Am.  Jour.  Pharm.  \ 
January,  19 18.  J 
Current  Literature. 
57 
the  agglutination  test  is  absolutely  unable  to  confirm  a  clinical 
diagnosis  of  typhoid.  The  behavior  of  the  agglutination  titer  in 
vaccinated  typhoid  or  paratyphoid  patients  is  not  distinguishable 
from  the  behavior  of  the  same  titer  in  vaccinated  individuals  suffer- 
ing from  any  other  disease.  In  a  case  of  clinically  confirmed 
typhoid  occurring  in  a  previously  vaccinated  individual,  the  agglu- 
tination test  has  a  practical  diagnostic  value  whenever  it  shows  a 
constant  predominance  of  the  agglutination  titer  for  one  of  the 
paratyphoid  germs.  But  this  is  a  very  rare  finding.  In  the  greater 
majority  of  cases  the  agglutinating  titer  for  B.  typhosus  predomi- 
nates. It  has  no  diagnostic  value,  the  probability  of  mistaking 
paratyphoid  for  typhoid  being  slight.  Blood  culture  is  therefore 
the  only  reliable  method  to  ascertain  whether  a  typhoid  infection 
occurring  in  a  vaccinated  person  is  due  to  B.  typhosus  or  to  one  of 
the  paratyphoid  germs.  (E.  Rist,  Journal  of  Laboratory  and 
Clinical  Medicine,  St.  Louis.  Reprinted  from  The  Journal  of  the 
American  Medical  Association.) 
War  Wounds  Treated  with  Flavine. — This  is  the  authors' 
report  to  the  medical  research  committee.  Flavine  was  tested  out 
by  Drummond  and  McNee  clinically  as  well  as  in  the  laboratory. 
Seventy  patients,  many  having  multiple  injuries,  were  treated.  The 
flavine  was  at  first  employed  in  a  strength  of  I  in  1,000,  the  dilution 
being  made  in  normal  saline  solution,  in  which  the  powder  is  readily 
soluble.  This  routine  was  soon  given  up,  however,  as  it  was  found 
that  equally  good  results  ensued  if  the  use  of  I  in  1,000  solution 
for  the  first  dressing  was  followed  by  the  employment  of  a  solution 
1  in  5,000  for  all  subsequent  applications.  In  some  cases,  also, 
where  the  Carrel  method  of  irrigation  was  being  used,  the  strength 
of  the  solution  was  further  reduced  to  I  in  10,000.  The  surgical 
methods  adopted  depended  on  the  type  of  injury  met  with.  Long 
incisions,  with  free  excision  of  damaged  muscle  and  fascia,  must 
be  regarded  as  a  cardinal  part  of  all  operative  treatment  in  recent 
wounds,  no  matter  what  subsequent  methods  are  employed.  After 
this  preliminary  surgical  treatment  the  wounds  treated  with  flavine 
were  dealt  with  in  the  following  ways:  (1)  Primary  suture;  (2) 
drainage  by  tube  or  gauze  strip,  followed  by  secondary  suture; 
(3)  the  Carrel  method  of  intermittent  irrigation;,  (4)  gauze  packing 
in  open  wounds.  Wounds  treated  by  excision  of  the  infected  and 
damaged  tissue,  followed  by  primary  suture,  gave  excellent  results. 
