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Left eye.-Operation coloboma upwards; not much exudation.

Vision 6/9 pt, with - )-3D.sphere -Vision 6/9 pt. with -_ Ù;60-D.-i[-ax. 140° d. find o.).Blood.-The Wassermann reaction deiinitely positive (Spitta).Dr4ae.-Threads present ; no gonococci found. Dr. Stuker’s report

on the urinary tract was as follows :-ffMift.—Senile in size and feeling. The left lobe Is lobulated and

60ft; the right lobe enlarged and indurated at the margin. Left vas isenlarged and nodular near the globus major. The inguinal glands areenlarged; scars present in the right groin. e/t)’o"c"ptc eaaaminationMot’oe. A second examination (two weeks later) for gonococci provednegai1ve.Both the syphilis and gonorrhoea were treated, for, although no gono-

cocci were fuund, the condition of the prostate was, in Dr. Stoker’sopinion, typical of a gonorrh(jeal infection.The chief interest in this case is, the presence of signs of

gonococcal infection limited to the prostate, coupled witha positive Wassermann blood reaction. This raises the

question as to which poison has been responsible for theiridocyclitis,The onset of the left-sided attack of irido-cyclitis before

tontracting gonorrhoea and the amount of exudation in thepopiJ suggest syphilis, whereas the resulting good vision, theregular periodicity of the attacks, averaging every 11 months,the history of gonorrhoeal rheumatism, the condition of theprostate, &c., suggest a gonorrhoeal origin. On the whole. Ithink it possible that this is a case of mixed infection. Thecondition had in the past been diagnosed as a case of

gonorrhoeal irido-cyelitis, and although under treatment onand off for at least 20 years the patient has not had a bloodexamination or any attention paid to his genito-urinary tract.The iridectomy certainly seems to have lessened the

frequency of attacks, as has been pointed out by Nettleshipand Critchett, but it was no cure, nor could cure be expectedwhen the underlying syphilis and gonorrhcea had not beentreated; likewise, with treatment as above suggested, aniridectomy would probably not have been necessary.The class of case represented by the above four examples

is of great importance ; they are true carriers" of thedisease, inasmuch as the patient is totally unaware of thepresence of any infection. There can be no doubt thatthe muscular action brought to bear on the prostate duringa strong sexual orgasm is sufficient to express a poisonousdose of gonococci, and so infect the female.

C,riticis7iis on Above Findings.S. H. Browning has stated that he has rarely seen a case

of eye syphilis properly treated, but I can assert that I haveneber seen a case of recurrent gonorrboeal irido-cyclitis inwhich any attempt has been made to obtain a (Jure. The

result of a personal investigation of these cases satisfiesme that in the treatment of chronic gonorrhoea the prostatehas been "the neglected child," and routine examinationand treatment per rectum have been the exception ratherthan the rule.Some of the criticisms of these 1912-13 findings are not

without interest.1. One ophthalmic surgeon,7 with the help of a genito-

urinary expert, has endeavoured to demonstrate the gono-coecus by a technique of his own and has failed. Hedescribed how in a series of cases the posterior urethra hadbeen irritated with a silver salt, and a smear from the result-ing discharge produced a negative result each time. This

procedure, of course, was only levelled against the sub-epithelial urethral gonococci ; the cesspool-the prostate-was ignored ; neither was the deposit centrifugalised. Thisfailure, of course, was due to faulty technique and an incom-plete knowledge of the subject investigated.

2. It has been suggested that the organism demonstrated imay not have been the gonococcus. The decision has alwaysrested with an expert. I find that experts who examinefrom 30 to 40 slides daily, and find gonococci in over 90per cent., have never any doubt about the identity of thegonococcus.

3. Although the gonococcus is present in the genito-urinary tract, the irido-cyclitis may be due to anotherorganism, by preference a septic one. This, of course, is themost difficult criticism to meet, as short of a demonstrationin the aqueous it cannot be proved ; in the cases limited toinfection of the prostate this criticism does not apply, but it

5 After two negative examinations of the urine I ordered athird, insisting on its taking place within one hour of collecting thespecimen. Numerous colonies of intracellular gonococci were demon-strated. I attribute the first two negative results to some neglect ofRule II. 6 Trans. Ophthal. Soc. U.K., 1916, vol. xxxvi., 29.

7 Fisher, Proc. R.S.Med., Ophthal. Section, Dec., 1913, p. 64.

does to those complicated with gleet and stricture, wheresecondary infection always takes place.These so called" rheumatic " cases, however, are

clinically widely different from those septic in origin. Itwould be well, however, for those in favour of a septic originto examine the aqueous in these cases, for as long ago asten years Mayou and Hancock demonstrated the staphy-lococcus in the aqueous in cases of septic irido-cyclitis.As stated above, a genito-urinary surgeon (anonymous) has

made the statement that the gonococcus cannot live on

indefinitely in the tissues ; A. W. Ormond deduces from thisthat ’’ these late cases must be due to something else, eitherassociated with the gonococcus or independent of it." A

strange deduction based on a false promise l

8tunmary.To sum up, the first fact to grasp is the persistence and

latency of the gonococcus when established in the prostate.The next is that the oculist should obtain a first-hand

knowledge of the vagaries of the gonococcus, for it is on himthat the duty of curing the irido-cyclitis rests.

It is no longer admitted that the disease is cured when allperceptible urethral discharge has ceased; the prostate andvesiculae may be the seat for many years of a gonococcalinfection with all other parts of the urinary system un-affected.

I am convinced that in these so-called "rheumatic" casesa systematic examination would always reveal, quite apartfrom the presence of a gleet, a prostate infected by thegonococcus, provided the technique suggested is followed,and I do not doubt that the eradication of the gonococcuswould in all probability prevent the recurrences which aresuch a feature of the disease.

Medical Societies.ROYAL SOCIETY OF MEDICINE.

SECTION OF PATHOLOGY.

Nerv Counting Chamber for the Enumeration of Protozoa andother 02qanisg-its. -Ait tologous Grafting in Malignant andNon.mal1gnant Oonditwns.A MEETING of this section was held on Feb. 19th,

Professor W. BULLOCH. F.R.S., the President, in the chair.Mr. J. W. CROPPER read a note on a New Counting

Chamber for the Enumeration of Protozoa and other Organ-isms (from the Marcus Beck Laboratories, Royal Society ofMedicine). The chamber was designed on the principle of thehaemocytometer, but with a considerably larger area (namely,i 5 X 5 mm.) of the platform ruled in squares, the latter alsobeing increased in size. For various practical reasons thedepth of the chamber was retained as 1/10 mm. as in theolder chambers. Thus the organisms or cells in a compara-tively large volume, namely, 2’5 c.mm., could be counted,and in cases where the number present was scanty it waspossible to count a sufficient number of organisms to minimisethe statistical errors which were inseparable from a small count.The size of the smallest squares had been so arranged that theyoccupied the central half of the diameter of the field of the’microscope, using a 1/6 inch objective and a x 7 eye-piece,this permitting a rapid count being made. In cases wherethe organisms or cells could be easily recognised with a low-power magnification it had been found preferable to employan extemporised device, consisting of a large-sized micro-’scope slide on which columns 1/2 mm. in width had beenruled. On this a ring of paraffin wax, applied while moltenby means of a turn-table, was placed. A definite volume-

say, 10, 20, or more c.mm.-of the suspension of organismsto be counted was expelled from a graduated capillarypipette on to the ruled slide and a cover-slip was allowed tofall upon it. The organisms in the whole of the drop wereeasily and rapidly counted by working along the columns Ifrom end to end. The chamber and ruled slides could beobtained from Messrs. H. F. Angus and Co., Wigmore-street, W. I

Dr. J. A. MURRAY read a paper on Autologous Graftingin Malignant and Non-malignant Conditions. He said that

8 Section A., Ophthalmology, Proc. R.S.M., June 13th, 1917, p. 53.

338

the results of the long series of auto-transplantations madeby Haaland had been confirmed by Apolant, F. C. Wood,and himself, and it might safely be said that there wasno type of undoubted malignant new growth in which auto-transplantation had not been successful. The time hadtherefore arrived when in all investigations necessitating themost rigorous demonstration of the malignant nature of newgrowths the performance of auto-transplantation should beincluded in the tests applied. In his experiment an attempthad been made to apply this test to the discrimination ofan exceedingly ill-defined group of new growths-namely,those of lymph-nodes-lymphomata. A great variety of

growth-like enlargements of lymph-nodes occurred in themouse and might affect any one of the three componenttissues to the exclusion of the others. After repeated failureswith a considerable number of lymphomata involving homo-logous inoculation into many hundreds of normal mice,it was decided to relinquish this direct attack and inthe first place to attempt a segregation of those growthswhich could conform to the behaviour of malignant newgrowths of other tissues by growing progressively wheninoculated into the spontaneously affected mouse itself.When this was done the astonishing result was obtainedthat even when local recurrence and progressive involve-ment of other lymph nodes occurred the autologous graftsfailed to grow. Usually the latter were found as opaquewhite necrotic nodules, smaller than the piece of tissueintroduced. On microscopic examination the cells mightstill be alive, and in a few cases mitoses were seen in them ;in others the process of absorption was in progress or

complete. This striking contrast between the failure of thegraft and the natural progress of the disease differentiatedthe new formations dealt with from the ordinary carcino-mata and sarcomata and made it difficult to believe that

they were true malignant new growths. They were apparentlyin the majority of cases reactive hyperplaia-!, most probablyof toxic origin.-Professor S. G. SHATTOCK observed thatthe difficulty of diagnosing a lympho-sarcom-ttous neoplasmfrom a lymphatic pseudoplasm was admittedly great; andmetastasis might, of course, arise in connexion with aninfective proce3s, as well as in a sarcomatous. The test

adopted by Dr. Murray was an important one. and thespeaker saw no reason why it might not be applied in thehuman subject. For the excision of a small piece of adoubtful neoplasm, and its transplantation beneath, say,the loose skin of the dorsum of one of the fingers, would notbe of serious moment; if the graft commenced to grow itcould be excised whilst still a local lesion. Theoretically,it was not easy to understand why the transplantation of alymphatic pseudoplasm should not, in Dr. Murray’s experi-ments, have been followed by growth, seeing that any viruspresent in the tissue would necessarily have been transferredwith the latter. In the human subject the evidence of

autologous implantation might be naturally furnished bycontact infection from one part of a serous cavity toanother. The speaker had, for example, examined a diffusethickening of the pericardium, which histologically consistedsimply of lymphatic tissue, and where the opposite surfaceof the epicardium was the seat of a nummular and smallernodular formations highly suggestive of contact infection.There were metastatic formations in the kidneys. If thiswas accepted as an instance of implantation it would atleast prove the existence of lympho-sarcoma in man, theoccurrence of which seems to hang in the balance in view ofDr. Murray’s research.

Dr. MURRAY also showed and demonstrated ThreeTumours from the Zoological Gardens.

SECTION OF ELECTRO THERAPEUTICS.Electrical Treatment of Cases fit Ifljll/ry to Peripheral

Nerves.A meeting of this section was held on Feb. 15th, Dr.

HARRISON ORTOL, the President, being in the chair.Lieutenant NOEL BURKE, R A.M.C. (T.), read a com-

munica ion on the Electrical Treatment of Cases of Injuryto Peripheral Nerves. He complained that there had beenvery great lack of unanimity in the treatment which wasmost suitable for these injuries, a point which, in the netresult, was quite serious. ]Cven electro-therapeutists werenot fully agreed as to the best methods in every Kind ofinjury, while outside that specialty there was a wide diversityof view and practice. Some even counselled doing nothingfor such cases beyond the application of a splint and leaving

the rest to Nature, though the number of such was gratify.ingly few. With many practitioners there was a great lackof knowledge as to how electricity ought to be applied, whatform to use, and the results which might reasonably beexpected from it in any given class of case. Massageand electricity should not be regarded a9 twin sisters:their closest relationship was that of cousins, and

though of much younger growth, electricity was themore important of the two. When asking, in a particularcase, about previous electrical treatment it was desirable toknow not only what was given but also who gave it. Thespeaker believed that electro-therapeutists were too muchuound by tradition and too modest; they had not insistedenough in print on the claims and possibilities of theirimportant department of practice in many varieties of case.He urged more frequent mutual discussion and comparisonof results. Lieutenant Burke then di,cussed in detail, aidedby the exhibition of a number of slides by means of theepidiascope, the various forms of nerve injury and degenera-tion encountered, and the results he had obtained inthem. He said that in England neurologists had a

broad view of the treatment of peripheral nerve cases:

they recognised the necessity of postural treatment, andmost of them were convinced that electrical treatmentwas needed, though it was placed second in importance tomassage. Surgeons seldom did justice to treatment byphysical means. The Americans seemed to specialise moreon muscle training and systematised exercises. He con-cluded by discussing the consultative methods which shouldobtain in hospitals among members of the various specialties,in which way only could the best results be expected.A general discussion followed.

SOCIÉTÉ DE BIOLOGIE, PARIS.

THE following is a summary of papers read at the meetingof this Society on Feb. 9th :--

L. BORY.—Nature of the Specitic Substance of SyphiliticSerums in the S Reaction.BAZIN.-Experimental Research on the Antiseptic Power

of Vincent’s Boro-hypochlorous Powder.B. a etudie comparativement le pouvoir antiseptique de la poudre de

Viticent. de la teinture d’iode et de t’ioloforme. Une terre contftunt9 à 11 millions debaoteries par grammes, parmi lesqllel1es I- Vibrionseptique (obtenu par inoculation), le B. Coli. le Proteus vulgaris, leB. perfringens, etc , a selvl à ces expériences. DIX centigrammes etantagit6s dans un lirre de bouillon, il faut. pour em-dcher le développe-ment des bactérles, ajomer: iodoforme, 25 g. ; teinture d’iode, 10 g.;poudre de Vtnf-ent, 3 g. Pour detrutre les hactérles d’un grammede terre en 24 heures, il taut: teinture d’iode 20 g. ; poudre deVincent, 8 g. L’iodotorme est 4ans action à hautes dose. La temtured’iode est toxique, irritante d’une man ère intfnsf) pour le peritone dn

oobayp. E)le amène la mort de t’antmal. L’iodoforme agis de m6rne.Le tnetange Vincent n’amène qu’une reaction légère Dans les plaiescutanees, la teinture d’iode et la pou ire ie Vincen se comportent demême. Dans les plaies musculaires, la temtare d’inde est f rtementcaustique. La poudre d-i Vinoen. est très Wen tolérée. Les pttiessouillées de terre peuvent erre protegee par la teincure d’code, à lacondit on que l’épluchage chirurgieat soit pre -ot-e. Au contraire,1’emplmi de la poudre de Vincent les a protégées pendant 2 et 3 jourscontre l’infection. Dansces condttions les sutures faites aprè, épluchagedonnent d’excellents resu’tats.

P. P. LEVY and J. DE LEOBARDY.-A Practical Method ofFinding the Sp. icterohœmorrhagiœ in the Urine.

BONNEFON.—Corneal Grafts.B. a ehudie la regeneration et la transplantation du tissu cornéen

80US le contrale permanent du microscope et scs conclusi Ins au dounlepoint de vue biol -gique4 et chirurgi3 al a nt tfs s’tivantes: malgré desapparences d’tntegri e parfaite, les greffes dt tI.KU cornéen dégé érentrapidement après transplantatrrrn et sont régénérés r.econrlairementpar le porte-greffe. Seuls les etemenrs épithéliaux survivent. Lapresence ou l’absence de cette regeneration permet de classer les trane-plantations cornéennes en 1° as..iml1’1.bldS (autoplasr.ie et certainesheteruplastiesl ; 2° non assimilables (hé éroplasties, où la régénérationavo te par suitp d’obstacles mécanlques apporiés a la penetration deséléments ceiltilaires rege érateurs, ces greffons comme des corpsetrangera, tolérés). L’évolution cliiiique. et histologique de la kerato-plastie montre avec qurlle circonspection il c’ nvient de parler desurvie des tissus tranaptantes; quelle qui sott la perfection dur6sultat, clinique obtenu. Seule l’histologie expérimentale permetd’apprecier la valeur fespective des mots: survie et régénération.

CH. RICHET.—Normal Variations in Urea. -

R. 6tudie les variations individuelles du taux centesinial de 1’uroechez rleux indivi.tus Mormaux, soumis a un regime alternativementtres az(jt6 et peu azote. Difference indivi luelle cunense: chez run, Ietaux reste ii peu près invariable ; chez I’autre. H varie de t "a 6. L’élimi-nation d’azoteest lameme; ce qui est différeut c’e.t La quantité de l’eilollexcrétée

H. UARDOT and H. VIGREUX.—An Automatic Pipette forDelivering Culture Media.

P. GERARD.—Serum Diagnosis of Syphilis with Heatedand Unheated Serum.