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dissection and from formalin-hardened bodies. Hereferred to the practical discrediting of nephropexyexcept for comparatively rare cases in which the

dropping of the kidney was mechanically responsiblefor the symptoms produced, as in Dietl’s crises, and hesuggested that the operation of colopexy would proveto have a similarly limited field of usefulness. Dr.ROBERT HUTCHISON, in a noteworthy contribution tothe discussion, claimed that visceroptosis was a definiteclinical entity, but pointed out some of the difficultiesin connexion with it, notably its almost constant asso-ciation with neurasthenic manifestations and the factthat it not infrequently produced symptoms simulatingacute organic abdominal disease such as gall-stones orgastric ulcer, while on the other hand it might bepresent without symptoms. Dr. HUTCHISON criticisedthe views expressed by Sir CHARLTON BRISCOE as tocausation, suggesting that in women, in whom thecondition was most often found, diaphragmaticbreathing was less common than the thoracic type.He thought that the size of the pelvis in women andderangements of its floor, particularly as a result of

. pregnancy, were of more importance, together with aloss of the supporting fat within the abdomen. He

suggested that the symptoms developed when atonyof the visceral muscle resulted, or when weakness of theabdominal muscles led to diminished intra-abdominaltension. He recommended the adoption of measuresto strengthen the abdominal walls and to repack theabdomen with fat. He thought that the relief some-times afforded by belts was not due to the holding upof the viscera but to the increasing intra-abdominaltension. Several of the speakers maintained thatvisceroptosis was of congenital origin. Dr. F.HERNAMAN-JOHNSON recognised two types : one com-monly following pregnancy and due to laxness of theabdominal walls, this form being preventable bysuitable precautions and treatment ; the other type,which he regarded as congenital, occurred in tall, thinwomen. Dr. J. CAMPBELL MCCLURE, the President,referred to the two opposing innervations of the

alimentary tube-viz., the vagus and the sympathetic-and believed that a lack of balance between theseinnervations might result in gastro-intestinal stasis,and was anyhow an important factor in the productionof symptoms.The chief outcome of the discussion is to emphasise

the gaps in our knowledge of visceroptosis and thefar from satisfactory means of treatment at presentavailable. That there is a need for individual andcollective research must be obvious. The one pointof general agreement seems to have been that the r6leof surgery in the treatment of this condition is a

strictly limited one. The plea put forward by severalof the speakers for preventive measures in the formof proper rest and support after pregnancy and formeans to improve the abdominal musculature andvisceral tone of those prone to the disease, deservescareful consideration. The concomitant nerve imanifestations and the neurasthenic state, so often Iassociated, received but little consideration. Theyconstitute perhaps the most troublesome and dis-tressing features of the condition. They are difficultto explain and still more difficult to treat. It isprobable that the complex symptomatology is due tovarious combinations of mechanical, toxic, nervous,and endocrine factors. The recognition of the r6leof each of these and the determination of theirrelationship to one another should do much to clearup the causation and pathology of the condition. Thisdiscussion should stimulate fresh endeavours to puttreatment on a more satisfactory basis.

Annotations." Ne quid nimis."

THE LISTER INSTITUTE.

THE annual report of the governing body of theLister Institute of Preventive Medicine was presentedat the general meeting of members on May 16th, andgives an interesting summary of the activities of thatinstitution ; some of the results of the original workdone by members of the staff and others workingthere have also recently been distributed in the annualvolume of collected papers. Among a great varietyof important topics, the chief place is taken by theinvestigation of accessorv food factors. On theexperimental side the work of Prof. Korenchevsky,Dr. Goldblatt, Miss Hume, and their collaboratorson the relation of diet to growth and rickets in ratswill be familiar to our readers, and in the more difficultclinical field Dr. Harriette Chick, Dr. Dalyell, Dr.Mackay and their co-workers achieved a considerableadvance in our precise knowledge of human ricketsat Prof. v. Pirquet’s Kinderklinik in Vienna. Prof.Harden, Dr. Zilva. and Dr. Schutze have alsobeen engaged on various aspects of vitamin problems.The department of bacteriology under Prof.Ledingham has investigated diphtheroids, tularaemia,typhus, blood-platelets, streptococci, the bacterio-phage. protein therapy, the carriage of cholera vibriosby ship cockroaches, the relationships of the bacilliof bovine abortion, and Malta fever among othersubjects. At the serum department at ElstreeDr. MacConkey has been chiefly engaged in thestability of toxin and antitoxin standards and theconcentration of antitoxin sera. As many workingbacteriologists could testify, the National Collectionof Type Cultures, established at the Institute withthe help of the Medical Research Council, has beena great success. Among much happy progress, thereare unfortunately several deplorable events. Chiefamong these is the loss of that wonderful disciple oftrue learning, Mr. A. W. Bacot, who died of typhus

’ contracted in Egypt during his work there on thedisease ; Dr. Arkwright also took it, but fortunatelyrecovered. In maintaining the virus of the Californiandisease, tularæmia, in the Type Collection, Dr.Brooks, Dr. Schutze, and Miss Rhodes all caughtthe infection, as have most people who have workedwith it. We notice, too, with regret that the Universityof London appears to have now entirely withdrawnits support of the protozoological laboratory, and theabsence through illness of Dr. Robertson is alsomentioned. In face of a good many difficulties,however, the work of the Institute has continued toprogress on the high level which it has set andProf. Martin is s to be congratulated on anothersuccessful year. The financial position is satisfactoryin so far as there is a balance on the right side ; butabout two-thirds of the money which is spent inmaintaining research has to be earned in a ratherprecarious market by the manufacture of sera, &c.,and this uncertainty of income naturally hampers thegoverning body in embarking on any fresh schemeswhich involve any lasting financial responsibility.Twenty-nine years of service so good as that whichthe Institute has given to the cause of preventivemedicine deserve a more comfortable stability.

SYPHILIS OF THE SECOND AND THIRD

GENERATION.

BESIDES the ordinary congenital syphilis of the firstgeneration which parents transmit to their childrenthere are other much rarer forms in which the diseaseis transmitted from the grandfather to the grand-children, or from the great-grandfather to the great-grandchildren. Observations. which are not numerousbut of great interest as coming from authoritative esources. appear to leave no doubt as to the existence of

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this form of hereditary lues, and while Brunisgardexpresses the opinion that this form can only betransmitted by a mother who is definitely syphilitic,yet Gaucher, Clover, and others have shown that theheredity can also be transmitted by a father or byboth parents. Prof. Carlo Martelli, of the Universityof Naples,’ has collected nine cases which disclosefurther interesting facts regarding this condition andfrom which it appears that though it is easy to under-stand a toxic, dystrophic, and non-parasitic trans-mission from the grandfather to the grandchildthrough the father, these cases do not imply a virulentsyphilis in which transmission is connected not withtoxins but with active treponemes. In Prof. Martelli’scases relating to numerous grandchildren of variousgrandparents and great-grandparents, nearly all ofmaternal origin, there is almost always found a vigorousdefensive humoral reaction with presence of anti-bodies in the serum and a strongly positive Wasser-mann reaction. In most of the cases the subjectsof syphilis of the second generation are weak, proneto all those ailments which easily conduce to a fatalresult-and sometimes without appreciable cause,disposed to general dystrophies, such as infantilism,.dwarfism, and dental malformation ; but on the otherhand cases are not wanting, like those described by Prof.Martelli, in which the grandchildren are found possessedof all the best somatic and psychic developmentalendowments, so that only an accurate investigationis successful in revealing the slight anatomical andfunctional stigmata of the disease transmitted by thegrandparents. Rarer than hereditary syphilis of thesecond generation is that of the third generation, inwhich the great-grandfather transmits the disease evento the great-grandchildren. Such an event requires alapse of so much time that the opportunity of followingit to its conclusion is rarely afforded, yet a case ofthis character exists in literature and was communi-cated by Gaucher to the Academy of Medicine of Parisin 1916.

In this case the great-grandfather died of syphiliticparaplegia, according to reliable information furnished bythe son ; the grandfather, personally known, had numerousstigmata of hereditary syphilis and died of cerebral haemor-rhage ; the father was healthy and had never contractedsyphilis yet gave a positive Wassermann reaction. Hemarried a woman with negative reaction and had three’children affected with hereditary syphilis, one, a girl aged 9years, with scoliosis, adenoids, and notched incisors, another,a girl of 6 years, almost an imbecile, with flat nose, uneventeeth, and convergent strabismus.

One of Prof. Martelli’s cases carries this form offamilial syphilis as far as the fourth generation.The great-great-grandfather suffered from dementia, of

specific origin, his daughter (the great-grandmother) diedat the age of 75 from biliary calculus, having married awidower, who died of diabetes, but was free from syphilisand had had three healthy children by a former wife. Thismarriage resulted in 16 pregnancies, four being abortionsand four dying at an early age ; two others became grand-mothers one of whom had a, strongly positive W.R. andmarried a healthy individual, giving birth to seven children,three of whom died at an early age, one had spinal neur-asthenia, another died of oedema of the glottis, and a third hadrickets ; the remaining child, who was clinically healthy, yethad a weakly positive W.R., married a healthy man and hadthree children, one of whom suffered from dwarfism, anotherfrom hernia, the third beirg as yet unborn. Of the secondgeneration, three became mothers ; one having a weak positiveW.R. gave birth to two normal children and to one mentallydeficient and one with a weak positive «’.R. The secondmother having a strongly positive W.R. had two children,one of whom died at the age of 2 years from convulsions,while the other was apparently normal. The third motherhad a strongly positive W.R. and gave birth to four children,one with adenoids and notched incisors, two with adenoids,while the fourth was a degenerate.

Like alcoholism in the Rougon-Macquart family,so syphilis sends down its stigmata to the third andperhaps fourth generation. It may not conform to ithe classical description, but descends among the ’offspring and infiltrates everywhere to a more or lessextent without following fixed laws and, more oftenthan not, without giving rise to any specific mani-

1 La Pediatria, vol. xxxi., N. 6, 1923.

festations, such as syphilodermia and polyadenia.In Prof. Martelli’s opinion syphilis of the secondgeneration, overlooked in the majority of cases, ismuch more frequent than is generally believed, andif medical men, who have the opportunity of practisingfor 50 years in small localities among a known popula-

tion, know how to recognise it, probably even the

heredity of the third generation would prove to be lessrare, as his own cases show.

THE ROYAL SOCIETY CONVERSAZIONE.- AT the conversazione of the Royal Society heldon May 16th there seemed to be fewer strikingexhibits than usual, but there were several of parti-cular interest to those engaged in scientific medicine.Recent advance in microscopic technique were illus-trated by Mr. J. E. Barnard in a series of micro-scopes showing leptospira ictero-haemorrhagica underdifferent forms of dark-ground illumination. Thismethod has hitherto been of limited value becauseof the small numerical aperture of the objectiveemployed, but with this new apparatus it is possibleto obtain the full value of a numerical aperture of1’2 with a consequent great increase of resolvingpower. Dr. Leonard Hill and Dr. A. Eidinowdemonstrated the effect of temperature on thebiological action of light, showing that the lethal

power of ultra-violet rays is manifested much morerapidly at 200 C. than at 10° C. Mr. H. GrahamCannon exhibited specimens of the decapitated water-beetle Hydl’ophilHS, on which had been grafted thehead of the water-beetle Dysticus. One specimenhad been dissected to show that complete junctionof the cut ends of the oesophagus had taken place.Dr. Hele-Shaw demonstrated the action of a newstream line filter in which fluid is forced betweenparallel sheets of impervious material which can beregulated at will to produce films of such a degree ofattenuation that the matter in suspension can be

prevented from entering the interstices between thesheets. From the National Institute of IndustrialPsychology, through Dr. C. S. Myers, there came

charts illustrating the higher output in coal-mines

following improvement in illumination. Coal-miners

are unanimous in their opinion that " frosted "

lamps afford better vision and less eyestrain. Amongother interesting exhibits were those shown by theDepartment of Zoology, British Museum, of specimensof deep-sea cables damaged by sharks who had fedon the animals growing on the outer casings. Thespecimens showed the teeth of sharks broken off andembedded in the cables. Another exhibit from thesame department consisted of articles removed fromthe stomach of a man-eating crocodile ; they wererepresentative of several human beings, though thereptile’s last meal was a porcupine. 4Ir. F. HarrisonGlew’s levitating magnet attracted considerableattention. It showed a bar magnet of cobalt steelfloating by repulsion above the opposed poles of afixed magnet. During the evening a demonstrationwas given by Sir Richard Paget of plasticine models,reproducing the English vowel sounds, and Mr.Walter Heape showed cinematograph films, takenat rates of from 2000 to 3000 per second, of thebreaking of an electric bulb, and the behaviour of arubber ball driven against a solid target.

STERILITY IN WOMEN.

THE question of the aetiology and treatment ofsterility in women is one of importance not only tothe individual, but also to any State. Certaininquiries recently carried out by gynaecologists inGerniany are of more than local interest. Dr. LudwigNurnberger, of Hamburg, has recently reported theresults of these inquiries. Stress is laid on the impor-tance of establishing a diagnosis of the conditionresponsible for the sterility before any treatment is

1 Deutsche medizinische Wochenschrift, March 30th andApril 16th.