probably played a great part, but it was stretch-
ing the word too far to make it include antitoxic
PATHOLOGY AND BACTERIOLOLY.
Diphtheria, Discussion on, at the Glasgow
Medico-Chirurgical Society (continued from page
366). (Glasgoiv Medical Journal, August 1895).
?Dr. Joseph Coats said he approved of the term
"antitoxin" on the ground that when one spoke
"
of a toxin one did not think of a simple chemi-
"
cal action but of an intimate vital process?
chemical no doubt, but belonging to vital chemis-
try, and therefore "antitoxins" might be pre-
sumed to act in the same way but in an opposite
direction and the name be thought a good one.
Dr. Ruffer, in speaking of phagocytes, had gone
farther than he could admit. In the case of
natural immunity he thought that phagocytosis
action. It was a peculiar and unlooked for
result of observation that the bacilli themselves,
which were primary agents in the whole process,
did not seem in their mere growth and multipli-
cation to be much affected by the antitoxin. It
appeared that the bacilli were being capable of
being cultivated in the blood serum of an im-
munized animal, or, in other words, in the
presence of the antitoxin. All the facts indeed
seemed to prove that the action of the antitoxin
was one of antagonism, not to the growth of
the bacilli, but to the action of the toxin, and
that this action of the antitoxin was not exer-
cised through phagocytosis, but consisted in the
opposition of one agent, having intimate relations
to the animal cells, to another agent which had
similar relations The rest of the
discussion was mainly taken up with statistical
and clinical evidence regarding the antitoxin
treatment.
The Leucocytosis of Djphtheuia under the
Influence of SeiiumTherapy.?Under this title
Dr. James Ewing, Assistant Pathologist to Roose-
velt Hospital, New York, has an interesting paper
in the JNeiv York Medical Journal, August
10th and 17th, 1895. He enumerates previous
researches?Bonchut's in 1879, and recently
Morse's and Gabritschewsky's?with which, as
the result of his examinations in 53 cases, he
agrees in the main. As regards technique
Dr. Ewing used the Thoma Zeiss' erythro cyto-
meter, the blood being diluted 100 times in
6 p. c. salt solution tinged with gentian violet.
The results were controlled by dry preparations
stained with Lage's hematoxylin and alcoholic
solution of eosin. By these methods the follow-
ing forms of leucocytes were enumerated: (1)
small mono-nuclear cells (lymphocytes); (2) large
mono-nuclear leucocytes; (3) poly-nuclear leuco-
cytes; (4) pseudo-eosinophil cells or amphophil
cells of Ehrlich ; (5) true eosinophil cells; (6)
amoeboid figures. The writer states: "In none
of the cases was it found possible to attach
any
prognostic value to a simple enumeration of the
leucocytes at any stage of the disease."
The following is the author's summary of the
conclusions arrived at from this study of 53
cases:?
Diphtheria is usually attended by pronounced
leucocytosis. The increase of leucocytes begins
a few hours after the infection,
probably appear-
ing earlier in refractory individuals, and often
being long delayed in susceptible cases with
severe infection. In favourable cases the leu-
cocytosis is greatest at the climax of the disease,
and steadily declines during convalescence.
There may, however, be prolonged hyperleu-
cocytosis after other local and constitutional
symptoms have subsided.
 Oct 1895.] CURRENT MEDICAL LITERATURE. 397

In unfavourable cases, the leucocytosis conti- OBSTETRICS AND GYNAECOLOGY.

nues until death ; but in somewhat prolonged
cases, with much septic absorption, there may
be an uninterrupted decrease of leucocytes
continuing up to the fatal termination.
A complicating pneumonia usually causes a
considerable increase in leucocytosis.
The degree of leucocytosis in diphtheria often
varies with the fever, but much more frequently
Rectal Examination of Pregnant Women.
By W. H. Beckman.?(Shurnal alcuocherstiva i
Shenslcich bolesnej) has tried this method with
great success in 100 parturient women, the
details of pelvis and cervix being easily made
out. The length of the pregnancy and state of
the bladder could not be determined in 7 per
cent, of the cases, and the fontanelles and sutures

corresponds to the extent of the local lesion. could not be felt in 28 per cent., but this was
The intravascular leucocytosis of diphtheria less important, since the position of the foetus
measures exactly the systemic reaction against
could easily be detected by external examination
the toxic products circulating in the blood and and especially by auscultation. It was always
absorbed from the site of infection. possible to distinguish the occipital from the
frontal portion of the head. The advantage of
High leucocytosis in diphtheria indicates a rectal examination is that infection through the
pronounced reaction against a severe infection,
but is not necessarily an unfavourable prognostic genitals is avoided, the only objection being that
sometimes examination through the vagina ma\'
sign. become necessary, and that infection may occur
Steadily decreasing leucocytosis usually, but
not always, accompanies a favourable course in through the examining finger, though the latter
the disease. is easily disinfected, since the rectum does not
indicates mild contain specific microbes. The author considers
Slight leucocytosis usually a
rectal examination of great value to midwives,
infection, but fatal cases may for several days
show no increase, or even a decrease, of leucocytes. enabling them to determine if the presence of an
The staining reaction of the leucocytes is an obstetrician will be necessary. Zweifel's ex-
accurate measure of the severity of a diph- perience in the Leipzig Obstetrical Clinic showed
that students instructed in the method of exami-
theritic infection, and variations in this reaction
nation could determine all the necessary details
often precede changes in other symptoms.
without recourse to vaginal examination. Ries
Antitoxin, within thirty minutes after its
believes that midwives should be forbidden to
injection, causes a h}rpoleucocytosis, the reduc- make examinations through the vagina, as their
tion affecting specially the uninuclear leucocytes,
while the proportion of well-stained multinuclear duty is only to assist at normal births. Kroeing
is inclined to permit vaginal examinations only
cells is increased. This action is due largely to the
immunizing principle contained in the serum. (1) when it is difficult to determine through the
rectum what part of the foetus is presenting, (2)
In favourable cases, after the injection of anti-
when the midwife is not able to bring about
toxin, the leucocytosis never again reaches its relaxation of the cervix, and (3) when the pains
original height. In severe and less favourable last more than two hours.
cases, the injection is followed in a few hours
by liyperleucocytosis and fever, exceeding those Deep Inctsion of the Parturient Cervix
symptoms as found in the original condition. for Rapid Delivery. (American Journal of
In unfavourable cases, an injection of antitoxin Obstetrics, June 1895).?Dr. J. Clifton Edgar
may be followed immediately by rapid liyper- in a long and well-illustrated paper deals with
leucocytosis or extreme hypoleucocytosis and the question of the scope and usefulness of deep
death. incisions of the cervix in parturient patients
The reduction of leucocytes immediately suc- with eclampsia. Duhressen has obtained brilliant
ceeding the injection of antitoxin, especially in results with this method of operative interfer-
severe cases of diphtheria, is an undesirable ence, having in thirty-five cases saved all the
feature of the action of this agent, and as far as mothers and all but two of the infants. Three
possible should be avoided. cases are reported, in two of which the above-
The multinuclear leucocytes found in the named operation was performed, whilst in the
blood of favourable cases after treatment by third the deep cervical incisions were accom-
antitoxin show increased affinity for gentian panied by mechanical dilatation. In the last
violet. This change may be observed within named case the mother and twins were saved
;
twelve hours after the injection, and the fsiilure in the former two instances the mother died in
of its occurrence is a very unfavourable prognos one and the child saved in both. In the case
tic sign. which proved fatal to the mother, an
The variations in the staining reaction of was obtained. Dr. Edgar believes that the autopsy
in indicate that opera-
leucocytes diphtheria the nuclei tion should only be undertaken when the entire
of these cells contain a
principle essential to supra-vaginal portion of the cervix is dilated
phagocytosis and immunity in this disease. i.e., when the defective dilatation is confined to
F. P. Maynard, m.b. the vaginal portion. The field for the
operation
 398 INDIAN MEDICAL GAZETTE. fOcT. 1895.

is a limited one, and the method of treatment
must be regarded as serious. It is not possible
yet to say what the ultimate value and real
danger of the incisions may be, for sufficient
cases have not been reported. The risk of septic
infection may be greatly lessened by strict surgi-
cal cleanliness. Haemorrhage is not much to
be feared, if the incisions are deeply made, still
it is well to introduce a tampon of iodoform
gauze into the genital tract. A useful biblio-
graphy accompanies the paper.
The NliPHLims and Eclampsia of Pregnancy
and Parturition. (.Edinburgh Medical Jour-
ncd, September 1895).?In a paper read before
the Sacramento Society for Medical Improve-
ment (Occidental Medical Times, June 1895), Dr.
Wallace A. Briggs discusses nephritis and eclamp-
sia in obstetric practice. He believes that the
symptoms of puerperal convulsions are identical
with those of renal convulsions, that with few
exceptions there exist in eclampsia the clinical
evidences of nephritis, and that in the vast
majority of cases, the autopsy reveals the lesions
of nephritis.
Pre-existing nephritis in primi-
after he states, invariably results in
parse forty,
death, unless pregnancy be interrupted. In rare
cases, however, eclampsia occurs without either
anti-mortem or post-mortem evidence of nephri-
tis. In some of thesa cases renal insufficiency
has been demonstrated, in others it is rendered
extremely probable either by analogy or by the
testimony in evidence. The causes of nephritis
whether acute or chronic, as far as determined,
are the toxins of various diseases, such as scarla-
never be quite sure as to how far this preven-
tion is going on, it is wise to flash the kidneys
by milk during pregnancy, as recommended by
Jacsend. Further, the care of the pregnant
woman's life should be reduced to a minimum,
in order to maintain the tone of the nervous
system. As regards curative treatment of ne-
phritis in pregnancy, Dr. Briggs recommends
an absolute milk diet to the extent of from
three to five quarts in the day. If the milk
disagree, it may be mixed with s me mineral
water. In the actual presence of eclampsia the
indications are to limit the production of toxins
and of retrograde material, to promote their
excretion, to dilute them in the circulation, to
depress the cerebral cortex, the motor tract of
the spinal cord and the conductivit}' of the
motor nerves; and lastly, to avert death. These
indications are fulfilled by maintaining the same
dietetic measures as suggested, and, in urgent
cases, by inducing or
promoting
or
forcibly pro-
ducing labour under full anjesthesia, and with
antiseptic precautions. Milk by the mouth and
saline solution by the rectum suffice to carry off
the toxins and to dilute them in circulation.
Chloral and chloroform are used to depress the
cerebral cortex.
Kedarnath Das, m.d.

tina, typhoid fever, measles, dysentery, cholera,

&c., various chemical poisons, such as turpentine,
cautharides, carbolic acid, alcohol and chlorate
of potash ; and certain extensive lesions of the
skin in which the kidneys probably undertake
the vicarious elimination of poisons that, in
normal condition are excreted by the cutaneous
surface. In eclampsia and in advanced nephri-
tis, the uro-toxic co-efficient is markedly dimin-
ished, whilst in both these conditions the toxi-
city of the blood serum is markedly increased.
Doubtless, the eclampsia is due to the same causes
as are convulsions of renal origin?that is, to renal

insufficiency. Dr. Briggs is in doubt as to the

existence of a toxin produced by a specific mi-
crobe in eclampsia, such as has been assumed by
Gerdes and Herrgott. The pathogenic chain of
eclampsia is excess of toxins, nephritis, renal
insufficiencies, retention and accumulation of
toxins, irritation of the cerebral cortex and
eclampsia. The prophylactic treatment of the
condition then is to limit the formation of toxic
substances, and specially toxins, and to sweep
them out of the system as quickly as possible
after their formation. By intelligent attention
to the functions of the digestive organs we can
generally restrict or prevent the undue produc-
tion of gastro-intestinal toxins; but as we cau