507 THE INTERNATIONAL CONGRESS OF OPHTHALMOLOGY. it is this aspect of the study of vaccinia which we should welcome, rather than the light it throws on the clinical accident known as post-vaccinial encephalitis. OPEN-AIR BATHING FACILITIES. THE return of the heat-wave brought a reminder of the disabilities suffered by Londoners who have few opportunities to get rid of their surplus heat in semitropical weather. The sufferers will gladly learn of the plans in the mind of the new Commissioner of Works. Mr. LANSBURY is S providing seats in Trafalgar-square and a playing space for children around the Albert Memorial in Hyde Park. He proposes further outdoor shelter for children in Bushey Park and is opening to the public the Cam- bridge enclosure at the Admiralty Arch. In all the public parks the policy is to be carried out of taking down the railings where they are not required to protect natural beauties. But all this leaves untouched the great desire of all children and most healthy adults to bathe in the open air during a hot spell of weather, and not only to bathe but to have the opportunity of sitting about in undress both before and after the dip ; and the proposal to make the Serpentine available for this purpose will be welcomed. Holiday visitors to the continent this year must have been struck by the prodigious increase in the facilities for open-air bathing provided wherever a lake or a bathing pool of any size is available. The capital outlay is small and the running cost is covered by the modest fee paid by the throngs of people of all ages who find refreshment and vigour from bathing in a judicious mixture of sun, air, and water. At the present time the Serpentine is of little, if any, use to women bathers since no provision has been made for dressing and undressing. Their need may be the less urgent since one of the most striking features of the emancipation of women in all civilised countries is the comparative freedom with which her clothing transmits air and sunshine ; there has been no effective corresponding movement to secure similar skin culture for the male population. But happily the problem of providing open-air swimming facilities need no longer be complicated by sex differentiation. Honest fears of the harmful effects of mixed bathing have long been set aside by experience, and there is now no possible excuse for refusing the facilities on any such grounds. Indeed, it is refreshing to see how the newer generation accepts, without thought of evil, behaviour that those of maturer years once feared as threatening inviolable principles. A little healthy humiliation may result to the elders from the comments and puzzled questioning of young people on hearing descriptions of ladies in voluminous garments, emerging from discreetly hooded bathing machines and bobbing in the shallow water as they clung to the end of a rope, whilst in a remote part, to which none of them would dare approach, the males carried out more daring feats ; for not only the garments but the other restrictions of those days made women swimmers rare among those whose visits to the seaside were an annual event. By insistence upon sex these elaborate taboos, with their opportunities for more or less indecent jest and allusion, cultivated, or perhaps indicated, the Peeping Tom state of mind. If we apply the standard of " evil to him who evil thinks " we must congratulate the present generation, for in the less populous seaside places anyone once familiar with the old regime must be impressed by the way young people of both sexes, in the absence of formal rules, regulate their undressing and dressing without offence and without self-consciousness. The healthy human figure is beautiful, and the student of human nature may wonder how it came to be associated with those taboos from which we are now freeing ourselves with benefit to health and happiness and with no detriment to our morals. If he lives long enough he may learn, for the history of fashion either in clothes and habits of thought gives little support to the idea that the sensible conventions now adopted will remain stationary. They will inevitably change-whether in the direction of what we would now call greater licence or in that of greater prudery. In either case we do not anticipate that any obstacles will be placed in the way of mixed bathing in our time. The plans of the Commissioner of Works accord with the trend of the times, and it is to be hoped that they will take some practical form before the summer comes to an end. Annotations. THE INTERNATIONAL CONGRESS OF OPHTHALMOLOGY. "Ne quid nimis." THE Ophthalmological Congress which was opened by the Queen Mother of Holland at Amsterdam on Thursday afternoon resumes the long series of inter- national gatherings which have twice been broken by wars in Europe since the first meeting at Brussels in 1857, when the ophthalmoscope was newly discovered and pioneers like von Graefe and Donders gave the fruits of their experience. The fourth meeting appointed for 1871 in Berlin was prevented by the Franco-German War, and the twelfth planned to take place at Petrograd in 1914 was not held, although the communications prepared for it were circulated to members. The present Congress is guided by the rules and by-laws drawn up by a committee under the chairmanship of Mr. Treacher Collins which met in conference at Scheveningen in 1927. Papers printed beforehand include reports on visual standards, standardisation of perimetry, of visual acuity, of the notation of the meridians of astigmatism, and on the light-sense test, on uniformity in the programme of teaching ophthalmology for medical students and future ophthalmologists, and on unification of the standards for airmen, motor drivers, railwaymen. and sailors. A directory has been brought out of all practising ophthalmic surgeons in the world, of all ophthalmological societies, institutes, hospitals, and asylums for the blind, and of ophthalmic journals. This alone makes a volume of over 350 pages, of great value for reference purposes. The list of papers to be read at the present Congress includes 232 items, each of which is abstracted in five languages-English, French, German, Italian, and Spanish. The pro- gramme obviously covers a wide range of subjects, many of them of international interest, and the promoters are to be congratulated on the achievement of a Congress which is likely to be a new landmark in the science and practice of ophthalmology. The gathering should not only advance knowledge but engender a spirit of mutual respect and esteem among the participants. Besides the devoted work of Mr. Collins the arrangements, as far as they concern the English-speaking world, owe much to the labours of Sir John Parsons, Mr. Leslie Paton, and Dr. de Schweinitz, of, Philadelphia. THE PATHOLOGY OF TRYPANOSOMIASIS. TRYPANOSOMBS are harmful in many ways. Within the vessels their mere presence and multiplication may block capillaries and do mechanical damage ; during their life or after their death they may form toxins causing perivascular inflammation. In the serous cavities they may multiply and cause irritation, giving rise, e.g., to pericarditis ; invading the tissues they may set up inflammation and degeneration. The presence of trypanosomes in the tissues after death is not often reported. P. Regendanz and R. Hoeppli of the Hamburg Tropical Medicine School, who have .. just published 1 the outcome of their prolonged 1Arch f. Schiffs-u. Tropen-Hygiene, July, 1929, p. 376.
Transcript
507THE INTERNATIONAL CONGRESS OF OPHTHALMOLOGY.
it is this aspect of the study of vaccinia which we shouldwelcome, rather than the light it throws on the clinicalaccident known as post-vaccinial encephalitis.
OPEN-AIR BATHING FACILITIES.THE return of the heat-wave brought a reminder
of the disabilities suffered by Londoners who havefew opportunities to get rid of their surplus heat insemitropical weather. The sufferers will gladly learnof the plans in the mind of the new Commissioner ofWorks. Mr. LANSBURY is S providing seats inTrafalgar-square and a playing space for childrenaround the Albert Memorial in Hyde Park. Heproposes further outdoor shelter for children inBushey Park and is opening to the public the Cam-bridge enclosure at the Admiralty Arch. In all thepublic parks the policy is to be carried out of takingdown the railings where they are not required toprotect natural beauties. But all this leaves untouchedthe great desire of all children and most healthyadults to bathe in the open air during a hot spell ofweather, and not only to bathe but to have theopportunity of sitting about in undress both beforeand after the dip ; and the proposal to make theSerpentine available for this purpose will be welcomed.Holiday visitors to the continent this year must havebeen struck by the prodigious increase in the facilitiesfor open-air bathing provided wherever a lake or abathing pool of any size is available. The capitaloutlay is small and the running cost is covered by themodest fee paid by the throngs of people of all ageswho find refreshment and vigour from bathing in ajudicious mixture of sun, air, and water. At thepresent time the Serpentine is of little, if any, use towomen bathers since no provision has been made fordressing and undressing. Their need may be theless urgent since one of the most striking featuresof the emancipation of women in all civilised countriesis the comparative freedom with which her clothingtransmits air and sunshine ; there has been no
effective corresponding movement to secure similarskin culture for the male population. But happilythe problem of providing open-air swimming facilitiesneed no longer be complicated by sex differentiation.Honest fears of the harmful effects of mixedbathing have long been set aside by experience, andthere is now no possible excuse for refusing the facilitieson any such grounds. Indeed, it is refreshing to seehow the newer generation accepts, without thought ofevil, behaviour that those of maturer years oncefeared as threatening inviolable principles. A littlehealthy humiliation may result to the elders fromthe comments and puzzled questioning of youngpeople on hearing descriptions of ladies in voluminousgarments, emerging from discreetly hooded bathingmachines and bobbing in the shallow water as theyclung to the end of a rope, whilst in a remote part,to which none of them would dare approach, themales carried out more daring feats ; for not onlythe garments but the other restrictions of those daysmade women swimmers rare among those whosevisits to the seaside were an annual event. Byinsistence upon sex these elaborate taboos, with theiropportunities for more or less indecent jest andallusion, cultivated, or perhaps indicated, the PeepingTom state of mind. If we apply the standard of" evil to him who evil thinks " we must congratulatethe present generation, for in the less populousseaside places anyone once familiar with the oldregime must be impressed by the way young peopleof both sexes, in the absence of formal rules, regulatetheir undressing and dressing without offence andwithout self-consciousness. The healthy humanfigure is beautiful, and the student of human naturemay wonder how it came to be associated with thosetaboos from which we are now freeing ourselves withbenefit to health and happiness and with no detrimentto our morals. If he lives long enough he may learn,for the history of fashion either in clothes and habits
of thought gives little support to the idea that thesensible conventions now adopted will remainstationary. They will inevitably change-whetherin the direction of what we would now call greaterlicence or in that of greater prudery. In either casewe do not anticipate that any obstacles will be placedin the way of mixed bathing in our time. Theplans of the Commissioner of Works accord with thetrend of the times, and it is to be hoped that theywill take some practical form before the summercomes to an end.
Annotations.
THE INTERNATIONAL CONGRESS OFOPHTHALMOLOGY.
"Ne quid nimis."
THE Ophthalmological Congress which was openedby the Queen Mother of Holland at Amsterdam onThursday afternoon resumes the long series of inter-national gatherings which have twice been broken bywars in Europe since the first meeting at Brussels in1857, when the ophthalmoscope was newly discoveredand pioneers like von Graefe and Donders gave thefruits of their experience. The fourth meetingappointed for 1871 in Berlin was prevented by theFranco-German War, and the twelfth planned to takeplace at Petrograd in 1914 was not held, although thecommunications prepared for it were circulated tomembers. The present Congress is guided by therules and by-laws drawn up by a committee underthe chairmanship of Mr. Treacher Collins which metin conference at Scheveningen in 1927. Papersprinted beforehand include reports on visual standards,standardisation of perimetry, of visual acuity, of thenotation of the meridians of astigmatism, and on thelight-sense test, on uniformity in the programme ofteaching ophthalmology for medical students andfuture ophthalmologists, and on unification of thestandards for airmen, motor drivers, railwaymen. andsailors. A directory has been brought out of allpractising ophthalmic surgeons in the world, of allophthalmological societies, institutes, hospitals, andasylums for the blind, and of ophthalmic journals.This alone makes a volume of over 350 pages, of greatvalue for reference purposes. The list of papers to beread at the present Congress includes 232 items, eachof which is abstracted in five languages-English,French, German, Italian, and Spanish. The pro-gramme obviously covers a wide range of subjects,many of them of international interest, and thepromoters are to be congratulated on the achievementof a Congress which is likely to be a new landmark inthe science and practice of ophthalmology. Thegathering should not only advance knowledge butengender a spirit of mutual respect and esteem amongthe participants. Besides the devoted work of Mr.Collins the arrangements, as far as they concern theEnglish-speaking world, owe much to the labours ofSir John Parsons, Mr. Leslie Paton, and Dr. deSchweinitz, of, Philadelphia.
THE PATHOLOGY OF TRYPANOSOMIASIS.
TRYPANOSOMBS are harmful in many ways. Withinthe vessels their mere presence and multiplicationmay block capillaries and do mechanical damage ;during their life or after their death they may formtoxins causing perivascular inflammation. In the serouscavities they may multiply and cause irritation, givingrise, e.g., to pericarditis ; invading the tissues theymay set up inflammation and degeneration. Thepresence of trypanosomes in the tissues after deathis not often reported. P. Regendanz and R. Hoeppliof the Hamburg Tropical Medicine School, who have ..just published 1 the outcome of their prolonged
1Arch f. Schiffs-u. Tropen-Hygiene, July, 1929, p. 376.
508 LUNATICS AS A PUBLIC DANGER.
investigations, believe it to be because autopsy isdelayed too long, for the parasites are altered by postmortem changes more quickly in the tissues than inthe vessels. The flagella disappear first, then theprotoplasm assumes a rounded shape and loses itsspecial staining affinities ; the blepharoplast andnucleus persist longer, but are apt to be mistaken forbacteria unless examined under a high power, whentheir irregular edge and lighter central staining dis-tinguishes them. Subjects of trypanosomiasis areapt to suffer from peri- and myo-carditis with dilata-tion ; is the infection brought by the blood stream ?The Hamburg investigators think not, but duerather to an extension from the pericardium withinwhich the trypanosomes are growing ; morbid changesare more advanced in the epicardium than in theheart, and in the superficial layers of the myocardiumthan in the deeper. The first histological evidenceof trypanosome infection is an oedema which may bedue to toxins, though such toxins have not yet beenisolated. Into this cedematous area the trypano-somes having penetrated, they increase, setting up asmall-cell infiltration similar to but less in degreethan that of bacterial inflammation ; the musclecells degenerate later. Trypanosomes, living andmoving, may be found in plenty in the fluids of serouscavities and in that of the conjunctival sac, evenwhen they are but scantily present in the blood.Conjunctivitis is not unusual in trypanosome-infectedanimals; iritis and keratitis also occur, and livingtrypanosomes have been found in the anteriorchamber. Thence they make their way along thelymph stream into the subconjunctival connectivetissue, causing oedema and inflammation, and so
reach the conjunctival sac, where they are mostnumerous about the fornix. This sequence of eventswas first observed with T. equiperdum, althoughmost of the work was done with T. gambiense andT. rhodiense, of which the latter gives rise to themore acute infection in apes. Whether the growthof trypanosomes in serous cavities accounts forrelapses will be discussed in a subsequent paper.
MINIMAL DOSES OF HEAVY METALS.
DR. Guisepp6 Sabatini, professor of special patho-logy in the University of Rome, has been investigatinglthe effect of injecting into the circulation extremelysmall quantities of salts of the oligo-dynamic metals,such as copper, zinc, and mercury. The vogue of the
infinitely small, he remarks, is continually extendingits influence in biology, and even in clinical medicine.He has been impressed by the demonstrations of16 ultravirus," of aphanozoa, of fatal anaphylaxisproduced by minute doses of serum, of the powerfuleffects of imponderable amounts of hormones, and ofthe posology in fractions of a decimilligramme of purealkaloids. In Italy there has been a tendency toreconsider the doses of commonly used drugs, andclaims have arisen for remarkable effects from dosesconspicuously smaller than those generally employed intherapeutics. It may easily be predicted that theedifice of necessary and sufficient therapeutic dosesfixed by scientific medicine is not really on the vergeof collapse, but according to Prof. Sabatini we shouldbe guilty of stupidity to ignore such investigationsaltogether. His own experiments were inspired bythe observations of A. van Egmond on the action ofcertain drugs on the bundle of His, and on the pro-duction of heart-block by the action of oligo-dynamicmetals. This author showed that simple contact ofthe bundle of His with a copper wire 2 mm. in diametercaused heart-block. Having excluded the possibilityof thermic effect, pressure, and galvanic current, heconcluded that it was due to an infinitesimal chemicalaction on the cells in the bundle. In the same field ofobservation, Stock, in 1926, maintained the possibilityof mercurial intoxication in man caused by theamalgam used in stopping carious teeth, and Seifert,examining several hundreds of syphilitic patients
1 Policlinico, Medical Section, June 1st, 1929, p. 281.
belonging to every social grade, noticed that about80 per cent. of them had no teeth filled with metallicstopping, while in a series of patients with many filledteeth syphilis was much less prevalent than in others,and he suggests that the minute doses of mercuryabsorbed by the organism in these subjects may actas a prophylactic. The researches carried out byProf. Sabatini fall into five groups : (1) chloride of
copper, one milligramme dissolved in 2 c.cm. ofdistilled water ; (2) chloride of zinc, in the same pro-portion ; (3) bichloride of mercury, in the same
proportion; (4) bichloride of mercury, half thatstrength ; and (5) controls consisting of injections of2 c.cm. distilled water only. These quantities wereinjected into a vein and samples of blood taken after1 hour, 8 hours, and 24 hours. These sampleswere examined as to the number of red cells, thenumber of leucocytes, the leucocytic formula, and forglycaemia. The specimens showed very definitechanges, the number of red cells and leucocytes beingdistinctly, and sometimes conspicuously, increased,while the glycaemic content was raised to aboutdouble the normal. The changes were transitoryand a return to the previous condition took place after24 hours. Dr. Sabatini is continuing his investigationsespecially with other salts.
RESEARCH IN TUBERCULOSIS.
Two years ago the Prudential Assurance Companyprovided a new pathological department for the Cityof London Hospital at Victoria Park, and the report for1928, recently issued, testifies very clearly to the valueof this benefaction. The laboratory has examinednearly 10,000 specimens from the wards and out-
patients during the year, and the report includes alsoreprints of four papers published by Dr. S. RoodhouseGloyne and his assistants. The chief one is a usefulreview by Dr. Gloyne of the clinical pathology andbacteriology of fluids obtained by tapping the pleura.With Dr. J. R. Simpson he has also attempted, andfailed, to produce tuberculous meningitis in rabbits.It is curious that generalised infections produced byintravenous injections in these animals hardly everinvolve the meninges, and it is suggested that this isso because the bacilli do not lodge in the cerebralvessels; tuberculous meningitis is perhaps alwayspreceded by lesions in the choroid plexuses. Lesserpapers deal with the viability of tubercle bacillusat freezing temperature and with the relationshipbetween syphilis and tuberculosis which seems to bevery small. The whole report indicates a livelyresponse to the help given by the Prudential Companyand augurs well for the extension and expansion ofactivity which future years will doubtless show.
LUNATICS AS A PUBLIC DANGER.
Lord Alness, the Lord Justice-Clerk, has beencommenting in the Glasgow High Court upon thedanger to the community from the freedom allowedto persons of unstable mind. In the case towhich our Scottish correspondent draws attentionon p. 525 a man had been proved to be ofunsound mind and unfit to plead. He was alsodescribed in the evidence as being in the same mentalcondition when released some time earlier from amental institution. While thus at large he hadshot a young woman dead and had attempted toshoot a man. The Lord Justice-Clerk, while refrain-ing from attributing blame to individuals, suggestedthat the general position was disquieting and thatthe authorities should inquire whether some machinerycould not be devised to prevent the recurrence ofsuch deplorable incidents. Similar comments mightat any time be made in England where full investiga-tion has been officially made without any attempt togive effect to the resultant conclusions. RoyalCommissions may make recommendations but, untilsome prominent personage is killed by a lunatic, itmay be difficult to translate those recommendations
