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of an immunized animal than the normal. My ex- perience' with such sera demonstrates that immune horse serum, inactivated by heat, is more bacteri- cidal than the normal serum. In such purchase suprax immune serum there appears to be a body, an amboceptor, which is entirely separate and dis- tinct from the specific immune body which is re- sponsible for the germicidal action. This might be 6i4 MEDICAL RECORD. [Oct. 20, 1906 termed, for want of a better order suprax name, the common immune body. It may be normally present in the blood, but it increases in amount under treatment, pari passu with the increase in the number of the leucocytes. The dried serum powder seems to have some ad- vantao;es over the serum, as it dissolves rather slowly and therefore is not so apt to be washed away by exudates. It is intended to continue these observations, using other immune sera, for it may be that these may possess even better qualities than the dried antitoxin. REFERENCES. 1. Calmette, A. : Comptes Rendus de I'Acadcmie dc Sci- ence, T. CXXXVI, 1903, pp. 1150-1152. 2. Dr. W. H. Park recently informed me that some time since a number of chronic ulcers which had resisted all other treatment were dressed with diphtheria antitoxin serum. In all there was a marked improvement. The same results have also been obtained with a dressing of antibiotic suprax normal horse serum. 3. The action of glycerin on bacteria in the presence of cell exudate; Journal of Experimental Medicine, 1905, Vol. VII, No. 6. A CASE OF INTESTINAL OBSTRUCTION, IN A CHILD, DUE suprax antibiotics TO TUBERCULOUS PERITONITIS FOLLOWING BRONCHOPNEUMONIA. By henry HUBBARD suprax mg PELTON, A.M., M.D., NEW YORK. CHIEF OF MEDICAL CLINIC PRESBYTERIAN HOSPITAL DISPENSARY; IN- STRUCTOR IN MEDICINE NEW YORK POSTGRADUATE MEDICAL SCHOOL. The patient, Catherine G., was born on May 5, 1905, the first child of a mother thirty-four years of age, being delivered by the writer after a normal labor lasting about twelve hours. The weight at birth was seven pounds fourteen ounces. The mother, being absolutely unable to nurse the infant on account of lack of milk, the latter was put upon modified cow's milk. The child thrived from the first, making regular and consistent gains in weight, and on July 24 weighed eleven pounds. About suprax cefixime 400 mg this time the digestion became slightly disordered, with the result of a loss in weight to ten and a half pounds on August 7. Upon August 11 a typical attack of summer diarrhea began and lasted for two weeks ; the stools were fluid in consistency, green and foul, and contained mucus in moderate amount. The treatment suprax tablets consisted of an initial dose of castor oil, followed by intestinal irrigations with normal saline solution after each defecation. The strength of the food was greatly diminished, but the intesti- nal symptoms continued for two weeks, being suprax cefixime ac- companied by occasional vomiting. The food for- mula was changed from time to time, but nothing was found to agree, and finally the child was put upon a mixture containing one of the proprietary foods ; from this time the patient began to improve, the digestive manifestations disappeared, and a gradual and steady increase in weight was noted. The child continued to prosper until late in Jan- uary, T906, when it suffered from a slight attack of bronchitis, which responded quickly to treatment. On February 17 it was taken ill with fever, accom- panied by cough. Physical examination suprax injections showed the presence of moderate rickets as evidenced by slight epiphyseal enlargements and prominence of the ab- domen ; percussion of the chest showed no marked dullness, but upon auscultation numerous fine, moist rales, scattered through both lungs, were heard, and the diagnosis of bronchopneumonia was made. Mild counter irritation, by means of mustard pastes ap- plied to the thorax, and steam inhalations were suprax 400mg pre- scribed. For the fever, which was at no time very high, never exceeding 103° F., occasional small doses of tincture of aconite were buy suprax given, and for the cough and restlessness small doses of antipyrin and sodium bromide were administered. The strength of the food was diminished. The patient continued to eat well and lost but little flesh ; the signs in the chest persisted, and after two weeks potassium iodide was prescribed, in the suprax 100 hope that resolution would be hastened. Following this medication, the rales became gradually fewer, but did not wholly disappear. The cough and a moderate degree of fever continued, and the possibility of tuberculous involvement of the bronchial glands and lungs was considered. There was, however, no distinct inter- scapular dullness. Creosote, combined with a liquid food, was prescribed, and the patient was put upon full strength food, which it digested without diffi- culty. The temperature still continued, reaching an evening elevation of from 100.5° to 102° F. The condition of the patient remained as de- scribed until March 18, when an attack of emesis occurred, the vomitus consisting of mucus and curds ; following this manifestation the child passed a restless night, was disinclined to take food, and vomited at intervals. The bowels moved upon the morning of the i8th. Upon the 19th the emesis continued, and there was no defecation. Intestinal irrigation resulted in the passage of a small amount of fecal matter, but no blood or mucus. Abdominal examination was difficult on account of the crying of the child, but upon one occasion satisfactory pal- pation was accomplished. The abdomen was dis- tended and tympanitic but no mass was made out, and there was no especial tenderness. The patient was seen at 4 a. m. on suprax generation March 20. At this time the child was manifestly worse, the face was anxious, and whatever was taken by mouth was vomited shortly afterward. The intestine was irrigated, the result consisting of a very small amount of fecal matter ; a small generic suprax quantity of gas was also passed. The stomach was washed and relieved of a little greenish fluid of faintly fecal odor. Digital exam- ination of the rectimi showed no abnormal condi- tion. At this time the temperature was 99.5° F. and the pulse was 150. regular, and of fair strength. At 10 A. M. the patient vomited matter of distinctly fecal odor. The probability of intestinal obstruc- tion and the need of operation was suggested to the parents. A consultation was agreed upon, and Dr. Alfred S. Taylor was called, who made the diagno- sis of intestinal obstruction of uncertain origin, and advised immediate operation. After gaining the parents' consent with considerable difficulty, the child was removed to the Presbyterian Hospital, where laparotomy was performed bv Dr. Ellsworth Eliot, Jr. suprax injection For the following report of the patient's condi- tion upon entrance to the hospital, and the result of the operation, the writer is indebted to Dr. E. St. John Ward of the interne staff of the Presbyterian Hospital. Physical Examination — Small infant in state of marked prostration ; throat, normal : heart and lungs, normal ; abdomen, full, distended, tense and tympanitic, except in flanks, where there is shifting dullness ; liver dullness is obscured ; general tender- ness, especially upon the right side ; moderate gen- eral rigidity ; peristalsis audible on left side ; rectal examination, negative: extremities, normal; opera- tion, exploratory laparotomy, by Dr. Eliot. Chloro- form poorly taken ; position dorsal, with arms across chest ; incision, four inch median laparotomy, ex- Oct. 20, 1906] MEDICAL RECORD. 61S tending about one inch above umbilicus. Find- ings. — Small intestine distended with gas and fluid, congested and dark in color ; considerable amount of clear, amber, serous fluid in peritoneal cavity ; peritoneum covering the gut appears somewhat granular, and is dotted here and there with suprax cefixime tablets specks suggesting miliary tubercles ; a considerable number of fairly distinct small miliary tubercles about the cecum, where adhesions are most abundant ; a few thin adhesions in suprax antibiotic for children various situations along the small intestine, but these are most abundant in the right iliac fossa about the cecum. At this point also is felt a hard mass in the lumen of the gut, which is movable upon manipulation. The large intestine is empty and collapsed. The intestine was carefully inspected after withdrawal from the abdominal cav- ity, and all adhesions were divided, special attention being paid to those about the cecum, where the con- striction seemed to be. The mass above mentioned was pushed on into the transverse colon. Follow- ing these procedures, the wound was closed. During the operation the patient's condition was poor, stimulation being necessar\'. After operation the child rallied temporarily, but in spite of further stimulation death buy suprax online took place about two hours after removal from the operating room. Autopsy was refused. .'\ specimen of blood taken previous to the opera- tion showed the following suprax 400 mg tablet conditions : There was an increase in the number of blood plates : the red cells were markedlv pale, and there was a slight poi- kilocytosis. The differential cotmt of the leucocvtes showed 57 per cent, of polynuclear cells: 13 per cent, of transitional forms, o per cent, of large mon- onuclear cells. 30 per cent, of lymphocytes. A cul- ture taken from the peritoneal exudate at the time of operation showed no growth. 781 Park Avenue. DISINFECTION OF ROOMS BY FORMAL- DEHYDE. COMPARATR^E BACT,ERI- CIDAL VALUE OF VARIOUS METHODS. By HENRY A. HIGLEY. M D.. BROOKLYN, N. T. DIRECTOR BROOKLYN DtAONOSIS AND RESEARCH LABORATORY. Since formaldehyde was first proposed as a gase- ous disinfectant for rooms, the literature relating thereto has been multiplied and duplicated in large proportions. As the result of numerous investiga- tions, we now know that formaldehyde gas, when

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