diary of the week

3
7 827 I 20% further operative procedures under a general anaesthetic will be necessary. The method is not intended to replace those used where an urgent and immediate evacuation of the uterus is required. The procedure carries certain risks. In our series of 71 cases the ill effects have been limited to a few days’ pyrexia in 6 patients (excluding the patient with active febrile pulmonary tuberculosis), and to some post- abortive bleeding in 4. The possibility of subsequent sterility from a chemical salpingitis cannot be neglected, but we have not seen this complication, whereas 4 of the patients subsequently became pregnant. I wish to thank Prof. W. C. W. Nixon for permission to use the records of the obstetric unit, University College Hospital. REFERENCES Barnes, A. J. M. T. (1946) Practitioner, 156, 56. Browne, F. J. (1946) Antenatal and Postnatal Care, London, p. 337. Riddell, Lord (1932) J. Obstet. Gynœc. 39, 1. Weilerstein, R. W. (1944) J. Amer. med. Ass. 125, 205. THE VIABILITY OF TREPONEMA PALLIDUM C. E. LUMSDEN M.B. Aberd. LATELY MAJOR R.A.M.C. From the Pasteur Institute, Shillong, Assam FoR some months in 1943 field hospitals in Assam were without adequate facilities for dark-ground examina- tion of material from penile sores. During this period, when capillary-tube samples from venereal sores were being sent to me by post or by courier, the question often arose of the reliability of this procedure, in view of the hazards to which such samples were exposed, some coming’ from isolated units in the jungle seventy or eighty miles away and taking four or five days in transit. My colleagues could not give any categorical opinion about the normal expectation of viability of Treponema pallidunt in such preparations, and the textbooks then available to us were not helpful. For instance, Topley and Wilson (1941) state of spirochsetes that " some of the highly parasitic members, such as T. pallidum, are unable to survive outside the animal body for more than an hour or two." Stitt et al. (1938) merely state that exudate from chancres " should be examined fresh " with dark-field illumination. On the other hand, Muir and Ritchie (1937) state that, in sealed tubes, apirochaetes may " retain their shape for days or weeks." Gradwohl (1938) is silent on this subject. Accordingly I decided, in addition to the routine examination of specimens submitted from outside, to investigate the viability of T. pallidur2 in preparations made by ourselves from fresh untreated lesions. METHOD AND FINDINGS In 10 consecutive cases of typical Hunterian chancre of the penis in which I had just found T. pallidum on dark-ground examination, I made several preparations (the number depending on the quantity of serum obtained without undue discomfort to the patient), which were examined at intervals subsequently. In cases 1-7, labouring as I was under the precon- ceived notion that T. pallidum was a delicate creature, several capillary tubes of serum from each case were taken, sealed, ’stored in the incubator at 37°C, and examined at intervals until the series of tubes was exhausted. In cases 1 and 2 typical motile T. pallidum Was seen up to the seventh and sixth days respectively, and on the eighth and seventh days respectively morpho- logical T. pallidum was readily identified but motility lost. This was encouraging, and, as it is difficult to obtain from a sore enough undiluted serum to fill more than six capillary tubes, I decided to examine the specimens on ’alternate days, as in cases 3-7. In cases 1-7 (table i) T. pallidum remained viable and readily identifiable to the sixth day at least. In case 5 motile T. pallidum was seen in the last capillary tube, which was reserved until the tenth day before opening. In case 8 only two preparations were made as before, but these were kept at laboratory temperature and not examined until the tenth and thirteenth days, when both were found to contain numerous typical spirochaetes still exhibiting natural movement. Case 10 was a similar preparation but had been inadequately sealed ; on examination on the eleventh day it was found to be dried up, and no spirochaetes were identified on emulsification of the residue in saline. As the foregoing were consecutive cases, there seemed little doubt about the prolonged viability of the trepone- mata in the capillary tubes, and, to minimise labour, I decided to see how long the paraffined slide preparations remained positive-i.e.; the original slide in which T. pallidum had been seen was reserved and examined daily. To avoid drying, I took care to use a fairly liberal drop of saline to mix with the serum and to ensure an adequate seal with the soft paraffin ring at the periphery of the coverslip. In each case several slides were made ; some were kept in the incubator at 37°C, and some at room temperature. The findings are set out in table 11. In every case T. pallidum continued to be readily identifiable and still motile from eight to fourteen days later. In case 14 morphological T. pallidum was seen on the sixteenth day on the slide kept at room temperature, but it was no longer motile. Usually the slides kept at room temperature gave better results, as they tended to dry less. General Observations.-No special precautions were taken in making the preparations, the object being to collect the specimens of serum in much the same way as I would expect others to collect them for submission . to the laboratory. The chief precaution was to ensure proper sealing of the capillary tubes and of the paraffined slide-and-coverslip preparations. During the observations the daily room temperature varied between 5° and 18°C. The presence of red blood-cells and of micro-organisms in otherwise reasonably good preparations did not appear to prejudice the result to any significant degree. There did not appear to be any great tendency for other bacteria to overgrow the spirochaetes, and even in the incubated preparations, where there were large numbers of bacilli present, the spirochsetes persisted quite well. TABLE I-VIABILITY OF T. pallidum IN CAPILLARY-TUBE PREPARATIONS MADE FROM TEN CONSECUTIVE POSITIVE CASES OF TYPICAL HUNTERIAN CHANCRE +, typical morphological T. pallidum with characteristic motility. R, kept at room temperature all the time. ?, morphological T. pallidum not showing motility. z , no T. pallidum found. *, this specimen had dried up. z2 2

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520

National Formulary, 1952The National Formulary, 1952, ’will replace the 1949

formulary on June 1. National Health Service chemist-contractors will receive copies from executive councils soonafter publication.

Congress of DieteticsThe first international Congress of Dietetics is to be held

at Amsterdam from July 7 to 11 under the presidency ofProf. B. C. P. Jansen. Further particulars may be hadfrom the educational bureau of the Nutrition Council, 42,Koninginnegracht, The Hague, Holland.

Seaweed SymposiumAn International Seaweed Symposium, sponsored by the

Institute of Seaweed Research, Inveresk, Midlothian, is tobe held in Edinburgh from July 14 to 17. Further particularsmay be had from Mr. T. W. Summers, secretary to theorganising committee, at the institute.

British StandardsA standard (B.S. 1823: 1952) has been issued for small

stainless-steel holloware utensils for use in hospitals.Specifications are given for instrument trays, kidney dishes,wash bowls, lotion bowls, and gallipots. Copies of thisstandard (2s.) may be had from the British Standards Institu-tion, Sales Department, 24, Victoria Street, London, S.W.I.

Closed-shop DisputeDr. John Dryden, Dr. John Young, Dr. Euphemia Guild,

Dr. Frances Carr, and Dr. Joyce Vasey, who have beenappointed to posts under the education authority of DurhamCounty Council, will not at present take up their appoint-ments, because the " closed-shop " dispute between theBritish Medical Association and the council is still unsettled.A member of the education committee in a statement to the

press (Manchester Guardian, March 1) said :" A conflict with the Ministry of Health appears imminent.

All would have been well had the council accepted the recom-mendation of the Emergency Committee to exempt doctors fromthe rule that applications for extended sick pay must go througha union or professional organisation. The B.M.A. would thenhave lifted its ban and the five doctors taken their appointments.Instead, the council sent the recommendation back to theEmergency Committee.

" The Ministry has been considerate over the fact that we havenot been able to make more frequent medical inspections atschools. This was because of the general shortage of medicalofficers. Now, however, the council appears to be deliberatelykeeping the dispute going, which means in effect it is not fulfillingits obligations in the school health service."

Anglo-French Exchange BursariesThe French Embassy in London has arranged for an

exchange of short-term grants between the Institut Nationald’Hygiene in Paris and the Ciba Foundation in London, toenable young British and French doctors to visit each others’countries and study special techniques. The grants, whichwill be of at least jE50 a month tax-free, will be awarded forperiods of two to six months to doctors who wish to obtainclinical experience, but they can also be awarded for medicalresearch. The British selection board is composed as follows:Prof. Alexander Haddow, Prof. John McMichael, the BritishCouncil (Dr. Margaret Suttill), the British PostgraduateMedical Federation (Dr. C. F. Hamilton-Turner), the MedicalResearch Council (Dr. F. J. C. Herrald), joint secretariesMiss A. M. Vidal-Hall (French Embassy) and Dr. G. E. W.Wolstenholme (Ciba Foundation). Applications for the 1952bursaries should be sent before March 31 to Dr. Wolstenholme,director, Ciba Foundation, 41, Portland Place, London, W.I.

EMERGENCY BED SERVICE.—In the week -ended last

Monday applications for general a,cute cases numbered 1138.The proportion admitted was 87-5%.CORRIGENDUM: Familial Intestinal Polyposis.-In this

article by Dr. H. H. Wolff last week (p. 446) fig. 1 was printedthe wrong way up.

The Journal of Clinical Endocrinology has been renamed theJo2irnal of Clinical Endocrinology and Metabolism.

The British Council has cooperated with the British MedicalAssociation in arranging a visit by Prof. F. A. R. Stammers toBagdad, Cyprus, and Khartoum.

Messrs. Vitamins Ltd. offer a limited number of places to doctorswho wish to view the Boat Race from their premises on March 29.Tickets may be had from Dept. B.R.l, Vitamins Ltd., Upper Mall,London, W.6.

Diary of the Week

MARCH 9 TO 15

Monday, 10thMEDICAL SOCIETY OF LONDON, 11, Chandos Street, W.1

8.30 P.M. Dr. G. W. B. James, Dr. P. M. Tow: TherapeuticTrauma of the Brain.

INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, W.C.15 P.M. Prof. J. C. Eccles (Canberra) : Physiological Responses

of Chromatolysed Neurones.INSTITUTE OF PSYCHIATRY, Maudsley Hospital, Denmark Hill, S.E.5

5.30 P.M. Dr. E. Stengel : Lecture-demonstration.

Tuesday, 11 thROYAL COLLEGE OF PHYSICIANS, Pall Mall East, S.W.1

5 P.M. Prof. John McMichael: Dynamics of Heart-failure.(First of two Oliver-Sharpey lectures.)

INSTITUTE OF DERMATOLOGY, St. John’s Hospital, Lisle Street,W.C.2

5.30 P.M. Dr. S. C. Gold : Contact Allergy.WEST END HOSPITAL FOR NERVOUS DISEASES, 40, Marylebone

Lane, W.15.30 P.M. Dr. T. Rowland Hill: Neurological demonstration,

CHELSEA CLINICAL SOCIETY8.30 P.M. (South Kensington Hotel, 41, Queen’s Gate Terrace,

S.W.7.) Dr. R. E. Smith : The School Doctor Looks Forwardsand Backwards.

MANCHESTER MEDICAL SOCIETY4.30 P.M. (University of Manchester.) Sections of Surgery and

Medicine. Dr. F. Avery Jones: Treatment of Heema-temesis.

Wednesday, 12thUNIVERSITY COLLEGE, Gower Street, W.C.1

5.30 P.M. Prof. R. B. Cattell (Illinois) : Recent QuantitativeResearch on Personality and the Culture Pattern.

INSTITUTE OF DERMATOLOGY5.30 P.M. Dr. 1. W. Whimster : Origin of Epithelial Neoplasms

in the Skin.LONDON COUNTY MEDICAL SOCIETY, St. James’ Hospital, Balham,

S.W.123 P.M. Clinical meeting.

MANCHESTER MEDICAL SOCIETY4.30 P.M. Section of Pathology. Dr. J. E. Kench: Porphyrins

in Health and Disease.

Thursday, 13thROYAL COLLEGE OF PHYSICIANS

5 P.M. Professor McMichael: Dynamics of Heart-failure.(Second of two Oliver-Sharpey lectures.)

ROYAL COLLEGE OF SURGEONS, Lincoln’s Inn Fields, W.C.25 P.M. Prof. V. W. Dix : Ureteric Calculus. (Hunterian

lecture.)BRITISH POSTGRADUATE MEDICAL FEDERATION

5.30 P.M. (London School of Hygiene, Keppel Street, W.C.I.)Sir Cyril Burt, D.sC. : The Psychology of Personality.

UNIVERSITY COLLEGE5 P.M. Prof. Wilson Smith, F.R.S. Structural and Functional

Plasticity of Influenza Viruses. (Sydney Ringer lecture.)INSTITUTE OF CHILD HEALTH, The Hospital for Sick Children,

Great Ormond Street, W.C.15 P.M. Mr. H. S. Sharp : The Ear, Nose, and Throat. ,

INSTITUTE OF DERMATOLOGY5.30 P.M. Dr. H. Haber : Histopathology of Foreign-body and

Specific Granulomas.ROYAL ARMY MEDICAL COLLEGE, Millbank, S.W.1

5 P.M. Dr. D. Evan Bedford : Common Difficulties in theDiagnosis of Heart-disease.

ST. GEORGE’S HOSPITAL MEDICAL SCHOOL, Hyde Park Corner, S.W.14.30 P.M. Dr. Desmond Curran : Psychiatry lecture-demonstra-

tion. ,

ALFRED ADLER MEDICAL SOCIETY8 P.M. (11, Chandos Street, W.1.) Dr. E. K. Ledermann:

Relationship of Body and Mind.MANCHESTER MEDICAL SOCIETY

8.15 P.M. Section of Anœsthetics. Dr. W. B. Bacon, Dr. C. E.Sykes : Control of Bleeding During Surgical Operations.

UNIVERSITY OF ST. ANDREWS5 P.M. (Medical School, Small’s Wynd, Dundee.) Sir Henry

Dale, o.M., F.R.s. : Transmission of Effects from Nerve-endings.

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MEDICAL SOCIETY FOR THE CARE OF THE ELDERLY11.30 A.M. (B.M.A. House, Tavistock Square, W.C.1.) Dr. J. A.

Scott, Dr. E. B. Brooke, Dr. Barbara Morton : CoordinatedMedical Care of the Elderly.

Friday, 14th .

INSTITUTE OF DERMATOLOGY5.30 P.M. Dr. S. C. Gold : Contact Eczema.

INSTITUTE OF DISEASES OF THE CHEST AND INSTITUTE OF CARDIOLOGY5.30 P.M. (London School of Hygiene.) Mr. R. 0. Brock:

Surgical Treatment of Mitral Stenosis.MEDICAL SOCIETY FOR THE CARE OF THE ELDERLY

10 A.M. (Langthorne Hospital, Leytonstone, E.11.) Dr. J. AlanHerd : Psychiatric Department in a Geriatric Hospital,Dr. P. J. Sonnek : Congestive Heart-failure in the Aged.Dr. Trevor Howell: Medical Care of Old People. (Film.)