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MILLON'S REAGENT AS A TEST FOR PUS.
A WORK OF SUPEREROGATION.-BOMBAY MEDICAL CONGRESS.
I
Mikulicz and Henle think that produced hmmatoma, intra- or extra.dural, which compresses the roots and ganglia of the spinal nerves, causing trophic changes which terminate in a kind of vertebral osteomalacia. In 1893 Pierre Marie and Leri made a necropsy in a case of traumatic kyphosis. Almost the whole of the lesions were found between the sixth and twelfth dorsal vertebrae j they consisted in projecting ossification of most of the ligaments, particularly of the common anterior ligament. There were also irregular and incomplete ossification of some of the elastic ligaments and a tendency to union of the spinous processes by ossification of the interspinous ligaments. The pathogenesis of traumatic kyphosis may be deduced from these findings. The sudden bending of the spine produced by a fall on the back or by the fall of a heavy body on the dorsal region ruptures certain ligaments, particularly the common anterior ligament. Kyphosis may immediately result from rupture of important ligaments. But it is generally produced more slowly. The torn ligaments, no doubt, carry with them fragments of periosteum and are repaired by ossification which determines a curve of the affected region that becomes more and more pronounced.
process of slow rarefaction. there is
a
A WORK OF SUPEREROGATION. THE Daily Ne7vs of April 22nd is responsible for a story from Woolsthorpe in Lincolnshire to the effect that Dr. J. A. Macdonald, the district public vaccinator, has been compelled’’ to carry a coffin to the grave containing the corpse of an old man who had died from small-pox, all the other residents having refused to go near the coffin." It seems
probable that this unpleasant episode has been exaggerated telling, for one man could scarcely carry an adult
in the
1291
hour when ordinary pus causes a distinct red staining of the Millon’s reagent, while with pus of tuberculous origin the fluid remains quite unstained. The drop of pus becomes red in colour in both cases. The explanation offered of the different results obtained is that the puriform matter from from tuberculous lesions is rich in protein substances which are coagulated by Millon’s reagent, whereas with ordinary pus the proteolytic ferment of leucocytic origin converts a considerable proportion of the protein into simpler disintegration products which do not coagulate but which become diffused into the fluid and yield the red colour owing to the presence of aromatic radicles in their molecules. Dr. Lothar Dreyer2 of Breslau has applied this test in a number of cases with a view to determine its value for surgical purposes in diagnosis. He employed it in 41 cases of ordinary pus and in 32 cases of tuberculous nature, controlling his results in every instance by bacteriological examination. The pus in the first group was produced by such organisms as staphylococci, streptococci, pneumococci, and bacillus coli. In all cases where the pus contained only tubercle bacilli the typical appearances described by Muller were obtained. With ordinary pus the friable disc described was obtained instead but Dr. Dreyer did not always observe the red staining of the fluid. In one instance only did the test leave him in doubt, where the pus from a case of osteomyelitis of the pelvis, which was of very viscid, thick character, gave a result more like the consistence of tuberculous pus. He also found subsequently that pus from a case of mixed infection with tubercle bacilli and pyogenic organisms gave a reaction corresponding to the latter. He is of opinion that the reaction is of considerable value from the little time which it requires and the ease with which it can be carried out. It would appear from Dr. Dreyer’s results that the appearance of a thick tenacious film as a result of the test is a strong presumption in favour of the tuberculous origin of the pus, whereas the more friable membrane, although showing the presence of pyogenic organisms, does not exclude the presence of tubercle bacilli.
corpse in a coffin unaided from house to grave, and if the devoted public vaccinator wheeled it on a barrow it is not accurate to say that he carried it. However, it seems probable that Dr. Macdonald played a part of conspicuous charity amongst a company of poltroons and he was rewarded in a manner well worthy of the great The Grantham board of heart of his neighbourhood. another medical man as deputy guardians has appointed BOMBAY MEDICAL CONGRESS. for public vaccinator Woolsthorpe, "as many people A PRELIMINARY meeting in furtherance of the Medical desired to be revaccinated, but were afraid to go near Dr. which it is proposed to hold in Bombay early next Congress Macdonald owing to their fear of infection." If the facts was held at Government House on March 25th year of the case have been stated accurately Dr. Macdonald has under the auspices of the Governor of the Presidency, Sir our sincere admiration for having performed an act which George Clarke, to whom the credit of initiating the project many men even with a keen sense of duty would have is due. It was resolved that the following gentlemen, who refused to carry out, and we can only hope that some reat the meeting, should form the nucleus of were all forming spirit may arise in the happily named village of a central present which should committee, representatives Woolsthorpe who will make the members of that panic- of all branches of the medical comprise in the Bombay profession stricken community thoroughly well ashamed of themselves and non-official: Colonel R. H. Forman, official Presidency, and testify the same by recompensing Dr. Macdonald against R.A.M.C., Principal Medical Officer, Bombay ; Lieutenantany loss of income which his act of devotion may have Colonel 0. J. Bamber, I.M.S., Sanitary Commissioner ; Lieuoccasioned him. tenant-Colonel M. Collie, I.M.S., Lieutenant- Colonel C. H. L. MILLON’S REAGENT AS A TEST FOR PUS. Meyer, 1.M.S. ; Lieutenant Colonel W. E. Jenni[1gs, I.M.S. ; Millon’s reagent has been employed as a simple means Major H. E. Winter, R.A.M.C.; Captain W. G. Liston, I.M.S.; Bhalchandra Krishna; Dr. J. A. Turner, Dr. Coghill, of differentiating between pus of tuberculous.origin and that Dr. S. A. Powell, and Dr Choksy. The duties of honorary resulting from the activity of pyogenic organisms by Dr. Eduard Müller.1I The method recommended is to fill a small secretary were undertaken by Lieutenant-Colonel Jennings and it was decided that the members of the Governor’s deep porcelain dish nearly to the brim with the reagent and to allow a drop of the pus to be tested to fall into the middle council, the surgeon-general with the Government of Bombay, of the fluid. If the pus is of tuberculous origin it coagulates the principal medical officer, Poona Division, and some other to form a firm film, whereas if it is of ordinary character it distinguished people should be invited to act as viceforms a less tenacious disc. The former can be lifted out on presidents of the Congress under the presidency of Sir George Clarke who had consented to accept the post. It was also a platinum loop with ease, whereas the latter breaks up into decided that the drawing up of a definite programme should fragments when it is touched by the loop. If the membrane be entrusted to the central committee which should be asked formed by the drop of tuberculous pus be pushed down into to give special prominence to sections dealing with the the fluid by the loop it takes on a shape like a pea or bean. A further distinction becomes apparent, after a quarter of an etiology and prophylaxis of tropical diseases, as well as with ___
Sir
1
Zentralblatt fur Innere Medizin, No. 12.
2
Münchener Medizinische Wochenscrift, April 7th, 1908, p. 728.
I
Mikulicz and Henle think that produced hmmatoma, intra- or extra.dural, which compresses the roots and ganglia of the spinal nerves, causing trophic changes which terminate in a kind of vertebral osteomalacia. In 1893 Pierre Marie and Leri made a necropsy in a case of traumatic kyphosis. Almost the whole of the lesions were found between the sixth and twelfth dorsal vertebrae j they consisted in projecting ossification of most of the ligaments, particularly of the common anterior ligament. There were also irregular and incomplete ossification of some of the elastic ligaments and a tendency to union of the spinous processes by ossification of the interspinous ligaments. The pathogenesis of traumatic kyphosis may be deduced from these findings. The sudden bending of the spine produced by a fall on the back or by the fall of a heavy body on the dorsal region ruptures certain ligaments, particularly the common anterior ligament. Kyphosis may immediately result from rupture of important ligaments. But it is generally produced more slowly. The torn ligaments, no doubt, carry with them fragments of periosteum and are repaired by ossification which determines a curve of the affected region that becomes more and more pronounced.
process of slow rarefaction. there is
a
A WORK OF SUPEREROGATION. THE Daily Ne7vs of April 22nd is responsible for a story from Woolsthorpe in Lincolnshire to the effect that Dr. J. A. Macdonald, the district public vaccinator, has been compelled’’ to carry a coffin to the grave containing the corpse of an old man who had died from small-pox, all the other residents having refused to go near the coffin." It seems
probable that this unpleasant episode has been exaggerated telling, for one man could scarcely carry an adult
in the
1291
hour when ordinary pus causes a distinct red staining of the Millon’s reagent, while with pus of tuberculous origin the fluid remains quite unstained. The drop of pus becomes red in colour in both cases. The explanation offered of the different results obtained is that the puriform matter from from tuberculous lesions is rich in protein substances which are coagulated by Millon’s reagent, whereas with ordinary pus the proteolytic ferment of leucocytic origin converts a considerable proportion of the protein into simpler disintegration products which do not coagulate but which become diffused into the fluid and yield the red colour owing to the presence of aromatic radicles in their molecules. Dr. Lothar Dreyer2 of Breslau has applied this test in a number of cases with a view to determine its value for surgical purposes in diagnosis. He employed it in 41 cases of ordinary pus and in 32 cases of tuberculous nature, controlling his results in every instance by bacteriological examination. The pus in the first group was produced by such organisms as staphylococci, streptococci, pneumococci, and bacillus coli. In all cases where the pus contained only tubercle bacilli the typical appearances described by Muller were obtained. With ordinary pus the friable disc described was obtained instead but Dr. Dreyer did not always observe the red staining of the fluid. In one instance only did the test leave him in doubt, where the pus from a case of osteomyelitis of the pelvis, which was of very viscid, thick character, gave a result more like the consistence of tuberculous pus. He also found subsequently that pus from a case of mixed infection with tubercle bacilli and pyogenic organisms gave a reaction corresponding to the latter. He is of opinion that the reaction is of considerable value from the little time which it requires and the ease with which it can be carried out. It would appear from Dr. Dreyer’s results that the appearance of a thick tenacious film as a result of the test is a strong presumption in favour of the tuberculous origin of the pus, whereas the more friable membrane, although showing the presence of pyogenic organisms, does not exclude the presence of tubercle bacilli.
corpse in a coffin unaided from house to grave, and if the devoted public vaccinator wheeled it on a barrow it is not accurate to say that he carried it. However, it seems probable that Dr. Macdonald played a part of conspicuous charity amongst a company of poltroons and he was rewarded in a manner well worthy of the great The Grantham board of heart of his neighbourhood. another medical man as deputy guardians has appointed BOMBAY MEDICAL CONGRESS. for public vaccinator Woolsthorpe, "as many people A PRELIMINARY meeting in furtherance of the Medical desired to be revaccinated, but were afraid to go near Dr. which it is proposed to hold in Bombay early next Congress Macdonald owing to their fear of infection." If the facts was held at Government House on March 25th year of the case have been stated accurately Dr. Macdonald has under the auspices of the Governor of the Presidency, Sir our sincere admiration for having performed an act which George Clarke, to whom the credit of initiating the project many men even with a keen sense of duty would have is due. It was resolved that the following gentlemen, who refused to carry out, and we can only hope that some reat the meeting, should form the nucleus of were all forming spirit may arise in the happily named village of a central present which should committee, representatives Woolsthorpe who will make the members of that panic- of all branches of the medical comprise in the Bombay profession stricken community thoroughly well ashamed of themselves and non-official: Colonel R. H. Forman, official Presidency, and testify the same by recompensing Dr. Macdonald against R.A.M.C., Principal Medical Officer, Bombay ; Lieutenantany loss of income which his act of devotion may have Colonel 0. J. Bamber, I.M.S., Sanitary Commissioner ; Lieuoccasioned him. tenant-Colonel M. Collie, I.M.S., Lieutenant- Colonel C. H. L. MILLON’S REAGENT AS A TEST FOR PUS. Meyer, 1.M.S. ; Lieutenant Colonel W. E. Jenni[1gs, I.M.S. ; Millon’s reagent has been employed as a simple means Major H. E. Winter, R.A.M.C.; Captain W. G. Liston, I.M.S.; Bhalchandra Krishna; Dr. J. A. Turner, Dr. Coghill, of differentiating between pus of tuberculous.origin and that Dr. S. A. Powell, and Dr Choksy. The duties of honorary resulting from the activity of pyogenic organisms by Dr. Eduard Müller.1I The method recommended is to fill a small secretary were undertaken by Lieutenant-Colonel Jennings and it was decided that the members of the Governor’s deep porcelain dish nearly to the brim with the reagent and to allow a drop of the pus to be tested to fall into the middle council, the surgeon-general with the Government of Bombay, of the fluid. If the pus is of tuberculous origin it coagulates the principal medical officer, Poona Division, and some other to form a firm film, whereas if it is of ordinary character it distinguished people should be invited to act as viceforms a less tenacious disc. The former can be lifted out on presidents of the Congress under the presidency of Sir George Clarke who had consented to accept the post. It was also a platinum loop with ease, whereas the latter breaks up into decided that the drawing up of a definite programme should fragments when it is touched by the loop. If the membrane be entrusted to the central committee which should be asked formed by the drop of tuberculous pus be pushed down into to give special prominence to sections dealing with the the fluid by the loop it takes on a shape like a pea or bean. A further distinction becomes apparent, after a quarter of an etiology and prophylaxis of tropical diseases, as well as with ___
Sir
1
Zentralblatt fur Innere Medizin, No. 12.
2
Münchener Medizinische Wochenscrift, April 7th, 1908, p. 728.