1277

tive. He allows that the complement-fixation testdoes not yet approach in value the Wassermannreaction in syphilis, though he claims that it may behelpful. He finds that a strong positive reaction

suggests a tuberculous infection, but that its degreeis not necessarily proportional to the clinical conditionor to the activity of the disease. It may also be

positive in non-tuberculous conditions, and the

presence of a positive Wassermann reaction muchimpairs any deductions from a positive complement-fixation test unless the latter is of higher value thanthe Wassermann. Pirquet reactions were usuallycarried out, but gave no consistent results in regardto the complement-fixation tests ; indeed, the obser-vations were often mutually contradictory. Othertuberculin reactions were not employed owing to thepossible risk of activating arrested or quiescent lesions.The examination of the sputum for albumin provednot to afford any help in diagnosis either as to thepresence of the disease or to the activity when present.In regard to the value of radiographic reports, it is

interesting to find that in 127 cases the X ray findingstended to corroborate the positive clinical evidence,while in 66 cases, in which on clinical grounds tuber-culosis was diagnosed, the radiographic findings werenegative. On the basis of these figures Dr. PRICEurges that the negative results of X ray examinationmust not be allowed to overweigh the diagnosis madeon clinical grounds. He sums up his views on therelative values of clinical, pathological, and radio-

graphic observations in diagnosis by maintaining thatapart from the finding of tubercle bacilli the chiefreliance must be placed on clinical evidence, a perspec-tive with which most observers who are concerned inthe diagnosis of pulmonary tuberculosis will agree.This conclusion serves further to emphasise theimportance of the clinical study of this disease bystudents and practitioners.

NON-POTABLE SPIRIT.

IN accordance with the announcement in theBudget Statement, methylated spirit sold to thegeneral public for domestic purposes has, since May lst,contained an addition of crude pyridine in order tomake it less acceptable as a beverage. The newmineralised spirit will contain, to be exact, crudepyridine 0-5 per cent., wood naphtha 9-5 per cent.,mineral naphtha or paraffin oil 0-375 per cent., andmethyl violet a trace. The Chancellor was advisedthat this spirit would be so nauseous and so difficultto swallow as to give pause to the would-be drinker,and if his reluctance were overcome, the draughtwould make the victim so ill (but not mortally) that hewould be unlikely to attempt to defraud the Revenueby continuing to drink it. We learn from the Chemistand Druggist that it had been the practice by thosewho wished to drink the old methylated spirit toremove the petroleum by diluting and shaking thespirit with salt or charcoal. Our contemporarysuggests that there is a simple method of separatingthe pyridine from the new spirit, and it remains to beseen whether the public will find this out or not.Major F. J. W. Porter, writing to us from the SurgicalNursing Home in Bombay, recommends the additionof one half per cent. each of caoutchoucine andpyridine for the denaturing of spirit for surgicalpurposes. Every surgeon, he says, knows that it isimpossible to use tincture of iodine made frommethylated spirit denatured by the British Customs,whereas that prepared by the Indian Customs in theway suggested can be used for such a purpose. He cansee no reason why the British Excise authorities shouldnot allow hospital spirit to be prepared in this manner,seeing that it is absolutely undrinkable even byIndian fishermen.

Annotations.

LOCAL ANÆSTHESIA.

" Ne quid nimis."

THERE is still a certain amount of rivalry betweenlocal and general methods of analgesia in the sensethat one or other is more in favour in the practice ofmost surgical clinics, and a perspective can be obtainedonly by observing the practice at a number of centres.So much depends upon adequate technique andassistance, and where the arrangements are adaptedfor the one method things run so smoothly as to limitthe demand for the other. Particularly is this the casewhere an abundant supply is available of highly-trained assistants in general anaesthesia. The growingexperience and popularity of local anaesthesia isevident on perusal of the second abstract-review ofthis subject contained in the June issue of thePrescriber (Edinburgh), whose editor, Mr. ThomasStephenson, D.Sc., F.R.S. Edin., has long made it apractice of collecting and collating information on theborderland of medicine and pharmacy. Attention iscalled in this review to the unrivalled position stilloccupied by cocaine by reason of the intensity andpersistence of its local ansesthetic action. Novocaineappears to be destroyed by contact with the tissues,and of the series of allied preparations, such as

eucaine, tropocaine, stovaine, and alypin, all seem tobe harmful in some degree to the tissues surroundingthe sensory nerve endings. In the case, however, ofstovaine this damage may be slight or even negligible,in view of the remarkable results of 400 operationsunder spinal analgesia, related on p. 1256 by Mr. B. H.Slater, medical superintendent at St. Luke’s Hospital,Bradford. No death in this series could be ascribedto the stovaine employed-the two patients dying onthe table being already in a moribund condition-andMr. Slater can of his own experience cite no disadvan-tage of spinal analgesia, provided the technique becorrect, save the slight extra work which devolves onthe surgeon. The advantages speak for themselves.Spinal analgesia is safer than general; it gives rise tono chest complications ; the comfort of the patient isvastly increased, so that a stroll through the wardsafter operation day suggests " a convalescent home " inthe case of spinal analgesia, and " the deck of a cross-Channel packet in dirty weather’’ in the case of generalanaesthesia. With spinal anaesthesia the surgeon findscomplete muscular relaxation ; he has no anxstheticanxiety ; the patient does not suffer from shock andcan be consulted if necessary during the operation ;the air of the theatre remains pure. General anaes-thesia must set its claims very high to overshadow thisrecord. The review in the Prescriber alludes toanother application of regional anaesthesia, originatedby Sellheim in 1905, of which more is likely to beheard : paravertebral anaesthesia consists in blockingthe last five dorsal nerves on each side by means ofnovocaine injection, and has been lauded as the methodof choice for operations on the kidney. Of other newlocal anaesthetics set out in the review, we have alreadygiven attention to tutocaine. There remains apothesine,a local anaesthetic of the novocaine type, effective forinjection anaesthesia, the solutions not being injured byboiling ; and a new substance known as butesin, whichin the form of picrate salt combines anaesthetic andantiseptic properties and may fill a useful place in thetreatment of burns, ulcers, and other denuded painfullesions of the skin. Surgeons and anaesthetists willbe grateful to the Prescriber for the readily accessibleform in which so much accurate information is given.

ACUTE GONORRHŒA IN WOMEN.

I THE treatment of acute gonorrhoea in women,

which is discussed on p. 1281, presents certain socio-logical difficulties not encountered in any othercondition except syphilis. The point of most momentis whether or not the patient should be informed ofthe nature of the complaint, and, if she suspects