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Vaginal Discharge in Children. — I. C. Rubin I Boston Medical and Surgical Journal, January 31, i()i8) says that to establish the diagnosis of gonor- rheal vaginitis in children and infants the following facts must be evident: i. There must be a purulent discharge from the vagina. 2. The intracellular < irani negative diplococcus of Neisser must be dis- covered in the pus cells. 3. This organism must further be grown on suitable culture mediums and properly identified as the gonococcus. 4. In case of doubt complement fixation tests and agglutination tests should be resorted to. In the absence of these tests we are not justified in considering any vaginal discharge in children as gonorrheal, nor are we jus- tified in treating it as such. The smear examina- tion, even by the Gram stain of secretion or dis- Is It Illegal To Order Cialis Online charge from the vagina, is unreliable and misleading, .iiul lience valueless as a method of diagnosis. Diagnosis and Bacteriology of Endocarditis Lenta. — R. Dcbre {Pressc nii'dicale. December 17, 1917) states that the diagnosis of this condition is rendered difilcult because of the insidious onset, because the heart lesion is apt to be erroneously considered independent of the existing general dis- ease and referred to^ a former rheumatic fever, and because the less characteristic general signs of the disease are those which stand out the most prom- inently, and careful examination is necessary to detect the more typical Is It Illegal To Order Cialis Online signs, such as splenic en- largement, skin disturbances, the heart signs, and the presence of the pathogenic germ in the blood stream. Particularly difficult is the differentiation of slow malignant endocarditis and a grave form of articular rheumatism. The chief differential fea- tures are as follows: Malignant rheumatism occurs especially in children; slow malignant endocarditis, in adults. In the latter the pericardium and pleura are hardly at all involved, while markedly afTocted ;n rheumatism. Nodular skin lesions, purpura, and Osier's phenomenon are constant in slow endo- cairditis, in which, furthermore, the anemia and loss of weight are much more pronounced, the fever more irregular, the course more protracted, splen- omegaly constant, and renal involvement with heinaturia nuich more frequent. Sodium salicylate fails and the appearance of embolism in the viscera is very characteristic of the endocarditis. The blood culture, negative in malignant rheumatism, when positive settles the question. Debre collects twenty mils of blood by vein puncture, and to increase the chances of a positive result, divides fifteen mils be- tween two llasks containing, respectively,^200 mils of two per cent, glucose bouillon and a like amount of "liquid T medium," the remaining five mils being divided between two Petri dishes, one con- taining glucose agar to be mixed with the blood, and the other some solid T mediimi. The T medium, formulated by Truche, Cramer, and Cotoni, consists of peptone, forty grams ; salt, five grams, and glucose, two grams, in a litre of water. The solid medium is made by adding two per cent, of agar agar. Repeated tests should be made. The special pathogenic agent is always a strepto- coccus which is nonvirulent for laboratory animals and nonhemolvtic, these being its only constant properties. Surgical Significance of Abdominal Pain in Children. — Willis E. Plartshorn {Medical Record, January 19. iyi8) writes that the most common source of abdominal pain in children is intestinal disturbance, due to indiscreet eating or constipation ; appendicitis ; peritonitis from pneumonia, surgical conditions elsewhere in the body, empyema, sub- phrenic abscess, tubercle bacillus, infectious diseases and typhoid perforation ; or volvulus, intussuscep- tion, or pyelitis. Every case of acute pain with tenderness localized in the region of the appendix should be classed as appendicitis, especially if there is a high leucocyte count with an excess of polynu- clears of eighty per cent, or over. Pyelitis should be thought of in a sick child witji obscure symp- toms and uranalysis establishes the diagnosis. War Nephritis. — Thomas Oliver (British Med- ical Journal, December 8, 191 7) discusses certain aspects of this baffling disease and points out that the etiology is as yet quite obscure. In a number of cases he has been able to demonstrate the pres- ence of lead in the urine, and this, together with the peculiar pathological lesions of the disease, suggests that this metal must be considered as a possible cause in some cases at least. The source of the lead is uncertain, the canned food and drink- ing water supplies being found free from the metal, except for infinitesimal traces in the former. On the other hand it is to be borne in mind that many of the men who have been wounded still retain in their tissues fragments of leaden missiles and in a certain proportion of such cases lead has been found in the urine. In this connection, how- ever, it is pointed out that the occurrence of lead in the urine of such men is not necessarily associated with any renal disttu-bance. The suggestion that the continued absorption and excretion of lead by the kidneys may, in part, be the underlying cause in some cases does not in any Is It Illegal To Order Cialis Online way exclude the exist- ence of other factors in these and other Is It Illegal To Order Cialis Online cases. Spinal Anesthesia. — Giovanni Cocci (La Ri- fortna medico. November 17, 1917) from a wide experience with this method considers that it should be employed only in operative procedures of light or moderate gravity and of short Is It Illegal To Order Cialis Online duration. It should never be used in operations which in them- selves are likely to produce shock, Is It Illegal To Order Cialis Online such as major laparotomies, or in patients who are already in a state of shock. Proceedings of National and Local Societies Till'. NICW YORK NEUROLOGICAL SOCIETY. Riujiihir Meetmg, Held April j, 191J. lilt I 'resident, Dr. Frkdf.rick Tii.nkv, in the Chair. (Contiiiiicd from page 432.) Ataxic Type of Cerebral Is It Illegal To Order Cialis Online Birth Palsy.— Dr. J. Ramsay Hunt, of \c\v VurU, did not think the term "ccrebroccrebellar" was a good one, as it was