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Formalin Results of Two Cases.

* Or ? very slightly positive.

In other words, it is highly probable that theformalin results of these two cases really agreed withthe Wassermann test results, making the total agree-ments 10 out of 11, or over 90 per cent. Gaté andPappacostas found 85 per cent. to agree, whileMajor J. Mackenzie2 found 100 per cent. to agree ina series of 23 cases. On the other hand, A. MurrayStewart3 in a series of 25 tests got 14 positive Wasser-mann reactions but no positive formalin reactions.

I am aware that a series of 11 cases is not of muchvalue, and would have preferred to collect more.Unfortunately, I have not now the opportunity ofcontinuing this research, so have decided to puttogether the little already done, especially in viewof the fact that there is as yet little published evidenceof the importance of this easily applicable test.My thanks are due to Dr. D. Macmillan for coöpera-

tion in my tests.

Medical Societies.ROYAL SOCIETY OF MEDICINE.

SECTION OF OPHTHALMOLOGY.A MEETING of this section of the Royal Society of

Medicine was held on Nov. 11th, Sir WILLIAM LISTERoccupying the chair.

Exhibition of Cases.

Mr. HUMPHREY NEAME showed a case of cyst ofKrause’s gland, and also a lad, aged 16, with papularformations in the lid. A third case was that ofa boy with tuberculosis of the conjunctiva. Hecycled from London to Southend for a holidav,arriving very exhausted. After his return to work,while stooping down, he felt something give way inhis left eye, and since then he noted a progressivefailure of sight in that eye, and in six weeks hecould only perceive with it fingers held fairly close.In September last year there were swellings in theneck, and in March this year a cough started, withwatering of the right (the sounder) eye. At a hospitalhis condition was diagnosed as Hodgkin’s disease ;no signs of tuberculosis were elicited in the chest, andthe sputum showed no tubercle bacilli. During thepast year he had lost a stone in weight, but duringthe last three months his weight had remained con-stant. Four months ago the left eye was removedfor irido-cyclitis. The cornea was hazy, and theanterior chamber was filled with a whitish substance.Mr. Neame exhibited sections of this eye on thescreen, showing cellular and fibrous material in theanterior chamber, and destruction of iris and ciliarybody. A small portion of conjunctiva excised fromthe right eye a month ago showed fairly typicaltubercle formation.Mr. LINDSAY REA showed a patient on whom he had

successfully performed a Poulard operation for ptosis.He also showed a case of angeioma of the retina.

Mr. P. G. DOYNE presented a patient with con-

genital malformation of the iris and anterior chamber.There was an absence of anterior layers of the irisin many places, and a hole in each eye through whichthe red reflex could be seen. The angle of the anteriorchamber was malformed and seemed to be filled bya whitish substance, while strands could be seen

running from the posterior surface of the sclero-corneal junction to the anterior surface of the iris.

2 Brit. Med. Jour., 1921, i., 854. 3 Ibid., 1921, ii., 263.

Sir WILLIAM LISTER recalled a case of a man whohad nine pupils, one fairly central, the remaining eightbeing ranged peripherally round it. Eventually theman developed glaucoma, probably due to a develop-mental defect at the angle of the anterior chamber.

Mr. M. S. MAYOIU and Mr. TREACHER CoLLixs dis-cussed the probable causation of coloboma with abridge.

Mr. C. F. HARFORD read a paper on

The New Psychology in Relation to Problems of Vision,demonstrating a number of schematic diagrams. Hesaid that the attention of the psychologist hadhitherto been mainly directed to the anatomical andphysiological aspects of the problems associated withvision. Parsons, in his " Diseases of the Eye," aftertracing the processes of vision from the impressionsderived from external objects to the cortex, had usedthese words : " Here the nervous impulse is trans-formed into a psychic impulse, which is not, andprobably never can be, understood." Mr. Harfordcontended that psychology could render importanthelp in supplementing physiology, and that psycho-analysis had thrown new light on human thought.The mechanism of what Mr. Harford termed " ThePsyche " he subdivided into cognition, affection (theemotional result of cognition) leading to action. Onediagram represented the " store-chambers of thePsyche," which Mr. Harford classified as results ofcareful observation, results of casual observation,amnesia of common life, pathological repressions,infantile impressions, and instinctive and hereditaryfactors. He laid particular stress on the emotionalfactor of the Psyche-i.e., the activator of eachmental concept, which Bergson had named the’’ energie spirituelle." Mr. Harford went on todiscuss repression, association, dissociation, andapperception. The vision of the infant was onlygradually evolved, not because of any organic defectin the structures concerned with vision, but becausethe awakening of the intelligence was a gradualprocess.

Thrombosis of Retinal Vein, with Hole and Star at iheMacula.

Mr. ARNOLD WILLIAMSON read a paper on TwoCases of Thrombosis of a Retinal Vein, one showing aHole, the other a Star at the Macula. He first re-ferred to the careful paper on holes in themacula published by the late G. Coats, in whichwere summarised the various theories of causation.Monteith Ogilvie considered there were two factorsconcerned : the fact that the retina is thinnest at thefovea, and thicker around it than elsewhere, and thefact that waves of disturbance passing through theeye meet at the posterior pole and tear the fovea by" contre-coup." Fuchs attributed the appearancein traumatic cases to mild traumatic retinitis, theslight serous exudate rupturing the membranalimitans externa, and so causing the appearance ofa macular hole. Coats believed oedema was the under-lying cause, stating that a hole had never appearedless than 60 hours after the injury ; also that opacityin the retina had been observed after injury in a casein which a hole subsequently developed. In 1908,however, Kipp and Alt had published. in the AmericanJournal of Ophthalmology, a case in which a shotpassed through the orbit, tearing the optic nerve andits sheath and entering the skull. On the follow-ing day the retina was whitish and vessels narrow,except for a vein passing from macula to disc. Atthe macula was a red deep round spot, one-third D ;two days later the retina was more opaque. Fourdays later the eye was excised, and there was a largehole at the macula, surrounded by swollen retinaltissue. There was evidence of oedema everywhere.Kipp and Alt considered that the retina at themacula could be torn by contre-coup. Mr. Williamsonshowed slides of his own case because they madeclear the dependence of the formation of a hole inthe macula on the occurrence of sub-retinal oedema,associated with thrombosis of the central retinal vein.

1109

= The first patient was a woman aged 62, whose sight beganto fail 14 years ago. For two years, until excision of the eyein July last, she had continual pains in the head. The eye ewas excised because of absolute glaucoma. Thirty yearsago she had a fall, blacking both eyes, but the sight was notimpaired. The excised eye showed a corneal nebula, acellular exudate adherent to the posterior surface of thecornea in places, hyaline exudate passing round the lensand causing some adhesion of the iris to it. There was no

cupping of the disc. Sections were exhibited on the screen

by means of the epidiascope, when there was an absenceof the inner nuclear layer and inner reticular layer,and the retinal pigment layer was separated from the innerlayer of the choroid. There was also some cedema in theouter molecular layer of the peri-macular region. The

special point was that the cyst was formed not in the retina,but in the accumulation of cedematous material betweenthe membrana limitans externa and the retinal pigmentlayer. In consequence of the presence of this cyst theouter layer of the retina appeared to undergo a degenerativeprocess, so allowing of the formation of a hole.Mr. Williamson also demonstrated a second case.

In both cases there seemed to be a toxic influence.as shown by the irido-cyclitis, acting on the retinal

, veins and producing thrombosis, and acting on

the delicate macular choroidal capillaries causingdegeneration of their walls, increased permeabilityto fluid, and hence cedema. The fluid then osmosedthrough the potential space between the rods andcones and the pigment epithelium, preventing theaccess of nutrient materials from the choroido-capillaris, so that the superjacent retina degeneratedand formed a hole.Mr. MAYOU showed slides from a typical case of

of albuminuric retinitis, showing exudation from twosites: inter-retinal and sub-retinal. The albuminousfluid in the layers of the retina was, he thought,derived from the retinal vessels, but the sub-retinalfluid from the choroidal vessels was of differing con-sistence, and responded differently to the stain.

SECTION OF PATHOLOGY.A MEETING of this section of the Royal Society of

3ledicine was held on Nov. 15th, Prof. LAZARUSBARLOW, the President, being in the chair.Dr. W. E. GYE communicated the results of work

undertaken by him in association with Dr. W. J.PURDEY on the Poisonous Properties of Colloidal Silica.Mr. A. T. GLENNY read a paper by himself and Miss

K. ALLEN on

A Guinea-pig Epizoötic Associated with Dietary" Deficiency."

Owing to a failure in supplies no green food wasavailable and guinea-pigs for a period of six weeks hadmangolds only in addition to the basal diet of bran,oats, and hay. Immediately after the commencementof this diet a slight increase in death-rate occurred.Two to four weeks later the death-rate increasedrapidly reaching to between 15 to 20 per cent. perweek. The first animals to be affected were pregnantdoes, experimental and small animals. During thefirst four weeks the post-mortem and bacteriologicalexaminations showed typical Gaertner infection, witha few cases of pneumonia during the third and fourthweek, During the fifth and sixth week 76 per cent.of the deaths were due to bronchial pneumonia causedby Bacillus fæcalis alkaligenes. After the introductionof green food fresh cases of infection did not occur,and the death-rate reached the normal level ofunder 1 per cent. per week within two weeks. A seriesof experiments were performed showing that swedeswere of more feeding value than mangolds, and thatthe presence of an efficient diet such as green foodwould entirely control the epizootic. During theseexperiments no attempt was made at isolation ; the animals used were all fed, cleaned, and handled bythe same assistant, and the presence of deaths in the"deficient" cages and the absence of deaths in the" full diet " cages were sufficient to show that isolationwas of little importance in the prevention of spread ofinfection.Prof. F. HOBDAY discussed the Pathology of Cleft

Palate in Animals, showing specimens and illustrations.

Mr. J. B. BUXTON and Mr. GLENNY describedThe Active Immunisation of Horses against Tetanus

by means of mixtures of toxin and antitoxin. Fivehundred horses tested had no normal tetanus anti-toxin. An injection of 10 c.cm. of toxin containingin all 20 "test doses" and definitely over-neutralisedwith antitoxin was given three times at intervals ofthree days. A month later an immunised horse wouldtolerate a dose of toxin upwards of 2000 guinea-piglethal doses, which was probably equal to severalhundred horse minimum lethal doses. This methodproved of great use in the large scale production ofanti-tetanic sera during the war. In order to demon-strate to the War Office that it was possible toimmunise army horses against tetanus arising fromwounds, four horses were immunised with two orthree injections of the mixture ; about two monthslater they tolerated, without any symptoms of tetanus,2 c.cm. of actively growing culture of the laboratoryroutine toxin-producing strain of tetanus, together witha suspension of sterile garden soil. A dose of 0’02 c.cm.killed rabbits and guinea-pigs. Smaller doses werenot tested, though the toxicity probably went verymuch lower.

Dr. H. J. SUDMERSEN read a paper by himself andDr. A. J. EAGLETON on the .

Standardisation of Anti-Dysentery Serum.The method had been in use at the WellcomePhysiological Research Laboratories for some 10years. 1-0 mg. of dried dysentery (Shiga) bacilli,which was equal to 10 intravenous lethal doses foran 1800 g. rabbit, was mixed with dilutions of theserum to be tested, and after half an hour was injectedintravenously into a rabbit. The rabbits that failedto survive died with the well-known syndrome ofascending paralysis and diarrhoea. The amount ofserum necessary to neutralise the test dose of toxinwas called one unit. Sera of some 400 units had beenproduced. The agglutinative did not run parallel tothe real protective antibodies ; it was thereforefallacious to accept the agglutinin titre as an indica-tion of the therapeutic value of a serum. Charts ofvarious horses showed that sera might have anagglutination titre of 2-4000 while possessing noprotective antibody.

SOCIETY OF MEDICAL OFFICERS OFHEALTH.

AN ordinary meeting of this Society was held at1, Upper Montague-street, W.C., on Nov. 18th,Dr. W. J. HowARTH, the President, being in the chair.Thirty-two new members and four associates wereelected.

Prof. E. L. COLLIS (Welsh National School ofMedicine) delivered an address, as president of theTuberculosis Group, onTuberculosis-Infection, Immunisation, Sensitisation,in which he considered the causes which had broughtabout the great fall in tuberculosis that had occurredsince the early part of last century. The disease wasindefinite both in its clinical course and in itsepidemiology ; thus contrasting with such diseases asscarlet fever, mumps, and influenza, which had adefinite incubation period, and ran a definite andshort course clinically in the individual and epidemio-logically in the community. Unlike these diseases,tuberculosis was " positively correlated " with thegeneral death-rate. In this respect it resembledpneumonia. Clinical and epidemiological evidencesuggested that in the case of tuberculosis, immunity,such as occurred with other infectious diseases, existed(it definitely did in the case of pneumonia), but wasdifficult to establish. The speaker rejected the theorythat tuberculous invasion in the adult was to beascribed to infection in early life. While certaindiseases, like small-pox and leprosy, had been broughtunder control by specific measures (vaccination andisolation), others, like malaria and typhus, in thiscountry had been reduced without any definite