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of the plethora present in these cases, too rigid a restriction of fluid must seriously hinder the excretion of the hypo- thetic toxic substances which we have assumed to be the cause of the disorder. Endemic Hematuria. — P. G. Stock gives some notes on sixty-five cases of endemic hematuria, occurring among the soldiers in the late South African war. These observa- tions seem to show that the average incubation period of the disease is about six weeks. Concerning treatment, the author is inclined to think that the best results have fol- lowed the administration of methylene blue. It has been suggested that the use of a toxin in such cases should pro- duce good results, and this is borne out by the following facts : Two patients who Cost Of Toprol Xl were suffering from bilharzia contracted enteric fever and on convalescing the urine was found to be free from the ova, and during the time they were under observation (some months) they had no Toprol Xl Vs Generic re- currence of symptoms. M the post-mortem examination which was held on a native who died from dysentery and in which the bilharzia parasites were dissected out within two hours of death, the worms were found to be dead; there were well-marked dysenteric lesions of the intestines. The ascaris himbricoides is almost invariably killed by acute infections. This seems to offer some hope of suc- cess in what must be either an incurable disease or one in which time is the only remedy. The toxin might be con- veniently administered by the hypodermic injection of Wright's antityphoid serum. It would not be necessary to give sufficiently large doses to produce a serum reaction, but a series of small doses might be tried which would cause little or no inconvenience. The author notes the general opinion that there is no danger of patients spread- ing the disease, but admits that no positive opinion can be given on this point until more is known of certain phases in the life history of the bilharzia. A Case of Plague. — This study is made by J. B. Cle- land. The points brought out may be expressed in the following statements : Living plague bacilli exert only a mechanical effect and not a toxic one on the tissues, and as they only rarely remain and multiply at the seat of inocu- lation, there is seldom any local reaction and as rarely 1 lymphangitis. The .elands of the groin are those draining the area of inoculation. In them the bacilli are first ar- rested, and greatly multiply before passing on to other glands or to the blood stream. Hence we have an intense local reaction, i.e.. the bubo. These are sometimes wanting, because the bacilli may have entered the body through other routes than the skin, or if the latter has occurred they may have escaped Metoprolol Vs Toprol Xl the nearest glands by entering more directly into the blood stream, or may have multiplied in the glands to a less extent than usual. Symptoms do not appear during the incubation period because the living bacilli are not toxic and some Toprol Xl Generic Name days must elapse before antimicrobic bodies or other forces can destroy a sufficient number of the bacilli and so set free large doses of toxin. British Medical Journal. September 29, 1906. Tuberculous Cervical Adenitis. — k Gregor reports the case of a child of six years with a swelling on the left side of the neck, of one week's duration. There was a dis- tinct family history of tuberculosis on the father's side. The gland was tender and painful, and in a few days sup- Oct. 20, 1906] MEDICAL RECORD. 627 puratetl. The abscess was opened and drained. The discharge continued ten days and the whole gland began to break down. The parents refused a general curetting of the cavity under anesthesia. It was finally subjected to irradiation, fifteen sittings being held, each lasting fifteen minutes. No violent reaction followed, but the granulating surface closed up and healintr was finally complete. Remarks Upon the Pneumotoxin. — A. Macfaydcn de- tails the results of certain animal experimentation. He finds it possible to extract an acutely lethal toxin from the bodies of virulent pncumococci, and one of much greater potency than the soluble to.xins described by pre- vious writers. The endotoxin of the pneumococcus is sen- Toprol Xl Vs Metoprolol sitive to the action of heat. A filtered cell juice heated to 55° C. for an hour failed to kill in doses of 0.5 and i c.c, while 2 c.c. only caused death at the end of five days. The unheated juice was acutely lethal in doses of 1-20 c.c. The prolonged action of chloroform vapor is also injurious to the toxin. After an exposure of one hour to chloroform vapor, 0.5, I, and 2 c.c. did not kill the test animals, the lethal dose of the untreated toxic cell juice being 1-20 c.c. References are made to the work of other observers. Cerebral and Ophthalmic Complications in Sphenoi- dal Sinusitis. — St. Clair Thompson makes a careful and elaborate study of this question, and reports two cases in which the sphenoidal origin of intracranial suppuration was confirmed by autopsy. He has made a careful search for previously recorded cases and has been able to bring together 40 cases, which Toprol Xl Beta Blocker are carefully analyzed. In 17, meningitis was the only or predominant symptom ; in 4, Toprol Xl Coupon thrombosis of Metoprolol Tartrate Vs Toprol Xl the cavernous sinus; in 13, thrombosis and basic meningitis; in 2, meningeal septicemia. Encysted dural abscess, hemorrhagic encephalitis, intracranial ab- scess, phlebitis of the cavernous sinus, intracranial hemor- rhage, and suppurative encephalitis were found respectively once. The symptoms of sphenoidal sinusitis are classified according to their effects on neighboring and distant or- gans and on the general health. Various affections are simulated by cerebral infection from this source. Thus patients thus affected were admitted to hospital for phleg- mon of cheek, ear disease, croupous pneumonia, tubercu- lous meningitis, tonsillitis, typhoid fever, etc., but in each instance the progress and termination of the case showed cerebral infection from the sphenoidal sinus. The route of infection may be from the sinus mucosa, then to the sub- arachnoid space by direct transference through bone, by the Is Toprol Xl A Beta Blocker veins, or by the lymphatics. Various bacteria have been isolated from these cases, streptococci, staphylococci, pneumococci, etc. It is quite possible that the sinus itself becomes originally infected through the tonsil. A series of cases is referred to, bearing out this theory. The nearness of the sinus to the orbit would naturally lead to prominent eye symptoms. In one of the author's two personal cases, proptosis and chemosis were present and due to a retro- ocular abscess. Edema of the eyelids, coincident with a nasal discharge, should always make us suspicious of deep- seated trouble. The nasal discharge is not always in evidence. Its absence has been noted in several cases. The outpouring of pus from the sinus may be intermittent, and it is often very difficult to wash out this sinus without a preliminary operation on the middle turbinate. Several diagrams illustrate the anatomical points of the paper, which is an able contribution on a most important topic. A full bibliography is appended. BcrVmcr kliiiische Wochenschrift, September 24, 1906. The Treatment of Postoperative Sinuses by Wright's Vaccine Toprol Xl 100 Mg Method. — Weinstein employed a method founded Generic For Toprol Xl on Wright's researches on opsonins for the treat- ment of obstinate sinuses follow^ing laparotomies. In each instance cultures were made from the sinus, and the vac- cine prepared from these according to Wright's directions. Great stress is laid on the fact that the organisms used in producing the vaccine must be those that are found in the wound of the particular patient. Four cases were treated, and in two of them the sinus was caused to heal completely, after having persisted for four years in one instance. The third Toprol Xl Generic Equivalent sinus was almost completely closed at the time of writing, but the fourth, which communicated with the intes- time and was the result of an operation for appendicitis in which the appendi.x was not removed, still remains open, though the general character of the wound and of the dis- charge has improved. Clinical and Experimental Observations on Gastrop- tosis. — Rosenberg reports on observations made to de- termine the correctness of Loening's recent statement that in nearly all cases of gastroptosis the motility is in- creased. Rosenberg Toprol Xl Generic Recall examined twenty cases of this sort and found hypomotility in 70 per cent., hypermotility in 20 per cent., and normal motility in 10 per cent. He believes that in *he earlier stages of ptosis there may be a period of temporary hypertrophy of the gastric musculature just as is the case with the development of cardiac dilatation, ow- ing to the increased resistance to be overcome. Later on dilatation takes place, the muscle weakens, and hypomotility results. He suggests that Loening's results were gained from a study of patients still in the stage of hypertrophy. Miiitclieiier mediziitische IVochenschrift, September 2S, 1906. The Transplantation of Human Ovaries. — Cramer reviews the history of attempts in this direction, as well as the theoretical considerations underlying them. He has performed the operation in two cases, in each instance using for the purpose ovaries removed from patients with osteomalacia with the object of curing this condition. In each case the laparotomies were done simultaneously on the patient who was to furnish the ovarian tissue and on the one Toprol Xl Vs Metoprolol Tartrate who was to receive it. In the one case the attempt was made in order to secure the possibility of child- bearing for a young woman suffering from atrophy of the uterus and ovaries. The other patient was the victim of a very stormy artificial menopause, resulting from a pan- hysterectomy. All the patients recovered from the opera- tions without complication and the woman with the atrophic pelvic organs some months later had what apparently was a miscarriage. Preceding this the breasts had become swollen and colostrum could be expressed. In the second case the implanted tissue apparently underwent absorption with considerable promptness, for ten weeks after the oper- ation no trace of it could be detected by bimanual exam- ination. Pernicious Anemia jmd Leukemia. — Kelling has al- ready published his opinion that malignant tumors are the result of the implantation in the body tissues of embryonal cells derived from animals in various articles of food, such as raw eggs and uncooked sausage, which latter frequently contains as one of its components uteri of the slaughter animals. He now endeavors to explain the etiology of the malignant blood diseases in similar fashion, and describes several cases of pernicious anemia and leukemia in which he was able to demonstrate in the blood serum of Generic Name For Toprol the pa- tients specific precipitin and hemolytic reactions for animal tissues, such as sheep and fowl. He was also able to pro- duce artificial pernicious anemia in a dog by injecting em- bryonal fowl cells into it, and he Toprol Xl 50 Mg Recall found that the animal's bone marrow gave the specific reactions with fowl serum. It is Kelling's opinion that the proliferation of the blood- forming organs which is observed in these diseases is in reality the result of the growth of the foreign cells which have become engrafted in the body. He seeks to explain the nature of pseudoleukemia in a similar way, though he has yet no experimental evidence to justify this view. Chloroma of the Skull. — Pfeiffer describes a case of this affection occurring in a boy of four years. The first symptoms noted apparently pointed toward an otitic affec- tion, but were soon followed by the development of marked bilateral exophthalmos, severe anemia, enlargement of the cervical lymph glands, marasmus, and death. At the au- topsy the typical green tumors were found in the retro- bulbar tissues, dura, mastoid process, vertebral column, ster- num, and some of the internal organs. The author considers that the following may be regarded as typical Toprol Generic Equivalent symptoms of this unusual condition : Painful exophthalmos, followed by atrophy of the Generic Name For Toprol Xl optic nerve, otitic symptoms accompanied by swelling in the temporal region, either on one or both sides, anemia or acute lymphatic leukemia, with glandular enlargements and subcutaneous or submucous hemorrhages, and. finally, the rapid course of the disease and the youth of the patients. Deutsche medisinische IVochensehrift. September 27, 1906. Testing the Ftincttonal Efficiency of Arteries. — Miiller describes a method by means of which it is possible to gain some insight into the functional efficiency of any given individual's arterial system. The underlying prin- ciple consists in measuring with the plethysmograph the extent of vascular dilatation or contraction caused by the application of thermic Is Toprol A Beta Blocker stimuli to the forearm. In the one case a block of ice of a certain size is applied to the bend of the elbow for a certain length of time, and in the other warm water is allowed to circulate through several spiral turns of rubber tubing applied in the same situation. The amplitude of the plethysmographic curve obtained under these conditions affords a means of estimating the func- tional capacity of the individual's arterial system. As the result of his studies Miiller concludes that the functional

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