soft; there was nothing abnormal with the appendages and only a slight discharge from the uterus. The temperature was 102.5 degrees and pulse very weak. The bloody discharge from the uterus showed pure culture of the streptococcus. The patient's medreine was discontinued with the exception of stimulation and medicine to control diarrhoea. Twenty c. c. Streptolytic Serum vas ordered night and morning with a very grave prognosis. After the first injection, the temperature by noon dropped from 103 to 100 degrees, and remained until the evening, when 20 c. c. of serum was again injected. Four hours later temperature was 97 degrees, and the pulse was 80, and, while weak, was better than it had been for some time. Patient continued to perspire much during the night, but slept soundly, and appeared improved the next morning with a temperature of 100 degrees. The 20 c. c. of serum was repeated during the morning and evening. The temperature remained below 100 degrees, pulse not more than 90, and there had been such a change for the better that the serum was discontinued, as the supply had been exhausted. Thirty-third day-Morning temperature. 98 degrees; pulse, 89 degrees; afternoon temperature, 100 degrees; pulse, 90 degrees. Thirty-fourth day-Morning temperature, 100 degrees. Ten c. c. of the serum was given. Temperature at noon was 99 degrees; pulse remained about 90. Ten c. c. was given during the evening; temperature dropped to normal. Ten c. c. serum was continued night and morning, including the thirty-seventh day, when it was discontinued, as pulse and temperature had been about normal for several days. From the thirty-seventh to the forty-third day, temperature and pulse remained about normal, when a gradual return of the septic condition occurred. The forty-third day the temperature was 102 degrees, and the next morning the temperature was 103.5 degrees. at which time 10 c. c. serum was injected, and afternoon temperature was 102 degrees. Forty-fifth day--Morning temperature was 101 degrees. Serum was not used until the evening, when the temperature was 103 degrees. Ten c. c. serum was given; temperature dropped in four hours to 101 degrees. Forty-sixth day--Morning temperature was 100 degrees; pulse, 90. Ten c. c. serum was given; evening temperature, 103 degrees. Forty-seventh day-Morning temperature, 99 degrees; pulse, The serum was not administered until the afternoon. Temperature was 102 degrees, dropped to 100 degrees. 100. Forty-ninth day-Morning temperature, 99 degrees; pulse, 100. Ten c. c. serum injected. Afternoon temperature, 100 degrees, at which time 19 c. c. more serum was injected. Fiftieth day-Morning temperature was again normal; pulse, 82. Ten c. c. serum was injected, with afternoon temperature of 100 degrees. Temperature Chart of Case 1-Illustrating the marked effect from the administration of Streptolytic Serum. The next two days the temperature and pulse remaincu norinal. On the evening of the fifty-third day the temperature reached 99 degrees. The ten c. c. of serum was continued every afternoon for four days. The temperature and pulse remained normal, and the last injection was administered on the fifty-sixth day of the disease. Under the influence of the serum, she has made a rapid recovery after being confined to the bed for two months, and is now in perfect health. Case 2-Pyemia following infection of left finger. Mr. J. H., age 46; previous health, good; received injury to left finger April 15th, 1902. He suffered with a phlegmon, and later a phlebitis of left limb, with abscess of right arm. He had suffered with recurring chills, followed by perspiration, high and sub-normal temperature, rapid pulse and some delirium. I saw the man in consultation the last of May, with Drs. Dean, Alexander and Winton. At that time patient was in a very weak condition and had all the appearances of a person suffering with profound sepsis. The examination of pus from seat of primary injury and from abscess on leg, as well as urine, proved the case to be one of streptococcal infection. The examination of blood was not made. The patient appeared to be in a hopeless condition. His stimulation was continued, and during the next two or three weeks 240 c. c. Streptolytic Serum was given, with marked improvement from the first, as the chills and high temperature were relieved. The patient was confined to bed for three months, but finally recovered. I am unable to give an exact record of the case, as the chart has been lost, but there was no question about the diagnosis. I have used antistreptococcie serum in six septic cases, with a mortality of four. Four of the cases were streptococcic infection, two were staphylococcie and streptococcie infection. The serum was not used until after other remedies had been used in the cases. The two cases which recovered were where the infection was found to be streptococcic, and in both cases I used Streptolytic Serum. In the other cases, different makes of antistreptococcic serum were used. ROUTINE BLOOD EXAMINATIONS, WITH REPORT OF CASE OF PERNICIOUS ANAEMIA. President and Gentlemen of the Arizona Medical Society: I owe this society an apology for bringing before it today a paper dealing so extensively with figures. Conscious of the present demand for things intensely practical, I shall be as brief as possible. The examination of the blood today is just as essential as the examination of the urine or tissue pathology. It has the great advantage over tissue pathology that it does not require an expert to interpret what he sees. When we read of the Hemaglobin, it deals only with figures. It does not require an expert to recognize a multinuclear white corpuscle, a mononuclear or an eosinphile. When white blood corpuscles are counted with a reasonable amount of care it does not require an expert to say that 16,000 per c. m. m. is a moderate leucocytosis. But, in tissue pathology it may require an expert to differentiate between carcinoma nests, sarcoma, and cross sections of ducts of certain glands. When the importance of every day blood examinations shall have been recognized, in medicine, the primary anaemias will be diagnosed, spectic conditions diagnosed from non-septic, the effects of treatment calculated in figures, as when a case of chlorosis er secondary anaemia comes for a hemaglobin estimation, showing exactly whether they are improving or not, and how much; and many, many times an important link in difficult differential diagnosis, even if the blood is negative. Typhoid fever complications will be recognized by a leucocytosis, perforations will be diagnosed many times when otherwise they would not; malignant disease of stomach and spleen from leukaemia--as in Dr. Craig's case, which was very anaemic and weak, with a very large tumor in the region of the spleen, moving up and down with respiration, being the shape and having a notch in the anterior border same as the spleen. This patient denied positively having any stomach symptoms, and, in fact, had been sent to Phoenix for pulmonary tuberculosis. It was looked upon as a case of leukaemia or malignant disease of the spleen. A leucocyte count showed only 20,000 per cubic millimeter and did not have the characteristics of leukaemia. Post-mortem in this case showed it to be an extensive carcinoma of the cardiac end of the stomach, without ulceration. Without the leucocyte count in this case it would have been positively diagnosed as leukaemia. Many cases which have the appearance of chlorosis will be found not anaemic, or only having a secondary anaemia. Pneumonia, when central, will be diagnosed from malaria and simple febrile conditions not accompanied by leucocytosis, as in a case where I was called to make a blood examination for supposed malaria. The man had just returned from an intensely malarial district; had had malaria previously, and the chest, upon physical examination, was negative. A leucocytosis of 25,000 in this case and the absence of the malarial organisms in the blood enabled us to say positively that it was not a case of malaria, and caused us to look further for the seat of the trouble, finding on the following day a typical pneumonia. In surgery, shock will be differentiated from internal hemorrhage, as when we have a wound of the kidney or liver or a large internal vessel, because if it is shock, operation will be deferred, but, if internal hemorrhage, will operate at once. Extrauterine pregnancy and rupture and hemorrhage will be differentiated from septic pelvice conditions. Patients will be spared an operation and probable fatal termination, when the hemaglobin is below 30 per cent. (Mikalutz). A better prognosis will be given as to immediate operation in appendicitis and with what safety we may defer operation, when the immediate surroundings are not conducive to good results. A low or descending leucocytosis almost always warrant a delay, and a high or ascending count demanding immediate action. After laparotomy, a patient developing profound shock will be spared the reponeing of the abdomen to ascertain if a ligature has slipped and hemorrhage is occurring, and by estimating the hemaglobin, and, if need be, counting the reds. It is only recently that I heard a surgeon of excellent ability state before the Northeast Medical Association that a patient developing symptoms of shock following an abdominal operation, where there had been any vessels of consequence ligated, the abdomen should be at once ropened, to ascertain if hemorrhage were taking place. This, as just stated above, may be determined within five minutes by the estimation of the hemaglobin, or, if necessary, counting of red blood corpuscles. Hence, in supposed hemorrhage, the blood count is important: 1st-To ascertain whether such has taken place. 3rd-Whether operation is to be immediate or not. 5th-How soon the patient has so far recovered to make operation safe. PERNICIOUS ANAEMIA. In calculating the different percentages I have used as basis of Hemaglobin 100 per cent. Reds, 5,000,000 c. c. Normal. Whites, 7,000 c. m. -- Male; age, 34; habits, good. Came under my care having the clinical symptoms of severe primary anaemia, and the following examinations show the characteristics of the blood: December 23 Hemaglobin, 25 per cent. Great increase in average size Reds, 1,260,000-25 per cent. W. B. C. 3, 927-1-320 Reds. Many megalocytes. January 30 Hemaglobin, 23 per cent. R. B. C.. 796.000--15 per cent. W. B. C., 4,687-1-167. |