Wassermann Reaction Research Articles

Effect of Electrolytes upon Kahn Precipitates from Human and Animal Sera

The problems created by the existence of falsely positive serologic reactions have been a source of difficulty since the advent of the Wassermann test. Kahn reported the first satisfactory differential test; this was based upon specific temperature differences. We became interested in determining whether or not reactions in human and animal sera could be distinguished by the effect of electrolytes. Animal sera were used in these studies because they give general biologic reactions which are apparently of the same type as those found in human falsely positive serologic reactions., while studying the effect of Nacl solutions upon the Kahn Precipitates from animal sera, it was observed that the precipitate resulting from the reaction of Kahn antigen and horse serum was soluble in 4% NaCl solution. At the same salt concentration, precipitates from syphilitic human sera remain insoluble. The effect of other concentrations of NaCl (ranging from 0% to 30%) upon horse, human, guinea pig, hog, cow, sheep, and chicken sera were investigated. All sera were diluted to give approximately two plus reactions in the standard Kahn test by a method previously described. Verification tests were made upon each serum to check the specificity of the reaction. All sera gave the expected reactions (i.e., either syphilitic, general biologic, or negative type) with this test. Controls were also made using the same quantities of serum and salt solution. However, an artificial antigen containing the same quantities of alcohol and saline as in the original antigen was used. Control reactions were completely negative except in the chicken sera. It was found that each species of animal serum investigated gave characteristic aggregation and dispersion patterns of the Kahn precipitate.

Clinico-Pathological Conference

Dr. Smith (reading the clinical summary): A fifty-one-year-old white grocery salesman was admitted because of fever of six weeks' duration. The patient's general health had been good until the present illness. He had Cuban fever in 1899, which lasted for two or three weeks. He had two penile sores at the age of seventeen, with bilateral enlargement of the inguinal nodes. Concomitantly he had pain on urination and urethral discharge. He was treated with iodides, mercurials, and intraurethral medication, and recovered in a few weeks without sequelae. Blood Wassermann tests made thirty and fifteen years before admission were reported negative. Four months before entry the patient began to feel generally below par and slightly feverish, with a few chilly sensations. Thinking he had malaria, he gave himself a course of atabrine, following which his skin turned yellow. Subsequently he visited his physician, who gave him a course of quinine, without improvement in his symptoms. About six weeks before admission, ...

Clinico Pathological Conference

C. D. (Case A40,933), a five-year-old white boy, was first admitted to the hospital in February 1940, with a history of pain in the joints and recurrent fever of seven months' duration. During this time he had been treated for acute rheumatic fever, without improvement. Onset of the pain had been in the right knee and right lower leg, and the knee joint had been moderately swollen and tender. Subsequently, similar episodes occurred involving the other knee and both ankles and elbows. Symptoms subsided after several weeks but recurred in spite of bed rest and salicylates. It was noted that each episode was associated with tenderness along the shafts of the adjacent long bones. Past history and family history were not contributory. Physical examination on admission showed a pale, under-nourished, under-developed boy with slightly swollen tender knees and elbows. Temperature was 99.8°, pulse 100, and respirations 20. The positive findings were marked pallor of the mucous membranes, a blowing systolic murmur at the cardiac apex, and limitation of motion of the elbows and knees due to pain. There was exquisite tenderness along the shaft of each tibia from the knee to the ankle. There were no enlarged lymph nodes and no abdominal organs or masses could be felt. Laboratory examinations showed a hemoglobin of 50 per cent (S) with 2,800,000 red blood cells. The white blood cells numbered 2,000, of which 68 per cent were adult lymphocytes. The Wassermann reaction was negative and blood chemistry and urinalysis were normal. A biopsy of the sternal marrow was performed. Roentgen examination of the skeleton showed numerous punched-out areas of rarefaction in the skull, pelvis, and the diaphyses of the femora and tibiae. All the long bones showed a striking, smooth, regular periosteal proliferation extending along the shafts. (Figs. 1, 2, 3.) During the next two months the patient remained chronically ill, and enlargement of the liver, spleen, and lymph nodes appeared. Dr. Belk: Before proceeding to a discussion of the differential diagnosis, I think we should be told about therapy, inasmuch as this patient's response to therapy has diagnostic significance. Dr. Taylor: This little boy was given supportive therapy, including iron and vitamins and numerous small transfusions during the eight months before his death. Roentgen radiation in divided doses totalling 300 r, given with an intermediate-voltage unit, proved specific in relieving bone and joint pain. In addition, small doses (10 r) of whole body irradiation at 70 cm. at weekly intervals seemed to maintain the child in fairly good health during most of the summer before his death. With the coming of October, the patient began to lose ground steadily in spite of treatment. Subcutaneous ecchymoses and a persistent neutropenia developed. The week before death, the white count was 300 with absence of polymorphonuclears. This agranulocytosis was associated with generalized furunculosis.

The Wassermann Reaction in Infectious Mononucleosis with Special Reference to the Kolmer Test

The Wassermann Reaction in Infectious Mononucleosis with Special Reference to the Kolmer Test

CARCINOMA OF THE LIMBUS

Primary carcinoma of the limbus is relatively uncommon. The following case is significant and of interest because (1) it illustrates a similarity to cases already reported, (2) the only sign remaining after treatment was a small conjunctival scar, and (3) no recurrence, metastases or complication has resulted at the time of writing. <h3>REPORT OF A CASE</h3> A white man aged 47 was admitted to Bellevue Hospital on Oct. 9, 1940 complaining of itching and tearing of the left eye. The family and the past history were essentially unimportant except to reveal the fact that the patient had been punched in this eye about seven years before. . Examination showed that he was underweight, and the apex of the right lung contained an area of old, healed tuberculosis. Auricular fibrillation was present, but there were no signs of decompensation. The Wassermann test of the blood was negative. Examination of the blood showed

Abdominal aneurysm: A report of twenty-four cases

Twenty-four cases of abdominal aneurysm have been reported. The etiology has been discussed with especial reference to the Wassermann test. A study of the symptomatology and the differential diagnosis has been made with emphasis laid upon the frequency of error. A pulsating mass was found to be the most frequent diagnostic symptom, while bruit and thrill were noted in only five cases. The diagnosis was confirmed in twenty of the cases by postmortem or laparotomy.

Lymphatic Leukemia and Tuberculosis

Case / . W. Y., white, 78 year old farmer, was admitted to the Edward J. Meyer Memorial Hospital January 8, 1941, complaining of dyspnea, productive cough and 70 pounds loss in weight during the previous 4 years. Past history. Typhoid fever in 1890, pneumonia in 1900 and 1920, malaria in 1920 and herpes zoster in 1936. No family history of tuberculosis. History of present illness. Apparently began rather insidiously in 1936 with anorexia followed by gradual loss of weight. Later, a cough developed productive of moderate amounts of sputum with fatigue and dyspnoea on exertion, night sweats and occasional chills. For several months prior to admission his symptoms had increased in severity. Physical examination. A poorly developed, emaciated, senile white male, dyspneic, cyanotic and acutely ill. Chest examination revealed impaired resonance and fremitus of the left side with flatness and absent breath sounds at the base. Bronchovesicular breath sounds and medium coarse rales were heard over the upper lobes of both lungs. The heart sounds were regular, of poor tone with a systolic apical bruit. Blood pressure 128/68i In the left epigastrium a firm tender mass was palpated extending to just below the costal margin. The prostate was somewhat enlarged. There were numerous purpuric spots on the right ear, wrists, scrotal sac and legs. Cervical, axillary, epitrochlear and inguinal lymph nodes were palpable. Clinical course. Three days after admission approximately 1000 cc. of dark red bloody fluid was aspirated from the left chest. The patient ran a low grade fever daily (97°100.6°F.), remained cyanotic and dyspneic, rapidly became weaker, finally irrational and expired on January 23, 1940, or 15 days after admission. Laboratory and x-ray studies. Sputum positive for tubercle bacilli. Chest roentgenogram showed a fibrotic type of tuberculosis in the right lung from the apex to the 4th rib anteriorly with a cavity 2.5 cm. in diameter between the 1st and 2nd ribs. The left lung showed a fibrotic infiltration in the apex with a hazy homogeneous shadow occupying the lower half of the lung field, suggesting a pleural effusion. The pleural fluid had a specific gravity of 1.018, Rivalta test was 1+ and a smear showed 90 per cent lymphocytes, 5 per cent polymorphonuclear leukocytes and 5 per cent large monocytes. No organisms were found on culture. Blood count on admission showed a hemoglobin of 9.9 grams, RBC 3,640,000, WBC 87,799 with 99 per cent small lymphocytes. The urine was negative. The Wassermann and Kahn tests were negative. Blood count on January 12, 1940 showed a hemoglobin of 10.6 grams, RBC 3,710,000, WBC 88,200 with 98 per cent small lymphocytes. Because of the abnormal blood count a sternal bone marrow biopsy was performed. Supravital study (Dr. D. K. Miller) of smears of the biopsy material showed many adult lymphocytes and a few lymphoblasts. Very few cells of the erythroor granulopoietic series were seen. Sections stained with Giemsa showed an increase of the cellularity of the marrow, the fat cells being almost entirely replaced by cells of the lymphoid series as shown in figure 1. The .final clinical diagnosis was advanced pulmonary tuberculosis and chronic lymphatic leukemia. An autopsy was performed under the direction of Dr. W. F. Jacobs.

Cavum Septi Pellucidi Biloculere

The purpose of this paper is to record a case in which the cavity of the septum pellucidum was biloculated as the result of a vertical mid-line adventitious partition. The normal septum pellucidum is a thin vertical partition composed of two thin laminae in apposition with each other in the median plane and separated by a narrow median cleft of variable size which is known as the cavum septi pellucidi. The septum pellucidum is triangular in shape and intervenes between the two lateral ventricles. Posteriorly it is prolonged backward for a variable distance between the body of the corpus callosum and the fornix, to both of which it is attached. In front it occupies the gap behind the genu of the corpus callosum, and below it is prolonged downward in the paraterminal body toward the base of the brain. On the normal encephalogram the septum pellucidum is represented by a well demarcated vertical linear shadow, about 2 or 3 mm. in width, interposed between the air shadows of the lateral ventricles in the anterior-posterior or posterior-anterior view. Abnormally, more often in infants, the two leaflets are separated and form the lateral walls of the cavity of the septum pellucidum. This cavity, known also as the fifth ventricle, may be subdivided by the apposition of the fornix and the corpus callosum into an anterior portion, for which the designation fifth ventricle is retained, and a posterior portion or sixth ventricle. Congenital absence of the septum pellucidum alone is very rare. Perforation of the septum is usually associated with internal hydrocephalus, of which a considerable number of cases have been reported. More often, absence or defects of the septum are accompanied by defects in the corpus callosum and other variations in the brain. Secondary septal perforations may occur in cases of tumor of the third ventricle with obstruction of the foramen of Monro and internal hydrocephalus. No example of biloculation of the cavum septi pellucidi in a vertical direction in the mid-line could be found in the literature. Case Report A one-year-old colored girl was admitted because of general underdevelopment. Her weight at birth, at full term, was 4 pounds; at one year it was 12 pounds. The child was the first born to a seventeen-year-old mother, whose previous and present history was normal. Examination of the patient revealed underdevelopment both physically and mentally. The Wassermann test was negative. The blood count and chemistry were normal. Stereoscopic roentgen examination after encephalography revealed a cavity of the septum pellucidum which was biloculated by a vertical mid line partition. This was associated with a slight generalized internal hydrocephalus and generalized cerebral agenesis.

SEROLOGIC DIAGNOSIS OF SYPHILIS

When complement fixation in syphilis was discovered by Wassermann and his colleagues and independently by Detre in 1906, it was naturally assumed to be a specific reaction between the syphilis antibody and Spirochaeta pallida present in the extracts of syphilitic tissues employed as antigens. On the subsequent discovery that saline and alcoholic extracts of normal mammalian tissues served equally well as antigen in the test, the idea of the Wassermann reaction being a specific antigen-antibody reaction was largely abandoned with the suggestion that the reaction was biologically nonspecific owing to the production in syphilis of a reagin characterized by its ability to sensitize and flocculate tissue lipids in vitro with the fixation of complement. But on the successful cultivation of S. pallida in pure culture by Noguchi in 1911 it was possible for the first time to investigate the problem by the use of saline suspensions and alcoholic extracts of

LICHEN PLANUS CONFINED TO THE ORAL CAVITY IN TWINS

Familial lichen planus is rare. As far as I can see its occurrence in twins, as presented here, has not been reported in the literature. <h3>REPORT OF CASE</h3> V. S., a white man, born Aug. 31, 1914, was first seen at the office on Jan. 13, 1939. He had noticed white lesions in the mouth about two months previously. Examination revealed typical lichen planus confined to the oral cavity. Numerous confluent reticular lesions covered nearly all of the mucous membranes of the cheeks. On the left side of the tongue, two oval annular lesions were present, unnoticed by the patient. The lips were not involved. No other lesions were found. The results of urinalysis and a blood count were normal, and the Wassermann reaction of the blood was negative. Six months later, after the intake of 60 cc. of solution of potassium arsenite U. S. P., the eruption cleared up

Adenocarcinoma of the rectum and chromargentaffine tumor of the jejunum

ILlr. A. C., a forty-eight year old, married restaurant worker, entered the hospital on March 28, 1939, complaining of weakness and pain in the rectum. He was well until two months previous to admission when he experienced pain on defecation and his stools became covered with streaks of bright red bIood. There was a weight loss of fifteen pounds and a moderate loss of strength since the onset. He had the usual childhood diseases. With the exception of chronic constipation which four years ago became more marked and required On physical examination, the positive findings were limited to the rectum, where a tender 3 cm. ulcerated mass was feIt in the midline on the posterior wail 4 cm. proximal to the anus. The blood pressure was 160!/90. The urine was essentially normal. Hemoglobin was 80 per cent (Tallqvist), red bIood cells 4.2 million, and white blood cells I 0.0 thousand with 76 per cent polymorphonuclear leucocytes. The Wassermann test was negative. Proctoscopic examination confirmed the physica findings. A biopsy taken at that time revealed the presence df adenocarcinoma, type II plus. Laparotomy, on April 3, 1939, disclosed a fixed rectal mass firmly adherent to the pelvic floor. There were two 3 cm. metastatic nodules within the liver. A palliative colostomy was done and he was discharged on the thirty-eighth hospital day.

CHANCROID

This report deals with 175 patients with chancroid, 150 treated with sulfanilamide and 25 with sulfathiazole. There were 167 men and 8 women, 127 Negroes, 44 white persons, 3 Puerto Ricans and 1 Chinese. The average age was 30.2 years, the youngest patient being 18 and the oldest 58. The majority of the lesions were on the external genitalia (fig. 1). Two patients had ulcerations on the pubis, and 2 had them around the anus. Forty-eight had multiple lesions. The average duration of the lesions was thirty-one days. There were two of five days' and one of three years' duration. DIAGNOSIS The diagnosis of uncomplicated chancroid was based on the identification of Hemophilus ducreyi on smear from a characteristic ulcerative lesion and a positive reaction to Ducrey vaccine given intradermally. In addition, absence of Treponema pallidum on dark field examination and negative Wassermann and Frei reactions were required. The most

HEALTH OF SHARECROPPERS

<h3>To the Editor:—</h3> The two serious diseases which were found prevalent in the -histories of the Negro sharecroppers were gonorrhea and malaria. All these subjects had been under medical care and, as far as one could determine, had been cured. That they had been adequately treated and had recovered is not deplorable. Two subjects showed positive Wassermann reactions, and 1 of these was not a sharecropper. However, accepting the figure of 8 per cent, Roberts and Williams (<i>South. M. J.</i><b>30</b>:458 [May] 1937) report an incidence of 11.7 per cent in the white population of Gibson County in Tennessee, and Usilton (<i>Ven. Dis. Inform.</i><b>16</b>:147 [May] 1935) estimates that 8 per cent of males from 20 to 30 years of age contract syphilis. I cannot regret the fact that the figure for the Negroes is, if anything, lower than that for the white population. That the cardiac and respiratory signs found on clinical

LYMPHOMA OF THE LARYNGOPHARYNX

The case to be reported is of interest because of the rather uncommon type and location of the tumor and its occurrence in a patient in his seventh decade: REPORT OF A CASE Mr. R., 71 years old, was first seen by me on Oct. 14, 1940, referred by Dr. W. T. Heldmann and the patient's son, Dr. O. W. Race, of Staten Island, N. Y. For the past year he had experienced considerable difficulty in swallowing and was troubled with regurgitation of food and severe paroxysms of coughing. Recently, there had been some wheezing. There had been occasional attacks of dyspnea at night. There was no expectoration of blood or mucus. Physical examination of the heart and lungs revealed nothing abnormal. The blood was normal; the sedimentation rate was normal. The urine contained a faint trace of albumin and a few hyaline casts. The Wassermann reaction was negative. An

BLOOD TRANSFUSION SYPHILIS

The transmission of syphilis by blood transfusion is extremely rare. In 1935 Jones, Rathmell and Wagner 1 reviewed 21 cases of blood transfusion syphilis and added 4 of their own. Eichenlaub and Stolar, 2 in a more recent survey, reported a total of 41 cases, discussed this clinical accident at length and suggested a method for sterilization of blood from syphilitic donors. In considering proof of transfusion syphilis the following criteria should be met: First, the recipient should have a negative Wassermann reaction before transfusion and a positive serologic reaction after transfusion, with or without a rash or other evidences of syphilis. Second, the donor before transfusion should be a syphilitic person with or without a positive Wassermann reaction or other signs of syphilis as detected by the physical examination or history. One cannot approach this problem without appreciating the danger of blood transfusion. In many large hospitals blood transfusions

Melorheostosis, with Report of a Case

Melorheostosis was first described by Léri and Joanny, in 1922. The term is derived from the Greek words μέλος, a member, and ρεω, to flow. Léri described the condition as “a flowing hyperostosis of a single extremity,” and reported two cases. He pointed out that it was a hitherto undescribed type of bone hyperplasia confined to an extremity, extending from one end to the other in a single linear tract, but usually leaving a few unaffected areas along the course. Case Report Alice 1., a Japanese girl, born in this country, five years of age, was referred to the writer by Dr. Y. S. Fukuda, at the Japanese Hospital, Los Angeles, Nov. 2, 1931. She had difficulty in walking and some valgus deformity of the left knee. There had been slight pain in the left leg at times. The onset had been gradual. The mother stated that the child had been late in starting to walk and had had a slight limp. Physical examination was negative except for moderate genu valgum. Routine blood and urine tests and blood Wassermann tests were negative. There was no significant family history. There was no muscular atrophy and no shortening of the bones of the left leg. The limp appeared to be due to the valgus deformity. No biopsy was obtained. Roentgenograms of the left knee, left hip, pelvis, and left ankle showed linear areas of increased density extending from the head of the left femur along the medial and anterior surface of the shaft, ending in a streak about a quarter of an inch above the distal epiphysis. The epiphysis of the femur at the knee showed an area of increased density involving the central portion of the anterior and of the articular surface. In the patella, which was displaced laterally, there was a spotty condensation of bone. The upper epiphysis of the tibia also showed a spotty condensation. Osseous tissue about the areas of condensation was decalcified. The tibia was rotated outward and there was a subluxation at the knee joint. A streak of condensation extended down the lateral and anterior surface of the tibia to the lower epiphysis. The fibula was not involved. A large area of condensation was seen in the astragalus, and there were traces in the os calcis, navicular, and first metatarsal. There appeared to be arrested development of the epiphyses at the involved sites, and normal growth of uninvolved bone. Recognizing the unusual character of the lesions, the writer sent the roentgenogram and history to Dr. J. C. Bloodgood, who commented as follows: “There is no doubt from an x-ray standpoint it is an area of sclerosed bone, and, in view of the non-development of the epiphysis of the tibia and of the astragalus, it must be an old affair—perhaps intrauterine. I know no literature on it.

Multiple Myeloma

A white male, twenty-five years old, was admitted to the Edward J. Meyer Memorial Hospital in November, 1938. He had had no complaints until 1936, when he began to experience aching in the anterior aspects of both thighs after working all day. Relief was sought through chiropractic treatments but none was found. In May of 1938 pain developed in the lumbar region, radiating down the legs. This grew progressively worse and forced the patient to stop work in October. At the time of admission he had intermittent sharp pains in the back and was unable to walk without support. The past and family history was unimportant. The patient was well developed, but poorly nourished, appearing moderately ill. There were no palpable deformities or softenings on the skull or ribs. The spine was rigid but not tender. There was spasm of the muscles about the right hip. The reflexes were normal. The blood pressure was 180/114. The urine was normal. Repeated attempts failed to reveal Bence-Jones protein. The Wassermann reaction was negative. The blood showed a severe secondary anemia. The blood calcium on successive occasions was 12.41, 13.17, 13.0, and 6.2 ionized (calculated from the total calcium as determined by the method of Clark and Collip). The phosphorus was 4.9, 5.1, and 4.3. The phosphatase was 3.2 Bodansky units; plasma chlorides 630; albumin 2.82 gm. per cent; globulin 3.73 gm. per cent; total protein 6.55 gm. per cent; the A/G ratio 0.72. A biopsy was made from a lesion in a rib. The section showed profuse proliferation of cells with occasional mitotic figures. These cells were about the size of a large lymphocyte. Some cells showed reticulation of the nuclei, but not regularly; others had cytoplasmic processes suggesting a reticulum (Fig. 1). There were many clusters of small lymphocytes scattered around among the larger cells. An occasional eosinophil was noted. None of the normal bone marrow elements was seen. Occasionally there was seen a large cell that was similar to a megakaryocyte. These cells, however, were not well defined, and were few in number. The picture was regarded as in keeping with myeloma. Roentgen examination revealed a widespread involvement of all the bones of the body (Figs. 2–4) except those distal to the knee and elbow. Numerous sharply circumscribed areas of decreased density were scattered through the bone marrow. In the spine and pelvis the tumors were so diffuse as to give the roentgenogram a rarefied osteoporotic appearance. There was no evidence of bone production.

The Epidemiology of Rheumatic Fever

FOR some years reasons have been obvious for promoting the public health aspects of rheumatic fever, a disease which may be classed as our third most common chronic infection (after tuberculosis and syphilis). But in spite of the obvious need, there have also been reasons why relatively little public health work has been done on rheumatic fever in this country, and not the least among them is the fact that it has not been at all clear what should be done. Rheumatic fever is not a disease which is going to be brought under control easily. First of all its etiology is obscure, for in spite of the plain fact that this disease has something to do with hemolytic streptococcus infections, the real nature of rheumatic fever is still poorly understood. Second, there are few, if any, tests which are yet available for diagnosis like the tuberculin test or the Wassermann test. In their absence, the practitioner must resort largely to his wits and to his stethoscope. There is nothing specific, nothing as yet beyond the experimental stage, which can be recommended as a means of prevention. All of these things tend to make the public health officer regard rheumatic fever with some

Acute interstitial myocarditis in an infant: Report of a case with autopsy findings

Hivtory.--H. T., a 1-year-old white girl, was admitted to the Jewish Hospital Pediatric Service on March 31, 1935, with the complaint of rapid breathing with grunting expiration, which had begun ten days previously and had become progressively worse. Her appetite failed, and she lost 5 pounds. For the previous two days she had been irritable and drowsy. Birth and developmental history were normal. The child had begun to walk two weeks bes the onset of this illness. There had been no previous illnesses of note. The child had played with toys, the paint on which which was found to contain lead. Fa~n~ly His~o~y.--Both maternal grandparents had arteriosclerotic heart disease. Physical Exa~nimation.--Examination showed a well-developed and nourished child, irritable, but alert. The temperature was 99 ~ (rectal) ; pulse, 160; respirations, 60. There was a mucoid nasal discharge. Breathing was almost entirely diaphragmatic, with grunting expiration. The percussion note was resonant, and the breath sounds were normal. No rMes were heard. The heart was not enlarged. The sounds were of good quality. A systolic murmur was heard best over the mitral area and was transmitted into the left axilla. The murmur was less intense over the aortic area. The liver could be felt 1 cm. below the costal margin in the midclavicular line. The spleen was not palpable. The child assumed a gun-hammer position. The patellar reflexes were hyperactive. The biceps and abdominal reflexes were not elicited. Babinski 's, Kernig 's , and Brudzlnski 's signs were negative. Laboratory Data.--On admission acetone and a trace of albumen were present in the urine, but these disappeared during the hospital stay. Dr. Robert :Kehoe reported no increase of lead in the urine. Repeated counts showed a red blood count of about 3,500,000, with hemoglobin 60 to 65 per cent. The white blood counts varied between 14,000 on admission to 10,000 later on, with the differential count showing 47.5 per cent polymorphonuclears and 48 per cent lymphoeytes. There were moderate anisocytosis, slight poikiloeytosis~ and on one occasion ] per cent eosinophiles and 2.5 per cent reticulocytes. There was no stippling. Blond calcium was 11.2 per cent. The lead content of the stool, determined by Dr. Kehoe, was normal. Spinal fluid pressure was normal. Globulin in the spinal fluid was negative. There were four cells per cubic millimeter. Lead content was at the upper level of normal. Sugar was 86 mg. per cent. The Wassermann test was negative. The Schick test was negative. Tuberculin tests with P.P.D. No. 2 were negative. Cultures from nose and throat showed staphylococci. No ]~lebs-L~ffier organisms were found. The mother 's blood Wassermann test was negative. l~oentgen Exam~nations.--On April 1, 1935, the ulna and radius showed no lead line. On April 2, 1935, lung films were interpreted as follows: Both lungs showed diffuse parenchymatous infiltration along the bronchial tree, apparently due to a bronchitis. The heart was normal in position, size, a~d shape. Teleoroentgenograms of the chest on April 11, ]935, showed the same findings as above. On April 23, 1935, the heart was deviated to the right, and in addition to the previous findings, there was a triangular dense shadow at the base of the right lung, possibly produced by atelectasis of the right lower lobe.

Diaphragmatic hernia complicating the puerperium

A HERNIA through the diaphragm occurs rarely, but, due to the position of the abnormal opening, is much more likely to be exposed to the force of increased abdominal pressure in labor than is an inguinal hernia, which is protected by the bulk of the uterus. This combination of diaphragmatic hernia and the immediate puerperium is sufficiently uncommon to merit the report of the following case: (An exhaustive survey of the literature brought to light only a single reference in the Journal of the American Medical Association. of 1937 under “Query and Minor Note, ” t.he case of a doctor’s wife whose labor and puerperium were complicated by herniation into the thorax of one-fourth of her stomach.) Our patient, a 20.year-old white gravida ii, first presented herself when three and one-half months pregnant. Her last normal menstrual period was on Aug. 25, 1939. She was considerad to be at term on June 2, 1940. The pertinent history obtained was a right inguinal herniorrhaphy at Billings Hospital in 1938, four months following a normal spontaneous delivery at Chicago Lying-in Hospital. Physical examination was essentially negative ; Wassermann reaction was negative. Her pregnancy, which was of forty-three weeks’ duration, was marked by excessive weight gain (29.5 pounds) and albuminuria. The labor came on June 27, 1940 and after thirteen and one-third hours terminated spontaneously in the birth of a g-pound female baby. A midline, second degree laceration was repaired under pudendal block anesthesia.