NON-POTABLE SPIRIT.

1277 He allows that the complement-fixation test tive. does not yet approach in value the Wassermann reaction in syphilis, though he claims that it may be helpful. He finds that a strong positive reaction suggests a tuberculous infection, but that its degree is not necessarily proportional to the clinical condition It may also be or to the activity of the disease. positive in non-tuberculous conditions, and the presence of a positive Wassermann reaction much impairs any deductions from a positive complementfixation test unless the latter is of higher value than the Wassermann. Pirquet reactions were usually carried out, but gave no consistent results in regard to the complement-fixation tests ; indeed, the obserOther vations were often mutually contradictory. tuberculin reactions were not employed owing to the possible risk of activating arrested or quiescent lesions. The examination of the sputum for albumin proved not to afford any help in diagnosis either as to the presence 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 findings tended to corroborate the positive clinical evidence, while in 66 cases, in which on clinical grounds tuberculosis was diagnosed, the radiographic findings were negative. On the basis of these figures Dr. PRICE urges that the negative results of X ray examination must not be allowed to overweigh the diagnosis made He sums up his views on the on clinical grounds. relative values of clinical, pathological, and radiographic observations in diagnosis by maintaining that apart from the finding of tubercle bacilli the chief reliance must be placed on clinical evidence, a perspective with which most observers who are concerned in the diagnosis of pulmonary tuberculosis will agree. This conclusion serves further to emphasise the importance of the clinical study of this disease by students and practitioners.

IN

NON-POTABLE SPIRIT. with the announcement in

accordance

the

Budget Statement, methylated spirit sold to the general public for domestic purposes has, since May lst, contained an addition of crude pyridine in order to make it less acceptable as a beverage. The new mineralised spirit will contain, to be exact, crude pyridine 0-5 per cent., wood naphtha 9-5 per cent., mineral naphtha or paraffin oil 0-375 per cent., and methyl violet a trace. The Chancellor was advised that this spirit would be so nauseous and so difficult to swallow as to givepause to the would-be drinker, and if his reluctance were overcome, the draught would make the victim so ill (but not mortally) that he would be unlikely to attempt to defraud the Revenue by continuing to drink it. We learn from the Chemist and Druggist that it had been the practice by those who wished to drink the old methylated spirit to remove the petroleum by diluting and shaking the Our contemporary spirit with salt or charcoal. suggests that there is a simple method of separating the pyridine from the new spirit, and it remains to be seen whether the public will find this out or not. Major F. J. W. Porter, writing to us from the Surgical Nursing Home in Bombay, recommends the addition half per cent. each of caoutchoucine and for the denaturing of spirit for surgical purposes. Every surgeon, he says, knows that it is impossible to use tincture of iodine made from methylated spirit denatured by the British Customs, whereas that prepared by the Indian Customs in the way suggested can be used for such a purpose. He can see no reason why the British Excise authorities should not allow hospital spirit to be prepared in this manner, seeing that it is absolutely undrinkable even by Indian fishermen. of

one

pyridine

Annotations. " Ne quid nimis."

LOCAL ANÆSTHESIA. THERE is still a certain amount of rivalry between local and general methods of analgesia in the sense that one or other is more in favour in the practice of most surgical clinics, and a perspective can be obtained only by observing the practice at a number of centres. So much depends upon adequate technique and assistance, and where the arrangements are adapted for the one method things run so smoothly as to limit the demand for the other. Particularly is this the case where an abundant supply is available of highlytrained assistants in general anaesthesia. The growing experience and popularity of local anaesthesia is evident on perusal of the second abstract-review of this subject contained in the June issue of the Prescriber (Edinburgh), whose editor, Mr. Thomas Stephenson, D.Sc., F.R.S. Edin., has long made it a practice of collecting and collating information on the borderland of medicine and pharmacy. Attention is called in this review to the unrivalled position still occupied by cocaine by reason of the intensity and persistence of its local ansesthetic action. Novocaine appears to be destroyed by contact with the tissues, and of the series of allied preparations, such as eucaine, tropocaine, stovaine, and alypin, all seem to be harmful in some degree to the tissues surrounding the sensory nerve endings. In the case, however, of stovaine this damage may be slight or even negligible, in view of the remarkable results of 400 operations under 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 ascribed to the stovaine employed-the two patients dying on the table being already in a moribund condition-and Mr. Slater can of his own experience cite no disadvantage of spinal analgesia, provided the technique be correct, save the slight extra work which devolves on the surgeon. The advantages speak for themselves. Spinal analgesia is safer than general; it gives rise to no chest complications ; the comfort of the patient is vastly increased, so that a stroll through the wards after operation day suggests " a convalescent home " in the case of spinal analgesia, and " the deck of a crossChannel packet in dirty weather’’in the case of general anaesthesia. With spinal anaesthesia the surgeon finds complete muscular relaxation ; he has no anxsthetic anxiety ; the patient does not suffer from shock and can be consulted if necessary during the operation ; the air of the theatre remains pure. General anaesthesia must set its claims very high to overshadow this record. The review in the Prescriber alludes to another application of regional anaesthesia, originated by Sellheim in 1905, of which more is likely to be heard : paravertebral anaesthesia consists in blocking the last five dorsal nerves on each side by means of novocaine injection, and has been lauded as the method of choice for operations on the kidney. Of other new local anaesthetics set out in the review, we have already given attention to tutocaine. There remains apothesine, a local anaesthetic of the novocaine type, effective for injection anaesthesia, the solutions not being injured by boiling ; and a new substance known as butesin, which in the form of picrate salt combines anaesthetic and antiseptic properties and may fill a useful place in the treatment of burns, ulcers, and other denuded painful lesions of the skin. Surgeons and anaesthetists will be grateful to the Prescriber for the readily accessible form in which so much accurate information is given. THE

ACUTE GONORRHŒA IN WOMEN. treatment of acute gonorrhoea in women,

Iwhich is discussed onp. 1281, presentscertain socio-

logical difficulties not encountered in any other condition except syphilis. The point of most moment whether or not the patient should be informed of the nature of the complaint, and, if she suspects

is