488

hydrated subcarbonate, is deposited on the respiratorysurface, from which it is dissolved by the tissue fluids and isthen taken up by the blood. Some of the nickel finds its

way directly through the lymphatic channels into thebronchial glands. In the dissolved condition the nickelenters into complex combination with some constituent ofthe body. The metal is carried by the blood to the tissues,but a selective absorption is exercised by the brain andadrenals. In some cases the lungs exert a specificselection but the nickel only stays for a short time in

these organs. The specific pathological changes producedare primarily a degeneration of the endothelial cells ofthe capillary vessels. It is possible that some further

primary action is exercised on the ganglion cells in the

brain and on the parenchyma cells of the adrenals.

Haemorrhages follow as the result of the fatty degenerationof the vessel walls and secondary changes result from theeffects of the hemorrhages. Nickel is excreted by the

kidneys and intestines. Both cobalt and iron carbonyls actsimilarly, the latter, however, being less toxic than the othertwo. Mr. Armit expresses his acknowledgments to Dr. LudwigMond who rendered the investigation possible and who

defrayed all the expenses which it involved, and Dr. LudwigMond may be congratulated, we may add, on intrusting theinvestigation to Mr. Armit who has made public a verysuccessful and interesting piece of research on a problem ofconsiderable hygienic and industrial importance.

SYMMETRICAL LIPOMATOSIS.

IN a paper by Dr. Morsaline on Symmetrical Lipomatosispublished in the Revista de la Soeiedad -zV6dica Argentina,September-October, 1908, several cases are mentioned in

which tumours consisting entirely of adipose tissue developednear or around joints affected by chronic rheumatism sym-metrically on the right and left sides of the body. In one

case, that of a rheumatic asthmatic woman, the buttocks and

posterior regions of the thighs were affected, calling to mindthe extraordinary deposits of fat seen in Bushwomen as figuredin THE LANCET of Jan. 30th, p. 341. Some of the cases seenor collected by Dr. Morsaline were somewhat similar to thatshown before the Clinical Section of the Royal Societyof Medicine on May 8th, 1908, by Mr. Albert Carless,lwhere the adipose tumours sent out prolongations betweenthe muscles and other organs. The cause of these lipomataappeared to be connected with malnutrition, due sometimesat least to deficiency of thyroid secretion in a subject whowas perhaps alcoholic or syphilitic as well as rheumatic.Considerable success was obtained by the cautious adminis-tration of thyroidin. -

LACTIC ACID BACILLI.

IN the course of an interesting lecture delivered before theChemists’ Assistants Association on Jan. 28th, Mr. W.Harrison Martindale made some useful practical observationson the preparations and behaviour of lactic acid bacilli. He

said that if properly made there is no reason why lactic acidbacilli in tablet form should not keep good for months oreven years. He examined various samples of commerciallactic ferments after 24 hours’ cultivation. Six samples soexamined gave the following amounts of lactic acid respec-tively : 0 - 738 per cent., ,0-63 per cent., 0 - 441 per cent., 0 - 79per cent., 0 558 per cent., and 0’477 per cent. Herschellhas stated that the lactic acid never exceeds 1. 6 per cent.even after 48 hours’ incubation. The amount, as Mr.

Martindale points out, depends upon the proportion of milksugar present, the average of this substance being 4 per cent.In any case nature, he added, will not allow an optimum

1 THE LANCET, May 16th, 1908, p. 1415.

yield, as the bacilli kill themselves by the acid which theyproduce, the maximum being reached in about 36 hours.Bacillus Caucasicus is the most resistant organism to its

own lactic acid. Under ordinary conditions it would

appear that the average yield of lactic acid is about 0’8 8

per cent. The lecturer concluded by giving a sketch of

the literature on the subject, especially in its therapeutic

bearings, that had appeared in these columns and elsewhere.THE ROYAL COLLEGE OF SURGEONS OF

ENGLAND AND THE PRINCE OFWALES.

THE Prince and Princess of Wales will honour the RoyalCollege of Surgeons of England with their presence at thedelivery of the Hunterian Oration by the President, Mr.Henry Morris, on Monday next, Feb. 15th. The Prince ofWales has graciously consented to become an HonoraryFellow of the College, and the diploma of Honorary Fellow-ship will be presented to His Royal Highness in the presenceof the Council on that day.

THE SIXTEENTH INTERNATIONAL CONGRESS OFMEDICINE.

WE are requested to remind intending speakers at theSixteenth International Congress of Medicine that the manu-scripts of their addresses should be despatched by Feb. 28thnext, at latest date, to the office of the Congress, VIII.

Esterhdzy-utca 7, Budapest (Hungary). We would alsoremind them that the subscription to the Congress is 25crowns in Austro-Hungarian currency, which sum may besent by post office money order to Professor Dr. de Elischer,treasurer of the Congress, VIII. Esterhazy-utca 7, Budapest.

THE LONDON COUNTY COUNCIL AND INFECTEDEARS.

WE learn that the Education Committee of the London

County Council has recently made arrangements with theQueen Victoria’s Jubilee Institute of Nurses for the treat-

ment in their own homes of children suffering from

suppurating ears. The proposal was accepted by the Councilat a meeting held on Feb. 2nd. It has been found that

in many cases the usual syringing treatment, requiringas it does time, care, and patience, is not properly carriedout by the parents, with the result that children have

become permanently deaf and there have even been cases ofloss of life. A card will be sent to parents whose childrenare found to be suffering from the affection, telling them thata nurse will attend at the house and administer treatmentafter the child has been seen by a medical attendant. On

the back of the card is an order to be signed by the medicalman requesting the nurse to ’’ syringe the ears of the childtwice daily for the next three weeks, using only warmboracic acid lotion, and afterwards drying out and insuffla-ting a very little dry boracic powder." After thus arrangingthe prescription for the medical man it seems a littleuncalled for on the part of the Council to add : " It is to

be distinctly understood that the nurse, if she attends yourchild, will act under the instructions of the doctor or the

hospital authorities as the case may be, and that the

London County Council will accept no responsibility for thetreatment prescribed or given."

A TELEGRAM from the Acting Governor of Mauritius

(received at the Colonial Office on Feb. 5th) states that forthe week ending Feb. 4th there was 1 case of plague and 1death from the disease.

__

THE thirty-seventh annual report of the Local Government

489

Board was published this week and contains, as usual, a massof information upon public health and local administration ofthe greatest interest to the medical profession. The medical

officer’s report will, as usual, appear as a supplement shortly.

THE MORISON LECTURES.

THE first of these lectures on the Pathology of Syphilis ofthe Nervous System in the Light of Modern Research wasdelivered in the hall of the Royal College of Physicians ofEdinburgh on Jan. 25th by Dr. F. W. MOTT, Director of thePathological Laboratory of the London County Asylums andPhysician to Charing Cross Hospital, its subject beingThe l1ficTObiology of the Spirochaeta Pallida and its Relation to

Diseases of the Nerv01bs Syste1n.Dr. Mott said that this organism was regarded as the

specific organism of syphilis by Metchnikoff, Hoff-mann, Neisser, Levaditi, Bertarelli, Shennan, and manyothers. Metchnikoff and Roux were the first to demon-strate experimentally the communicability of syphilisto animals and to show that the nearer the animal

approached to man, the more the disease approached in itscharacters and virulence the human form of the malady.Thus, though other animals, especially apes and anthropoidapes, had been successfully inoculated, the chimpanzee alonereproduced with absolute certainty the human symptom-atology and the blood precipitin reaction of this anthropoidapproached more nearly that of man. Dr. Mott mentionedin particular the important discovery of Bertarelli that hehad been able to inoculate the spirochasta into the cornea ofthe rabbit and had transmitted it through a series of suchanimals. Levaditi had used the cornea so infected with

spiiocha3ta3 to produce an infection of the eyelid of an

anthropoid ape. Attention was drawn to the bio-chemicalchanges in the fluids of the body by the Wassermann,Neisser-Bruck method of serum diagnosis. Every day freshevidence was forthcoming to strengthen the opinion that thetrue cause of syphilis had been discovered, and though novaccine had as yet been successful this was no longer ahopeless outlook.

Dr. Mott gave a description of the spirocbasta pallida andshowed the differences between it and other kinds of

spirocha3ta3. Schaudinn and Hoffmann proved that the spiro-chfeta was found in all cases of syphilis but never in anyother affections. It had been found on the surface ofchancres and papules and also in the tissues and in the juiceof enlarged syphilitic glands ; it was present in the liver andspleen of an infant affected with congenital syphilis, as alsoin the bullse of another child affected with pemphigus.Very careful search was necessary to discover the organisms.They were only occasionally found in the blood, but in

syphilis they were constantly present in the lymphaticvessels. At the seat of inoculation the organisms under-went a rapid multiplication and definite histological changestook place before there were any indications of primarysyphiloma. The organisms after local development soonreached the nearest lymphatic glands, where probably theyagain multiplied, setting up an adenitis. From there theymight pass into the thoracic duct and a general infection ofthe blood-stream might take place. Lang and Dr. Motthad observed early in the disease, and even before theprimary sore was healed, symptoms which pointed to

meningitis, and Dr. Mott had observed many severe andintractable cases of brain and spinal syphilis which occurredwithin 12 months of infection. Hoffmann had shown thatthe cerebro-spinal fluid might be infective.

Microscopic examination showed that essentially thesame tissue reactions occurred in late manifestations ofsyphilis as in the primary or secondary stages. Tertiarylesions were, as a rule, non-infective and hence thespirochagta pallida was absent from such or only presentin small numbers in a few cases. In these lesions the

organism might exist in a latent and attenuated and pos-sibly intracellular form. It was possible that late mani-festations might be the result of secondary lesions whichhad remained latent until raised into activity by someexciting factor (e.g., cold, trauma, toxaemia, &c.). The

organism had been found in a few instances in a gumma, as

of the liver, and Hoffmann inoculated an ape from a gummawhich occurred in a man three and a half years after primaryinfection.

In Dr. Mott’s opinion the spirochsetas pallidas had morecharacters which linked it to the protozoa than to thebacteria. A most important feature was the great similarityof the histological lesions of the nervous tissues of chronictrypanosome infections (sleeping sickness and dourine) tosyphilitic and parasyphilitic lesions. Dourine (mal de coit)might almost be regarded as the syphilis of equines, thehistological and clinical features being almost similar tothose found in man after syphilitic infection. Neisser wasunable to inoculate animals by injecting the virus of syphilisinto the blood or organs, but scarifying an epiblastic skinsurface and rubbing in the virus gave success, and experi-ments with the trypanosoma equiperdum gave almost pre-cisely similar results. As regards therapeutics, mercury andarsenic were specific for both trypanosoma and spirochastaaffections, while they were not of much use in bacterialinfections. Mercury, especially in the form of inunction,was specially valuable, and this might be due to its prevent-ing the pullulation of the spirochastse on the surface of thebody, a habitat which these organisms had found particularlyfavourable for perpetuation of their species by transmissionto another individual.

Dr. Mott then discussed the manner of appearance of a

gumma spontaneously in the central nervous system longafter the primary sore and apparent cure of the disease.

Bio-chemistry of Syphilis: : the 1mportance of the Lipoids illRela.tion to the Living Cell and their Relat’ion to

Hemolysis and Cytolysis.The second lecture, delivered on Jan. 27th, dealt with

this subject. Dr. Mott first referred to the nature of

lipoids. This name was given by Overton to fat-like sub-stances which were contained in the cells of all living things,both animal and vegetable. These lipoids might be dividedinto three groups: (1) nitrogen- and phosphorus-free chole-sterin, fatty acids, and lipochromes; (2) nitrogenous butphosphorus-free cerebrosides ; and (3) phosphatides containingboth nitrogen and phosphorus : of these the most importantwere the mono-amino phosphatide lecithin and the dio-amino-phosphatide sphygmo-myelin. Until recently these lipoidswere considered of little importance-e.g., cholesterin.Lecithin was known to be a constituent of red blood

corpuscles, but only after the experiments on cobra venom byFlexner and Noguchi was the importance of these bodies inthe action of toxins established. Munk had shown thatlipoid in cells was doubly refractile when the Nicol’spolarising prism was rotated, and Ambrose and Heldmade use of this method in order to determine theexistence of the myelin sheath in the anterior and

posterior roots of the embryo. Munk found that the

presence of lipoid droplets in the cell was associated withdissolution of the nucleus and destruction of the cell. A

lipoid substance in great abundance meant cell dissolution ;the nucleus highly charged with phosphorus and the cellprotoplasm broke up into a lipoid complex as a result of thenucleolysis and plasmolysis. Levaditi’s experiments showedthat the spirochsetse stimulated the cells to proliferate, andthen, invading this bed of young cells rich in nuclein, they,by the action of some secretion or otherwise, caused thesesame embryoric cells to undergo lysis, so providing thenecessary pabulum for their own growth. Probably the youngcells were more easily attacked than the old cells, and thismight account for the great number of spirocbastas in foetaltissues.

Although it was known that the syphilitic virus inducedmetabolic processes whereby larger amounts of lipoidsoccurred in the serum and in the cerebro-spinal fluid in

general paralysis and tabes, yet as these lipoids were foundin the normal tissues and fluids, the specific character wasmanifested by quantity rather than quality. The substanceswhich in haemolysis played the part of antigens werelecithins, and those which played the part of antibodies werepossibly complexes of cholesterin. Dr. Mott then pro-ceeded to describe the serum diagnosis of syphilis bythe Wassermann method by fixation of the complement.(An interesting paper upon this method was readat the recent Australasian Medical Congress upon whichwe comment in an annotation on p. 481.) Briefly it was

conducted as follows. The blood corpuscles of a sheep