John Gillan
1906 The Lancet  
1142 cases the crystals should always at least be examined microscopically and the melting point should preferably be determined. 9. The fermentation test is untrustworthy for small quantities of sugar and in this connexion requires further investigation. 10. The balance of evidence strongly supports the view that small quantities of sugar are normally present in urine. The minimum value which could be assigned for the average amount present would probably be 0' 01 per cent. approximately, and
more » ... he maximum average value assignable would probably be between from 0'05 to 0'09 per cent., and certainly not over 0' 1 per cent. Sir G. Johnson's application of the picrate test to prove the absence of sugar from urine, Seegen's carbon test, and Fluckiger's statement regarding the decomposition of reducing substances present I in urine on evaporation at 100° C. require further study. i 11. From the results of other observers and theoretical consideration' Wender's methylene blue test, Nylander's bismuth test, Hoppe-Seyler's ortho-nitrophenyl propiolic acid test, Sacchse's potassio-mercuric iodide test, and Knapp's mercuric cyanide test are probably inferior in convenience, or accuracy, or both, to the safranin test. 12. Finally, in testing for life assurance, as many tests as possible should be applied in doubtful cases. The safranin test if used as an auxiliary to the Fehling test might alone be sufficient to settle troublesome cases where small quantities of sugar and large quantities of creatinine cause the latter test to be uncertain. Glycuronic acid can be distinguished from glucose by the fermentation and phenylhydrazine tests. GOLOGIST TO THE BRADFORD ROYAL INFIRMARY. THE complications of mastoid disease are varied and often most interesting. The following case seems to me to be a p very unusual one and instructive in many ways. n A strong healthy lad, aged 14 years, had had a discharge Sl from the left ear, with occasional attacks of pain, for s several years. I saw him on August 23rd. He had had s severe pain in the mastoid region, off and on, for some days. o There was no swelling or tenderness over the mastoid or over r the jugular vein, but a large perforation of the drum with scanty offensive discharge. The temperature was 104° F. v and the pulse was 94. The discs were normal. He t was put to bed and glycerine-of -carbolic-acid eardrops s were applied. On the next day the pain had disappeared 2 and the temperature was normal. He felt perfectly well, 1 with no pain or fever, until Sept.-2nd, when there were 2 a sudden rise of temperature to 104° and a severe rigor. The mastoid was opened at once and the lateral sinus was v exposed. Some pus was found in the mastoid cells, but the 1 sinus was apparently quite normal, the dura mater was not i thickened, and there was no thrombosis. As the rigors 3 recurred and there was crepitation over the left lung the wound was reopened on Sept. 5th. The dura mater looked I quite normal, there was no extradural abscess, and the sinus was not thrombosed. An incision was made into the sinus I and there was a sudden gush of blood, which was difficult to control. There was no swelling or tenderness over the jugular vein. There was no papillitis, although the discs were rather congested. Both lungs became involved and there were signs of commencing endocarditis. The cerebellum was explored with negative results. The boy died on Sept. 19th. The post-mortem examination showed a small purulent clot in the jugular bulb. The lateral sinus itself was not thrombosed and the walls were nearly normal, with perhaps some thickening in the lower part. This case is interesting from several points of view. There never was any swelling or tenderness over the mastoid or over the jugular vein. The walls of the lateral sinus were practically normal and the thrombosis was situated low down in the bulb of the jugular. We should, in all similar cases, not only examine the upper part of the lateral sinus,
doi:10.1016/s0140-6736(01)32442-x fatcat:osfzfcsn2zab3l6xjqx62okdee