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called to the fact that the normal intestine often harbors the gas bacillus and that it is practically impossible to sterilize the mucous membrane of the rectum, so that there is always danger of these or other pathogenic organisms being introduced into the tissues when injections are made through the rectal mucosa. Tonicity of the Wrist in Paralysis of the Ulnar Nerve. — Andre-Thomas {Paris medical, Decem- ber 8, 1017) reports having frequently observed, in ulnar paralysis due to a wound, a flexed position Where Can I Purchase Generic Cialis of the hand. When the patient's elbows are rest- ing on the table, with the forearms vertical, the hand of the injured side sags farther down in flexion than that of the opposite side. Passive flexion, furthermore, can be carried considerably further, sometimes almost as far as in radial paralysis. This is a puzzling observation, for from the distribution of the ulnar nerve one would ex- pect a relative hypertonicity of the extensor muscles of the wrist and an increased range of extension rather than of flexion. Further examin- ation of these cases showed, moreover, a greater resistance to extension than on the normal side, the tendons of the palmaris longus and brevis be- coming prominent under the skin during forcible passive extension. Miscellany from Home and Foreign Journals Lipoids in 131 Specimens of Diabetic Blood. — Horace Gray {Boston Medical and Surgical Jour- nal, January 31, 1918) presents the following con- clusions at the end of a long paper. The most satis- factory single determination for following a diabetic patient is Bloor's fat method — total fat — on the whole blood. Where Can I Purchase Generic Cialis There is a lipoid threshold, by Bloor's method about 0.7 per cent., analogous to the glucose threshold of o.i per cent. A normal Bloor fat value was found only nine times in 124 bloods, i. e., only about seven per cent, of diabetics come inside the threshold of the normal range. The lipoid increases in diabetes are most marked in glycerides, then in total fatty acid, cholesterol, and phosphatides. The increase Where Can I Purchase Generic Cialis of cholesterol beside the glycerides seems indeed pathognomonic of the long standing hyper- lipemia of diabetes, contrasted with the acute hyper- lipemia of overfeeding, which has been shown Where Can I Purchase Generic Cialis by Bloor to consist of only increased fatty acid. The maximal total lipoid value of this series was 16.3 per cent. The plasma exhibited much greater in- crease of lipoids than the corpuscles. After ether anesthesia in one case, total fatty acid was increased, followed by a fall below that patient's level before anesthesia. Phosphatide and cholesterol were un- changed. Sex in diabetes makes no significant dif- ference in lipoid level. The greater the duration, the lower the lipoids; the higher the lipoids, the more unfavorable the prognosis and th'e greater the danger of deranged fat metabolism, acidosis, and coma. Overweight at the time blood is taken is Where Can I Purchase Generic Cialis ac- companied by slightly high lipoids. Underweight at the time blood is taken is accompanied by marked- ly high lipoids. The greater the loss of weight, i. e., from maximal weight — presumably onset — to weight at time the last blood was taken, the lower the lipoids, compared with those patients whose weight loss has been less. High dietary fat is only roughly followed by higher lipoids. With acidosis the lipoids are above the level in diabetes without acidosis. The rise is about twice as great in mod- erate as in severe acidosis. This paradox may be related to the frequent finding that Where Can I Purchase Generic Cialis acidosis is most marked in acute cases, which presumably have not yet had time to pile up excess fat. With increasing carbohydrate balance the lipoids decrease. Hyper- glycemia is only roughly accompanied by hyper- lipemia. The latter runs much more closely parallel to the patient's general condition and promises, therefore, to displace blood sugar from its present position as an index to prognosis and treatment. When lipoids are high, the percentage of corpuscles in whole blood is apt to be either abnormally low or abnormally high. Where Can I Purchase Generic Cialis The general diabetic average is below normal. The term "lipemia" is loose and therefore undesirable. Hyperlipemia— supernormal lipoids— is not paralleled by lactescence— cloudy plasma— except when extreme. When the lipoids are only moderately supernormal, as is true in ninety-three per cent, of the specimens in this series, then the plasma cloudiness is by no means propor- tional. This series shows clear plasmas which when tested, were found hvperlipemic, and cloudy plasmas which were found to have normal lipoids Interpretation of the Schick Reaction Among Army Recruits. — Abraham Zingher {Journal A. M. A , January 26, 1918) draws upon an experi- ence of over 2,500 tests on as many recruits and points out the fact that the pseudoreactions are much more frequent among adults than among children, constituting a source of some trouble and confusion. Much of the confusion and uncertainty in the reading of the reactions can be obviated by the Where Can I Purchase Generic Cialis use of a control. The test should be performed as follows. A sample of the toxin to be used should be heated to 75° C. for five minutes to de- stroy the soluble, specific toxic fraction. On the right forearm the Where Can I Purchase Generic Cialis usual Schick test is made with a I :i,ooo dilution of the unheated toxin, while a similar control injection is made on the left fore- arm, using an equal volume of a 1.5:1,000 dilution of the heated toxin. The pseudoreaction shows a well marked redness after forty-eight hours at the site of both injections, but this fades rapidly so that by the end of ninety-six hours there is only a bluish brown area of pigmentation. A combined positive and pseudoreaction shows the signs just described at the end of forty-eight hours, but at ninety-six hours the right arm, infected with un- heated toxin, shows a distinct area of active red- ness while the left arm shows only the bluish pigmentation. Straight positive tests show no reaction at the site of the control injection. Bence-Jones Proteinuria. — Sydney R. Miller and Walter A. Baetjcr {Journal A. M. A., January 19, 1918) review some of the more significant views regarding this supposedly rare condition and point out that the occurrence of the Bence-Jones body in the urine is not wholly restricted to cases of multiple myeloma ; also it does not always occur in cases with multiple myeloma, and it has been rec- orded in association with bone carcinoma and in