1154.

and we are inclined to agree with the views of Burri, whoholds that it is. necessary to work with cultures derived from

single organisms if absolutely reliable results are to be

obtained, though we recognise the great practical difficultiesinvolved. The facts that the search for colon bacilli is

usually made in certain limited materials, the isolation ofthe germ secured by the use of severely eliminating media,and its culture conducted on a few media and under limitedand fixed conditions, make the stability of their propertiesappear greater than it really is, as the variants are crushedout. It is the existence of these conditions which makesthe instability of less importance than it would otherwise bein differentiating members of the colon group, and, as

Houston has shown, secures a reasonable permanence of

type. At the same time it is recognised that the propertiesare not stable or that the chemical activities possessed by amicrobe are not always exercised. Indol formation is veryvariable and may be artificially checked or encouraged ;fermentative power may be acquired, as has been shown byTwort in relation to dulcitol, and though in the research hereconsidered the results are regarded by the author as negative,yet great modifications in the rapidity and amount of fer-mentation and other alterations were produced, so that strainsquite unrecognisable as colon bacilli were obtained.

TOWN PLANNING IN GREATER LONDON.

A CONFERENCE of local authorities to consider the questionof town planning in Greater London will be held, under theauspices of the National Housing and Town PlanningCouncil, at Caxton Hall, Westminster, London, on Friday,May 6th, at 10.30 A.M. Invitations to attend the con-

ference are being sent to the London County Council and to88 local authorities in the Home Counties possessing statutorytown planning powers in the Greater London area. It is desiredto impress upon the conference the great importance of the newpowers granted under the Housing and Town Planning Act,1909, and to secure harmonious action between all the autho-rities in regard to those features of town planning whichaffect the development and amenities of Greater London as awhole. Further particulars may be obtained from the secre.tary, Mr. Henry R. Aldridge, National Housing and TownPlanning Council, 4, Tavistock-square, London, W.C. The

questions involved under the inclusive heading of town

planning are many of them of the greatest medical import-ance, as we have pointed out on several occasions, and wehope that the professional voice will make itself heard at thisconference.

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THE USE OF TUBERCULIN IN THE TREATMENTOF PULMONARY TUBERCULOSIS.

IN another column we publish an article by Dr. H. *Warren Crowe on a New Method of Treating Acute

Phthisis by the Alternate Use of Human and Bovine

Tuberculin. His paper may be divided into two parts, thefirst detailing his method of treatment, and the secondcertain theoretical considerations which require careful.

study and comparison with the results of other observersbefore they can be fully accepted. Dr. Crowe adopts theplan followed by other physicians in employing very smalldoses of tuberculin (1/100,000th milligramme). He expresseshis opinion that in "active phthisis," with a rectal tem-perature ranging above 100° F., a further rise of tem-

perature, commencing sooner or later, and lasting a longeror a shorter time, is the most usual result of the smallestefficient dose of tuberculin. This is, however, contrary tothe opinions of several English and foreign observers, whomaintain that tuberculin given in small doses has an

antipyretic action. It would be difficult to distinguish thesubsequent rise described by Dr. Crowe from the effect of the

disease. The use of bovine tuberculin has been describedfrom time to time, but Dr. Crowe states that a prolongedreaction resulting from the use of either human or bovinetuberculin can be cut short by a dose of the other providedthat there has been developed some degree of hypersensitive-ness to the form of tuberculin which excites the reaction. He

then describes the method in detail, and offers three theoreticalconsiderations : 1. "Auto-inoculations theoretically must

have a greater curative action than therapeutic inoculationsof tuberculin in the treatment of phthisis (whether acute orchronic)." " This opens up a large field of conjecture, for

auto-inoculation as a therapeutic measure has not yet had asufficiently long trial to afford a definite answer to this pro-position. 2. " Tuberculin treatment causes hyperasmia atthe lesion." This is generally accepted. 3. Inoculation oftuberculin causes auto-inoculation. Dr. Crowe’s remarks

raise interesting questions which cannot be settled in the

space devoted to the subject in his paper. His observations

are suggestive, but we believe that the subject has alreadyreceived attention on the Continent. The tuberculin treat-ment has been carried out in such different ways thattime alone can settle the most advantageous manner in whichit can be administered.

ACUTE ARTHRITIS OF DOUBTFUL ORIGIN.

MANY cases occur in which acute inflammation of a jointappears without any obvious cause and without any definiteindications as to the exact nature of the condition present.Dr. G. Burnside Buchanan of Glasgow has contributed a

paper to this issue of THE LANCET in which he has relateda number of these cases and has detailed the course

of the disease and the treatment which he adopted.In many cases such as these there is no little risk

that a diagnosis of rheumatism may be made, and

often the greatest care is required to ensure that

this mistake is not committed. Acute epiphysitis is

one of the commoner of the conditions leading to acute

arthritis arising without obvious cause, and a timelydiagnosis of the site of the lesion, followed by incision anddrainage of the focus of disease, will often result in a rapidand complete healing. When it is possible to recogniseearly, and with certainty, whether an inflammation is rheu-matic in origin or not, surgeons will be in a better position-to deal satisfactorily with the obscure forms of arthritis ably

discussed in Dr. Buchanan’s paper.ON PUERPERAL AMAUROSIS.

IN a recent number of the Ophthalmoscope (March, 1910)Mr. Sydney Stephenson and Dr. W. P. Herringham recordtwo cases of temporary blindness without ophthalmoscopicsigns, associated with albuminuria in primiparag. In one

case there was eclampsia, but not in the other. Such caseshave commonly been reported as uræmic, but to this

designation the writers offer potent objections. In an

exhaustive and critical review of the literature of the

subject, which is to be commended strongly to the

notice both of obstetricians and ophthalmologists, cases

of amaurosis or amblyopia reported as occurring in

pregnancy, during labour, and post partum are described.Well-reasoned comments upon the material thus collectedlead the writers to the following conclusions :--1. A formof amaurosis or amblyopia, not accompanied by ophthalmo-scopic signs, or, at least, by none adequate to account forthe condition, may supervene during pregnancy, parturition,or the puerperium. 2. Rarely it may assume the form of anhemianopic defect or of a central scotoma in the fields ofvision, or still more rarely of night-blindness. (The writersuse the term "hemeralopia" " for night-blindness. Owing.