there is some evidence that the eventual life expectancy of patients undergoing surgery has been increased. 4. It is evident that the greatest difficulty in justly appraising the benefits of surgery to the coronary heart disease patient is the lack of proper control series anywhere in the literature.

The initial lesion may heal before secondary ones appear or may persist into the secondary stage. All other active lesions, apart from a few such as ganglion, hydrarthrosis and goundou, which may occur in more than one stage, are either secondary or tertiary.In many cases secondary lesions cease to relapse 2 to 3 years after infection.In some cases lesions of the secondary type may develop years after the earliest manifestations of infection have healed, while in other cases tertiary lesions may appear within a few years of infection. In many cases there is a more or less symptom-free period of years between the healing of the secondary eruption and the development of tertiary lesions. Lesions of these two types are never observed in the salve patient at the same time, nor is the initial lesion present when tertiary lesions have developed. Brief descriptions, with illustrations, are given of the chief manifestations of yaws seen in Lango.

The need for complete joint replacement in the surgical treatment of osteo-arthritis of the hip is becoming more apparent following the unpredictable results of other forms of arthroplasty where only one or other side of the joint is replaced. The introduction of total hip prosthesis poses the problem of fixation of the acetabular component. Charnley's contribution in using acrylic cement to grout in the stem of the femoral component has largely solved the fixation on this side of the joint. It is not so easy to apply the same principle to the acetabular part of the prosthesis. No fixation, long-screw fixation, and straight-pin fixation have not proved satisfactory. It remains to be seen whether the present method used by McKee and Charnley, of a press fit into cement, will prove the test of time. In the early stages of development of the Stanmore hip joint various forms of acetabular fixation were considered. It was finally decided that an adequate hold could only be obtained by three-point fixation, using diverging nails inserted into the three primary bony components of the acetabulum. This principle has been maintained in the later models, but by using cement for grouting the nails, it has been possible to simplify the prosthesis and discard some of the complicated instruments required for the insertion. A brief description of the surgical technique will be given.

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