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<!Nrrent 'Jltteratnrc J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from 348 Ourrent Literature retained, and the scheme of the book remains the same. A section dealing with the "Terms used in Prescriptions in Latin and English" has, however, been added. The favourable opinion expressed in the review of the third edition can be fully endorsed, and this book will be found most useful to all medical officers as a ready and accurate means of reference. O. L. R . • <!nrrent 'JLtteratnrc. The Biological Diagnosis of Gonorrhrea.-80mmer (Archiv f. Derrn. u. Syph. Originale, November, 1913, p. 583) gives an epitome of the literature of serum, skin, and vaccination reactions in' gonorrhma, and appends a bibliography of ninety-four references. Wildbolz and Barmen stated that the serum of gonorrhma patients agglutinates the gonococcus, but subsequent observers have obtained negative results only. Moreover, the serum of an animal that has been Protected by copyright. immunized with the gonococcus is not specific in its effects: it clumps staphylococci and streptococci as well as gonococci, though it does Dot agglutinate the meningococcus. On the other hand, an anti-meningo- coccic serum clumps the gonococcus. , Much work has been done on the complement deviation test in gO,norrhma. Dembska examined 100 patients and found that the serum of cases of more than a fortnight's duration deflected the complement, and in a manner especially marked if complications were present. Gardner and Glowes investigated 106 cases, and concluded that the reaction gives valuable information in gynrecology. Schwarz and McNeil find that the test is positive in all gonococcic infections, except when they are localized to the anterior urethra. The reaction is obtained usually not before the fourth week, and frequently persists seven or eight weeks http://militaryhealth.bmj.com/ or more. Of 165 cases, 13 per cent gave a positive response eight months after recovery. The complement deviation test is specific, but a negative result does not exclude gonorrhma. The intensity of the reaction generally runs parallel with the degree and severity of the infection. v. Pirquet's reaction, in which an emulsion of dead gonococci takes the place of tuberculin, has been employed by many investigators, but the method is uncertain and of no value in the diagnosis of gonorrhma. The intradermic reaction in which vaccine is injected into the substance of the skin, and the ophthalmo-reaction in which it is instilled into the conjunctival sac, also fail to be specific in their results. Some observers consider that tbe local reaction produced at the site of inoculation after a subcutaneous or intramuscular injection of vaccine on October 2, 2021 by guest. is suggestive of infection, but Sommer finds that no difference exists in the reactions seen in the infected or non-infected. On the other hand, a marked reaction of the implicated part after an injection of gonococcic vaccine is evidence in favour of the disease being due to gonococci. The reports of many investigators show that the pains in epididymitis and J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from Ourrent Literatu1'e 349 gonorrhrnal rheumatism are often temporarily aggravated after a dose of vaccine, or the urethral discharge is increased. Nevertheless, these reactions are not of universal occurrence; therefore, their absence does not exclude gonorrhrna. Such provocative reactions are of service in disclosing gonorrhrna which has been latent for long periods. Erlacher has reported instances in which he discovered gonococci by this method after being absent for months or years. The occurrence of constitutional symptoms with pyrexia after inocula­ tion with gonococcic vaccine often indicates gonorrhrna, but the absence of such a general reaction has no significance. Sommer experimented with intravenous injections of arthigon, a gonococcic vaccine prepared by Schering, and ascertained that they are of more value than subcutaneous or intramuscular inoculations. An elevation of 1.50 C. in the temperature after an intravenous dose of 0·1 c.c. arthigon usually denotes gonorrhrna; a rise of 2'50 C. and a saddle-back course of the pyrexia are almost certainly diagnostic of the disease or of its complications. Provocative reactions are more frequent after intravenous administra­ tion of gonococcal vaccine than after subcutaneous or intramuscular. No bad effects are caused by intravenous injections of gonococci. For women and children the dose of arthigon for intravenous administration must be less than 0·1 c.c. Protected by copyright. Sommer is of opinion that people contemplating marriage, who believe that they have recovered from gonorrhrna, should submit to an intravenous injection of arthigon. Such a course may prevent keen disappoint­ ment in the future, and may be the means of checking much married unhappiness. C. B. Antityphoid Vaccination in the French Army.-Medecin-principal Vincent (Archiv. Med. Pharm. mil., November, 1913) published an interesting report on antityphoid vaccination in the French army during the year 1912. He employs a polyvalent vaccine, sterilized by contact with ether, and without the addition of any antiseptic to preserve it; each cubic centimetre contains 400 million bacilli. During the year 1912 30,325 men were vaccinated in France and 22,832 abroad. In very few http://militaryhealth.bmj.com/ cases was there any local reaction, and in healthy subjects pyrexia was only observed in 0·8 to 1·5 per cent of those vaccinated. During the year 1912 the strength of non-vaccinated men serving in France was 447,159; the incidence of enteric fever among these was 2·22 per 1,000, with a death-rate of 0'3 per 1,000 of strength. At the same time there were 30.325 vaccinated men, among whom there was not a single case of enteric fever. In Algeria and Tunisia there were 41,514 non-vaccinated men, among whom the incidence of enteric fever was 12'14, with a death-rate of 1,88 per 1,000. Among 10,031 vaccinated men living under precisely the sa.me conditions the incidence of enteric fever was 0'9 and mortality on October 2, 2021 by guest. nil per 1,000. In Eastern Morocco the strength of non-vaccinated men was 5,807, among whom there were 222 cases of enteric fever with 32 deaths, the ratio per 1,000 being 38'22 and 5'51 respectively. In contrast to this there was not a single case among 962 vaccinated men. J R Army Med Corps: first published as 10.1136/jramc-22-03-16 on 1 March 1914. Downloaded from 350 Ourrent Literature In Western Morocco 6,293 non-vaccinated men had an incidence rate of 168'44 and a death-rate of 21·13 per 1,000 of strength;· while among 10,794 vaccinated men the corresponding ratios were 0'18 and 0'09 respectively. In an official communication sent to La France Militaire, on April 4, 1913, it was estimated that antityphoid vaccination has prevented about 2,100 cases of enteric fever, with probably 266 deaths, during the year 1912. J. V. F, Intravenous Injections of Concentrated Solutions of Salvarsan and Neo-Salvarsan.-Ravaut (Presse Medicale, April 3, 1913, p. 262) finding that 0·45 to 0·6 grm. of neo-salvarsan dissolved ih 10 C.c. of distilled water caused no hrnmolysis of human red corpuscles in vitro, has given without mishap 420 intravenous injections of such a solution. It is necessary to filter it through sterile gauze. Duhot (Munch. med. Woch., May 20, 1913, p. 1088) also reports that he has administered intra­ venously without untoward results on 750 occasions neo-salvarsan in quantities up to 0'75 grm. dissolved in 10 C.c. of water. Katz (Munch. rned. Woch., October 21, 1913, p. 2337) finds that the curative effects of 0·3 to 0'6 grm. of neo-salvarsan are enhanced by dissolving it in 10 c.c. of water only. Twenty-four hours after administration no spirochrntes Protected by copyright. are found. His experience extends to 130 injections. Alexandrescu Dersca (Munch. med. Woch, July 23, 1913, p. 1601) has given 40 intra­ venous injections of 0'39 to 0'6 grm. of neo-salvarsan dissolved in 1 to 2 C.c. of water only. He states that no after-effects were observed. Fruhwald (Munch. med. Woch., November 11, 1913, p. 2513) has tested Dersca's method, and has noted no bad consequences. Great care, however, must be taken to prevent these concentrated solutions escaping into the connective tissue. He also has given 259 doses of 0'6 grm. of neo-salvarsan dissolved in 10 C.c. of water, and finds that they act promptly on the treponemata. If three injections are administered in the course of ten days the patient loses all signs of the disease in a fortnight. In about two-thirds of his cases fever, headache or vomiting were observed, most frequently after the first dose. http://militaryhealth.bmj.com/ Strong solutions of salvarsan have been employed by Stern, who dissolved 0'3 grm. in 10 C.c. of water for intravenous use. Zimmern (Munch. med. Woch., May 20, 1913, p. 1087) has given 147 intravenous injections of a 5 per cent solution of salvarsan. Fever occurred twenty­ seven times, and vomiting followed on thirty-nine occasions. Very painful infiltrations also were caused by inadvertently injecting a few drops of the fluid into the tissues surrounding the vein. He has dis­ carded the use of such strong solutions, although he states that the salvarsan is retained in the body for a longer period when administered in concentrated form. Dreyfus (Milnch.
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