Selected Abstracts

Selected Abstracts New York State Journal of Medicine Vol . .5.5, No.8, Ap1·il Ui, .195li.

Hunter, Oscar B., Jr.: Cortisone in the Management of Hemolytic DiseaRe in the Newborn, p. 1136. Robertson, Theodore: The Use and Abuse of Blood TransfuRions, p. 1140. ·*1'\awitsky, Arthur, an(l Plotkin, David: Hypofibrinogpnemia aml Postpartum Hemor· rhage, p. 1153. Gould, Irving D.: Rheumatoid Arthritis Aggravated by Pregnancy and Controlled by Cortisone, p. 1164. Pitzgerald, James A., and Crossley, .James L.: (:]inical Vagaries of the RteinLeventhal Ovary, p. 1179. *Schaefer, George: Proceedings, Special Committee on Infant Mortality: Clinical Management of the Pregnant Woman With Tuberculosis, p. 1189.

Sawitsky and Plotkin:

Hypodbrinogenemia and Postpartum Hemorrhage, p. 1153.

The physiology of coagulation defects associated with low fibrinogen levels is reviewed. Three tests useful clinically to determine hypofibrinogenemia are describeu. They are: (1) Tube test-5 c.c. of the patient's hloou is incubated at 37° C. for 45 minutes. Jf no clot appears or if the clot disintegrates, the fibrinogen level is critically low. (2) Quantitative blood fibrinogen determination-this is too cumbersome for emergency use. (3) Schneider fibrin titer assay-the blood in question is succe~sively diluted in a series of 8 tubes. 'rhe resultant dilutions of the plasma component are 1, 10, 50, 100, 200, 400, 800, 1,600. 'ropical thrombin is then added and coagulation should occur in one minute. A fibrin titer above 400 is usually normal. Sixteen successfully treated cases of postpartum hemorrhage associated with coagulation defects are reported. In most instances from 2 to 6 Gm. of fibrinogen were necessary for rapid restoration of the blood level. If fibrinogen cannot be obtained, the authors note that each 500 c.c. of whole blood contains approxi· mately 500 mg. of this plasma fraction. Conclitions in which fibrinogenopenia may occur are listed. STEWART A. FISH, M.D.

Schaefer:

Clinical Management of the Pregnant Woman With Tuberculosis, p. 1189.

The importance of early diagnosis of pulmonary tuberculosis by routine chest x-ray is pointed out by Schaefer. When tuberculosis and pregnancy are associated, the question arises as to the effect of pregnancy on the disease and vice versa. }'rom this study it seem~ obvious that pregnancy does not necessarily have a deleterious effect upon pulmonary tuberculosis, either active or inactive. Medical treatment during pregnaney eonsists of bed rest and the usual supportive measures. Pneumothorax is not contraindicated nor i~ thoracoplasty. Pneumoperitoneum immediately after delivery, in an attempt to maintain the intra-abdominal pressure at pregnancy leYels, is appart'ntly of no practical \'alut>. Lung resection has become a recent adjunct in the treatment of localized disease and the author reports one case of normal pregnancy and delivery after lobectomy performed during the second month of gestation. Streptomycin, para-aminosalicylic acid, and isoniazid are the major adjuvants in the medical treatment of tuberculosis in pregnancy. There is no evidence that any of these drugs affects the fetus in utero adversely. Delivery

218

~1'1

Volume~~ '\lumb~:r

I

~hould be conducted with very little analgesia and preferably conduction anesthe~ia, i12 order to prevent dissemination of the pulmonary disease during general anesthesia. 1'h·· author points out that therapeutic abortion is rarely indicated in pulmonary tuhen·uloHi,;, None of the infants of this series was born with tubereulosis and the rarity of <·.ongenita: tuberculosis is emphasized. Isolation of the newborn from the mother is mandatory i.l' there is edtlenee of active disease. The problem of H.C.G. vaccination and socio<•eonomi<· factorf\ are dis~.ussed, and it is noted that repeat prt'gnanei~~ are not neee:;saril~· <'Ont raindi •·ated in women with arrested disease. i41'EWAHT :\. F11m, :\l.ll.

!"(!/. 5<'i, No. 10, May 15,1955.

G-ruhn, John G.: 1441.

The

Transfu~ion

of Blooi!, Components, Plasllla, and ExtPnd•'l's, I'·

Vol. 55, No. 11, June 1, 1955. Smessaert, Andre, Collins, Vincent .T., and Kra!'lllll, \'incent ]1.: Arrosol AdrniHi;.
Carrinoma of tht' \'ulva, p. :?35:1.

Wiener klinische Wochenschrift ro/. 67, No. t, .Tan·uary 7, 1955. Ant.oinP, '1'.:

Hormone Therapy in Carcinoma of tht> FPmale Genital Tra<·t, p. 1 +.

l'ol. 67, No . ."!, Janua1·y 21, 1955. Rruecke, 1<'.: The Effect of Hormones on Malignant Tumors, p. -!5. Reitinger, J., and Riess, H.: Prophylaxis and Treatment of 'l'hrombo~is in Prt'g·naw·y and Confinement, p. 56. Vol. 67, No.4, .January 28, 19/i5. Thalhannner, 0.: Four Examples of Congenital Disease, p.

li.~.

I' ol. 67, No. 6, l<'fbruary 11, 1955. Zacher!, H.: 1'he Gynecologist's Point of View on ThPrapeuti•· Abortion, p. 10:1. 1'ol. 67, No.7, February 18, 195/i. Mlczoch, F.: Drug Therapy for HypPrtension, p. 111. Husslein, H.: Nutrition and Pregnan<'y, p. 12!l. Vol. 67, No . .'1, .Jlarch 4, 1955. Tapfer, S.:

8ymptonmtology an•l 'l'n•atment of PrP·ec•lampRia and

Eclamp~ia,

p. 15:1.

J' ol. 67, No. 10, .Jlarch 11, 1955.

Fleisrhhar.ker, H.: Symptomatic TrPatment in Cancer, p. 169. "Koelbl, H.: Immediate and Ultimate Results in Brythroblastosi,; Ft•tali,; After .ExdmHg"<· 'l.'ransfusion, p. 172. Kofler, E., and Palmrich, A. H.: Influence of J<~ollielP Hormone Oll thl' Origin and
Koelbl: Immediate and Ultimate Results in Erythroblastosis Fetalis After Exchange Transfusion, p. 172. One hundred and sixty·eight cases are reported. 'l'reatment falls into three group': ( l) blood transfusion; (2) exchange transfusion several hour8 after delivery; and (3) iru mediate exehange transfusion. 'fhe respective mortality rates of 511 per cent, 1:!.5 p"r rent.

220

::
Am. f.

Ob~t. &

Gyne·,

Juh,

[tJ~~.

and 5.4 per cent emphasize the ouvious importance of ha;;te iu the treatmt>nt of these ehil· •h·en. Even at best, the fetal mortality is high, because these babies are particularly vulnerable to birth trauma and neonatal disease. In view of the tendenc~· toward infe,·· tion, it i~ suggested that prophylactic antihioties can improve the re~ults.

Vol. 67, No. 11, 1liarch 18, 1955. :Feur~tein,

V.:

Homologous Serum Jaundice and Blood 'l'ransfusionR, p. lH:l.

Vol. 67., No. 12, March fd5, 1955.

Hienert, G.:

Cardiac Arrest, p. 203.

Vol. 67, No. 17, April 29, 1955.

Kratochvil, K.:

Early Diagnosis and Treatment of Carcinoma of the Breast., p. :l97.

Vol. 67 .• No. 18, May 6,1955.

Rigler, R., and Rosenkranz, W.: On the Mechanism of Deciduoma ]"'ormation, p. 316 . .Tust, 0., and Linder, E'.: The Importance of Controlled Hypotension in Hurgery, p. :ns. Vol. 67, No. 22, .rune 3, 1.955. *Huber, E. 1<'., and Thaler, H.:

The Heart and Pregnancy, p. 389.

Huber and Thaler: The Heart and Pregnancy, p. 381:!. Pregnancy increases the load on the heart, but in most cases there is a sufficient reserve to cope with this. ]<'our per cent of pregnant women have circulatory symptoms; half of these have organic heart disease; and 75 per cent of these have rheumatic heart disease. In general, the prognosis is influenced by the cardiac reserve and the degree of compensation. In mitral stenosis, however, pressure in the pulmonary artery, which can be determined only by cardiac catheterization, is the determining factor. In evaluating compensation, it must be borne in mind that a certain degree of dyspnea appears also in normal pregnant women. 'l'he progntlSis of the Class I cardiac patient varies but little from the normal, if she is properly supervised, her weight well controlled, and her sodium intake limited. Mortality among Class III and IV cardiac patients, however, is 5 per cent and 20 per cent, respectively, with accompanying poor prognosis for the baby. 'fhe periods of greatest danger are in the sixth to the eighth lunar months, during labor, and in the immediate puerperium. There is also a sharp increase in risk beyond the age of 35. In advising women with heart disease on contemplated pregnancies, the main medical factors to be considered are the degree of compensation antl the patient's age. In multiparas, the ease or difficulty with which previous pregnancies were tolerated furnishes a good lead. Parity may be taken into eon~ideration in the interest of avoiding an onl,v child, if the patient withstood her previouR pregnan~y without undue difficulty. Interruption of pregnancy should he considered in r.ttses where the vital capacity decreases sharply, pulmonary artery pressure rises, an Ppisode of heart failure has been previously observed or determined from the history, or auricular fibrillation is present. Auricular fibrillation offers an especially poor prognosis. Interruption in cases where it appears desirable to terminate the pregnancy is relatively easy in the first trimester, when abortion can he effected relatively safely by eurettage. In more advanced pregnancies, the rlanger of hysterotomy must be weighed against that of permitting the pregnancy to continue. Usually laparotomy is more hazardous than a well-supervised prenatal course, provided only that the patient is cooperative and faeilities are available for proper care. Pregnant cardiac patients should be protected against subacute bacterial endocarditis by the prophylactic use of penicillin and streptomycin. The second stage of labor should be shortened by the use of low forceps. The anesthesia of choice for deli very, or for any

Volume 72 Number 1

SELECTED ABt
surgical intervention that may become necessary, is ether whieh permits maiutPI!Itlle'' of high oxygen levels. Heart disease, per se, is no indieation for <'esarean sertion whirh ~houtd be done only for possible intercurrent obRtetril'al rea~on~. WAL'I';;R

F.

TAnmR.

M.ll.

Wiener medizinische Wochenschrift Vol. 105, No.1, January 8,1955. *Heidler, H.: Etiology and Treatment of Gynecological Bleeding·, I'· 1. Tapfer, S.: Menopausal Symptoms and Their Treatment, p. ~+.

Heidler:

Etiology and Treatment of Gynecological Bleeding, p. 1.

The physiology of the menstrual cycle in terms of pituitary, ovan·, and endometrium .Metrorrhagia due to malfunction at any one point in this ~cheme, carcinoma of the uterus and cervix, and cervical polyps are discuRsed. 'l'reatments suggested include dilatation and curettage, the use of ergot preparations and Pitocin, for the benign condi· tions. It is also advised that androgens, estrogens, and progesterone be u~ed in selectetl cases. I:f irregular bleeding, proved to be of benign origin, occurs elose to the menopause, the author suggests that x·ray castration may be indicated. Bleeding due to benign erosion~; and vaginitis is treated with bac.teriostatic agents. When the b!eedh1g i~ due to functional ovarian tumors or fibroids, laparotomy must be performed.

is reviewed.

Vol. 105, No.3, January 22,1955. *Reitinger, .T.: Cesarean Sections With Special Consideration of Increasing Indication, p. 57.

Reitinger:

Cesarean Section With Special Consideration of Increased Indics.tion,

p. 57.

The cesarean sections of Division II, Department of Gynecology, University of Yienna, between 1942 and 1952 are summarized. The section rate is 1.04 per cent with a correr.•te:. The aneRthPsia of choice is nitrous oxidt• anll r·.unu''· l'ol. 105, No.8, February 26, 1955. KalkHchmid, W.: The Ability to Breastfeed in Patient8 Receiving Oxytocics, p. 151.

Estrogen~

H'

Vol. 105, No.9, Jliaroh 5,1955.

Koenig, W.:

Physical Therapy in Functional Disturbances in
Zeitschrift fiir Geburtsbilfe und Gynii.kologie Vol. 143, No.1, 1955. Sander, M.: 'rhe Placenta, an Active Defense Organ of tht' FetuK Pregnancy, p. 1. *Trap, .r.: Mechanism of Delivery in Breech Presentation, p. 30.

ill

Heterospecifie

\rll.

& r;ynet rnh·, 19~()

J ( )b:-t-

*RaR, M., and Rap~:
Trap: Mechanism of Delivery in Breech Presentation, p.

:w.

The author shows statistically that, in a large series of breech presentations, the best results, as far as fetal mortality is concerned, occur when the delivery is allowed to con· tinue spontaneouRly and without help from the obstetrician. In a series of cases it w:u; (!emonstrated that no death occurred when the labor was allowed to continue alone; there was an 8.2 per cent primary mortality with some manual help; and a 38.2 per cent mortality when extraction of the baby was done. The methods of Bracht of Germany and Ccvjanov of Russia are described. Both depend on the absence of cephalopelvic disproportion. In essence these methods consist of allowing the labor to continue until dilatation of the cervix is complete. The membranes are allowed to remain intact. Vaginal examination is
Sas and Rapcsak: Studies of Excretion of Neutral 17-Ketosteroids in Gynecological Disease and During Gestation, p. 40. Excreted neutral 17-ketosteroids a1·e minimal in childhood in both sexeH. In the female, excretion begins at puberty and increase~ until the late tllirties. Frorn the fottieth ~-ear excretion begins to decrease. The average values at all ages range between 10 and 14 mg. per 24 hour urine specimen as calculated by the Zimmerman method. Studies of excretion of neutral 17-ketosteroids at various ages and in different pathological and physiological conditions were made. In the female there was no variation in excretion with the changes in the menstrual cycle or with menstruation. In cases where ovarian functional changes were suspected (uterine displacement, adnexitis, endometritis, fibromyomas of the uterus, benign ovarian eysts, genital tuberculosiR, hyperestrinism, ovarian amenorrhea, pitnitar~- amenorrhea, and genital cancer) no changes were noted. The author states from his observations that, under normal conditions, the ovary has no part in the production of 17-ketosteroids. J
L. B,

WINKELSTEIN 1

M.D.

Volume7:!. ~~:mh•r I

SELEJCTF,D A BSTRAG'rS

Bleier: Gartner's Duct Cysts of the Vagina. Coupled With Other Ma.ldevelopments of the Urogenital System, p. 71. 'l'hree cases of Gartner's duct cystH were tle~cribed, together with a review nf six from the world literature. In two of the three caReR, the cysts communicut("l with the \'agina through a canal in the cervix. In the third the cyst was closed. All cy~t' were infected. All cases were of interest because the~, were accompanied by malformaLion:of the urogenital system. In one, aplasia of the kidney waH noted; in the second, congenital dilatation of the ureter; in the third, kidney and un•teral duplication were pre~ent hilaterallr. This last patient also had a duplex uterus and a cardiac ventricular septal rlefect. The importan<'e of a thorough study of both the urinary and genital Hystems i~ stre~~e'l in all eases where the diagnosis of Gartner's duct eyst iM made. Retroperitoneal pneumn ~ram~. h,nt<:>rn~alpingography, an•l arteriography !11'1.' only ~Olll<' of til(' 'P""ial pro•·l.'dnr·,,~ lo he €'tnployed. ra~m; ~ulled

Journal of Clinical Endocrinology and Metabolism rol. 1/i, No.9, September, 1955. "'·Payn<", H. W., and Latour, J. P. A.: Quantitative tHycogen, Using the Anthrone Method, p. 1106,

.E>timation~

of Endometrial

Payne and Latour: Quantitative Estimations of Endometrial Glycogen, Using the Anthrone Method, p. 1106. (t]yeogen is believed by many to be the direct ~ouree of nutriment for the early ron l'eptus from the time it enters the uterine cavity to the time it is actively supported by the maternal blood stream. Much work has been done to <'orrelat.e a.bnorma.litieg of glycogen deposition with primary sterility. The authors obtained speeimens of endometrium from uteri removed b,\' hystereetom.\ an•l by endometrial biopsy. They then submittl'rl these endometrial speeimenR to a quantitative determination for glycogen. Their reHnlts indicate that glycogen i~ low or abHent in the proliferative endometrium. It iH present in appredahle amounts in secretor',\' endometrium hut the amount \'Rl'i8;r.luring thP He<·ret.or~· phase. It is highest orr 22 . . 1. ~;IJWARJJ HALL, l\Lil.

The Lancet V (1/, I, .T1mr 11, 195ii.

*.Teffeoatl', 'T'. N. A., and p. 1187.

Wil~on,

.r.

K.:

'T'he rJffer.t of

H~·dergine

on rtE>rint> Artinn.

Jeffcoate and Wilson: Effect of Hydergine on Uterine Action, p. 1187. Hydrogenation of the alkaloids of ergot has been reported to deprive them of their and vasoconstrictor properties and endow them with spasmolytic ones (Stoll, A.: Indian J. Pharm. 15: 200, 1953). In this study Hydergine, which contains the rlihydrn· derivatives of ergocornine, ergocryptine, and ergocristine in ec1ual proportionH, was (>rrl ployed. At the time of labor, O,ti mg. of the drug in 1 L. of 5 per cent dextrose wa~ giw11 intravenously to 5 primigravidas. Three patients noted no change in the site and intensit.' of the labor pains. Two noted an increase and in these a.nd one other inRtance toeog-raphi•· records Ruggested that the drug had an oxytocic effect. In only one instance was reduc· tion in uterine activity suggested. Of 109 primigravidas in normal labor at term, 59 re ceived 0.15 mg. of Hydergine intramuscularly at hourly interval~ for 4 doses and 50 acted ox~·tocic

SELECTED ABSTRACTS

Am.]. Oh't.

& Gynec

July. 1956

aH t'Ontrols. All patients received 1,4 grain of morphine and 0.1 gram pethidine when the cervix was 2 to 3 fingers dilated. No significant difference was noted in the length of the first and second stages of labor and the course of the third stage was almost identical. In l 7 women with inefficient uterine action the results were equivocal. If the drug did quicken some of the labors oxytocic action is suggested as heing more likely than reduction of hypertonus. In only 2 instances did a quieting and regulating effect on uterine be· havior appear to occur. Jn ±women who were receiving an oxytocic drip infusion for the purpose of inducing labor, the 1lrug may have increased the frequency anrl strength of the contractions in two. In the third patient the effect of oxytocin was ac.,entuated when Hydergine waH given at a rate of \lO drops a minute but the contractions became les~ intense without change in frequency when the infusion rate was increased. In the fourth case the contractions were less intense after the drug was given. A possible inhibitory action of Hydergine is suggested by the tendency to uterine relaxation and hemorrhage during and after the third stage but this effect may also be explained by the withdrawal of the oxytocic action when the drug was discontinued at the time of full cervical dilatation. The conclusion is reached that despite laborator;· evidence hydrogenation of the ergot alkaloids does not deprive them of their oxytocic action, even lesR reverses it. The nse of these compounds involves a risk not compensated by any demonstrable effect on uterine efficiency. DAVID M. KYDD, M.D. Vol. 2, J1~ly ,9, 1955. *Moore, Keith L., and Barr, Murray L.: Smears From the Oral Mucosa in the De· tection of Chromosomal Sex, p. 57. Cummin, R. C.: Cervical Pregnancy, p. 68. Tom kin son, .T. K: Tissue· Forceps for Cesarean Section, p. 71.

Moore and Barr:

Smears From the Oral Mucosa in Detection of Chromosomal Sex,

p. 57.

In 140 instances (81 males and 59 females), the characteristic female sex chromatin in the nuclei of epithelial cells obtained from the oral mucosa of females while a similar chromatin maRs was not seen in cells obtained from the oral mucosa of males. Such a determination is simpler than skin biopsy for the detection of chromosomal Hex in congenital errors of sex development. DAVIIJ M. KYDD 1 M.D. wa~ vi~ible

f'ol. 2, July 16, 1.955.

St. Van Eps, L. W.: Psyehoprophylaxis in Labor, p. 112. *Carpentier, P. J., and Janssen, P. A.: a·p·Methoxy-phenyl a-Di·n·Butylamino· acetamide in Dysmenorrhea, p. 122.

Carpentier and Janssen: a-p-Methoxy-phenyl a-Di-n-Butylamino-acetamide (A.16) in Dysmenorrhea, p. 122. Either 50 mg. A.l6 (Janssen, P. A.: J. Am. Chem. Soc. 76: 6192, 1954; de Jongh, D. K., Janssen, P. A., and van Proosdij-Hartzema, E. G.: Acta physiol. pharm. neerl. 3: 331, 1954) or a placebo was given to female volunteers who had had dysmenorrhea for several years at every period. Neither the patient nor the physician knew whether the patient received the drug or a placebo. Tabulation of the results showed a strikingly high num· ber of good results following the administration of the placebo (48 per cent). Nonetheless, A.l6 caused a significantly greater number of good results (68 per cent). No side effects were noterl. DAVW M. KYDD, M.D. Vol. 2, July 23, 1955.

*Kelsall, G. A., and Vos, G. H.: Premature Induction of Labor in the Treatment of Hemolytic Disease of the Newborn, p. 161. Rountree, P.: Streptococcus Pyogenes Infections in a Hospital, p. 172.

Volunw "; 2 N nrnhe1 I

RELEC'f i'JI I AB~THAI 'T:-;

Kelsall and Vos: Premature Induction of Labor in the Treatment of Hemolytic Disease of the Newborn, p. 161. In a series of 246 consecutive incompatible pregnancies in motherB w hoHe ~t'l'a eon taineu abnormal rhesus antibo!lies against their infants, the pregnancy tE'rminatl!d ~pon t.aneously in 130 instances ancl the labor was induced prelflat.urely in l.lti. J n the fi l''>l group, 36 of the progeny were stillborn and !l died shortly after birth (total mortality c>l :LuJ per cent). In the second, 3 infants were stillborn and l:.l tlied after birth (mortalit.' 12.9 per cent). 'l'hese figures include deathR from all eauAes inrluding ;; death~ and on• Jiye baby in pregnancies ended by induetion before the thirty-Ji.ft.h week of gestation au,: 1\J deaths in pregnancies that ended spontaneously before the thirty-fifth wet'k. H< t>liminating these early terminations the authors "compare" their series with the ou•· reported by Mollison and Walker (Lancet 1: 261, Hl52). 'l'he cases of indur,emature induction of labor at the optimal time after 3:3 W(!Pks nf gestation associated with exchange transfusion of the infant la.rgely eliminatl'd "tillbi 1'1 ),, without inereasing the number of neonatal deaths. llAV!l> M, 1\:YLJ/l, .\l.ll. T'ol.

re,

Aug'USt 1J, 1955.

*Penrose, L. S.: Parental Age and Mutation, p. 312. Russell, J. K.: Lower·Segment Cesarean Rection for Placenta Previa, p. :l:!:!. O'Dwyer, .T. P.: Rupture of the Lower·l':legment Cesarean-1-\e(•tiMJ ,1..\ca r, p. :::!-L

Penrose: Parental Age and Mutation, p. 312. Spontaneous mutation in a cell in the germ line might be due to various (d from tilt• litnatur•· .,

SELECTED ABSTRACTS

,\rn.

J. ( lh-t.

& t;yiJ~c

luly, 1956

number of eondition~ are examined. In Mongoli~m anr! dizygotie twinning tile motll<'l' •, age is dominant. In achondroplasia the father's age is significant and argues that this condition is due to a mutation having to do with a copying failun·. In other eongenital de fects such as acrocephaly, anencephaly, and hydrocephaly the relationship is less dear. 'l'he observation that for constant maternal age groups tht> father's age was signilleantly associated with the general stillbirth rate even though the intlueu<·e of the father wa~ W<'a.kcr than that of the mother suggest~ that fresh mutations not uu<•ommonly ,·.au~·· mortality in early life. These inconclusive data are cited to emphasize the need for a comprehensive inquiry. ])AVIJ> M. KYIW, M.D.

Vol. 2, September 8, 1955. *Dennison, W. M.: Hematogenous Osteitis in the Newborn, p. -!H. *O'Sullivan, D. J., Higgins, P. G., and Wilkinson, .r. F.: Oral Iron Compouuds, p. 482.

Dennison: Hematogenous Osteitis in the Newborn, p. -!74. Of 41 eases of osteitis seen during the neonatal period, 22 were considered to be benign in the sense that at no time did the infant's life appear to be in danger although 6 of these children were left with permanent deformities due to bony destruction in the head of the humerus (3 eases), head of the femur (2 cases), and in the distal epiphysis of the femur ( 1 case). In the 19 severe cases, there were 4 deaths and recurring infection, sequestrum formation, and epiphyseal and metaphyseal damage led to a high morbidity although no detailed analysis of the final result in this group is given. Instead, 5 socalled typical case histories are given in some detail. In these 19 seriously ill infants the infection was caused by an anaerobic streptococcus in one fatal ease and in one ca~e the offending organism was not isolated. The remaining 11 infections were caused by a coagulase-positive Staphylococcus aureus which was sensitive to penkillin in two instances, resistant in 14, and the sensitivity was not assessed in one instance. The observation that minor staphylococcus infections appear in 10 to 15 per cent of infants and the incidence is increasing (Capon, N. B.: Brit. M. J. 1: 803, 1955) iR stressed. Also, the fact that the septicemia had presented as pneumonia or as g-astro· enteritis and only the appearance of a swollen limb or joint caused the correct diagnosis to be made emphasizes the importance of immediate and adequate therapy of these condi· tions and also the importance of realizing the possibility that the infant may have septicemia. 'rhe use of penicillin and streptomycin is reeommended in preference to long-continued use of chlortetracycline. DAVW

M. KYDD, .M.D.

O'Sullivan, Biggins, and Wilkinson: Oral Iron Compounds, p. 482. Ferric hydroxide, ferrous sulphate, ferrous succinate, and fenous gluconate in doses of 210 mg. of elemental iron were given to 80 patients. Ferric hydroxide in such doses was not effective but the other three compounds were equall? efficacious. Patients refractory to one drug were refractory to all oral iron drugs. Intolerance appeared in 13 per cent of the patients taking ferrous sulfate and in 1 per cent of those taking the succinate or gluconate. DAVID M. KYDD, M.D.

Vol.

re, September 10, 1955. Labrum, A. H.:

Ergometrine With Hyaluronidase, p. 522.