985FACTORS IN SEXUAL IMPOTENCE.

by the absence of any trace of haemosiderosis in itas by the failure of any beneficial effect from itsablation. As to the seat of the haemolysis, it is notthe spleen-for the foregoing reasons-nor the liver,nor the bone-marrow, nor the lymphatic glands,since it is impossible to imagine that globular destruc-tion could take place in these organs without leavingthe necessary residual changes. Haemolysis in thecirculating blood is not reconcilable with the absenceof splenic enlargement, of siderosis in the liver, or

of copious urobilinuria, and with the fact observedby Micheli that the amount of iron, which is increasedin the urine, remains normal in the faeces. Thered cell destruction must therefore take place inthe vascular system of the kidneys, and occurs intwo ways, one persistent and slow by the transforma-tion of the heamoglobin into haemosiderin in the

protoplasm of the renal epithelium, the other rapidand violent, whence the recurrent haemoglobinuriccrises. The disease, of which the case described isan example, is a form of anaemia of a special typewhich is easily distinguishable from all other forms-i.e., haemolytio splenomegaly, pernicious anaemia, andthe various forms of hsemoglobinuria. Micheli pro-poses to give to this disease the name of " haemolyticanaemia with haemoglobinuria and haemosidinuria."But considering that the haemoglobinuria shows itselfonly by crises at variable intervals and sometimes asin the first case described by Nazari once only in thelong course of the disease, and considering that onthe contrary the haemosiderinuria is constant andpersistent up to the day of death, it appears thatthe greater importance is attached to this, and thatthe proper appellation should be haemolytic anaemiawith persistent hoemosiderinuria.

FACTORS IN SEXUAL IMPOTENCE

THE sexual neurotic is unhappy not only becauseof his disability but because he is generally in despairof finding anyone who is prepared or able to helphim. As Mr. Townley Clarkson pointed out last

Friday at a meeting of the Society for the Study ofVenereal Disease, impotence lies in the no-man’sland of ailments between the neighbouring claims ofthe genito-urinary surgeon and the neurologist. The

surgeon, as a rule, has little time for what he toofrequently regards as a minor ailment, whilst theneurologist, skilled though he be in the treatment offunctional disorders, has little expert knowledgeof the organic lesions that may attack the organs ofsex. Mr. Kenneth Walker, in his opening paper atthe same meeting, laid stress on the psychologicalfactors in the causation of impotence. Even whenan organic lesion is found it is more likely than notthat this has served only as a nucleus around whicha functional trouble has formed. This indeed is themanner in which many other functional disordersarise, and although the elimination of the originallesion may be part of the treatment, a cure will notbe effected unless the psychological difficulties towhich the lesion has given rise are got rid of. It was,he pointed out, a matter of considerable difficultyto interpret the exact significance of the changeswhich were found in the genital tract of sufferersfrom primary impotence. These changes were wellrecognised by genito-urinary surgeons, and consistedof a swelling and tenderness of the prostate, andparticularly of that portion of it known to anatomistsas the verumontanum. Sometimes, when thetrouble had been preceded by a prostatitis, these

changes were definitely the cause of the impotence,but more often than not no history of infection could

be obtained, and the changes in his opinion mustbe considered secondary rather than primary.Functional disorders were often associated with anupset in vaso-motor control, and the swollen andhyperaesthetic verumontanum of impotence was a

phenomenon similar in nature to the tache cérébraleof hysteria. But while laying emphasis on the

psychological factors in the causation of primaryimpotence, the physical investigation of the genitaliawas, in Mr. Walker’s opinion, of the very greatestimportance, not only because of the necessity of

discovering any organic lesion that might be present,but because it was only by being thorough that thepatient’s confidence could be gained.i

THE NEGATIVE PHASE IN ANTIDIPHTHERIAL

IMMUNISATION.

Dr. Richard Prigge 1 has been carrying out investi-gations in the State Institute for ExperimentalTherapeutics at Frankfurt a.M. to determine whetheractive immunisation of guinea-pigs against diphtheriaproduces a so-called " negative phase " or increasedsusceptibility to the disease. He found that guinea-pigs which had been immunised against diphtheriatoxin or living diphtheria bacilli did not show anyincreased susceptibility to diphtheria toxin before

immunity was obtained, nor any increased suscepti-bility to infection by diphtheria bacilli providedthat the doses of the vaccine were not too high.Increased susceptibility was only produced when alarge overdose of the vaccine had been used. He wasunable to decide whether a negative phase in theordinary sense of the term had taken place in thisexperimental intentional overdosage which is not

likely to occur in the human subject, or whether thesymptoms were merely the result of an excessivelylarge dose of vaccine. In human inoculation of

diphtheria toxin the dose employed is 1 to 200 timessmaller than that used in experiments on animalswithout causing an increase in susceptibility. The

experiments strongly suggest that the developmentof increased susceptibility, or of the so-called nega-tive phase, can be excluded in human inoculation

against diphtheria. ____

TESTICULAR GRAFTS ON RAMS.

THE somewhat extravagant claims made bygrafting enthusiasts have induced two Australian

veterinary surgeons, Mr. R. M. C. Gunn and Mr. H. R.Seddon, to repeat the experiments carried out byVoronoff and record their results.2 The rams usedwere divided into three groups. In the first groupthe object was to determine the fact of testiculartissue being viable after being grafted for varyingperiods into the scrotum of young male rams. Thesecond group was employed to determine whetherincreased production and hastened maturity couldbe obtained by means of the testicular grafts, and thethird to determine whether old senile sterile rams couldbe reinvigorated and rejuvenated. The operativetechnique employed was that which V oronoff hasmade familiar. The conclusions arrived at were asfollows : (1) Normal living, but not growing, testicularand epididymal tissue can be recovered as long as24 days after grafting merino ra-ms. (2) Absorptionof testicular tissue grafted on the parietal tunicavaginalis of the scrotum appears to be rapid, usuallyoccurring in young rams within one year. (3) Thereis no good evidence of any beneficial influence on body-

1 Med. Klinik, March 20th, p. 419.2 Austral. Vet. Jour., Sept. and Dec., 1930.

986 PLANKTON AND BACTERIA IN SEWAGE.

weight or wool-production as a result of testicular

grafting or of injections of pulped testis or salineextract of testis. The operations were done with aproper use of control animals and in a critical attitudeof mind. Whilst the results seem to establishVoronoff’s contention that grafts implanted by themethod he recommends are viable, they clearlyindicate that they do not live so long as he supposed.Gunn and Seddon point out that any beneficialeffect produced by the absorption of grafts can be ofvery little importance since the storage capacity oftesticular tissue is infinitesimal. Apparently, therefore,testicular grafting is not likely to be of muchuse either in human or in veterinary practice. In

any case its high cost would limit its utility in thestock-breeding yard.

____

TRACHOMA IN POLAND

AMONG the general population of Poland theincidence of trachoma is estimated at about 1 to 1-5

per cent. It had a great stimulus after the warwhen about 3,000,000 refugees were repatriated fromRussia. In 1919 compulsory notification was enactedand the numbers notified rose continuously between1920 and 1929. The measures taken to combat the

scourge are told by Dr. M. Zachert, chief of the anti-trachoma service. 1 Special dispensaries, hospitals,and mobile units have been founded and the numberof cases treated in 1929 at these institutions wasover 35,000. Periodical examinations are made inthe schools and among recruits, children’s refuges,and orphanages. Thirteen special hospitals fortrachomatous children have been founded, each

hospital having a school so that the children’s educa-tion can be carried on uninterruptedly just as it isat Swanley. The results obtained in these hospitalshave been distinctly good. Out of 6640 childrenadmitted in ten years 5157 have been cured. Whereasin 1924 the percentage of trachomatous children inthe orphanages was 13 per cent., in 1929 it wasreduced to 5 per cent. We are not told in what theroutine treatment producing this result consisted.Besides the hospitals for children there were in 1929260 dispensaries treating over 31,000 trachomatouspatients and two mobile hospitals in which opera-tions were performed. An important part of the

campaign is the holding of special trachoma classesfor doctors at the State School of Hygiene, thenumber of doctors having attended these courses

being 220. The whole campaign is financed by theState, the amount allocated to it in the budget of1929 being a million and a half French francs.

PLANKTON AND BACTERIA IN SEWAGE.

THE role of bacteria in the purification of sewagehas been recognised for the last 40 years, and it is wellknown that the bacterial flora of an effluent is, undersuitable conditions, an efficient oxidising agent.The less numerous but nevertheless large populationof infusoria or protozoa always found in sewage andpolluted waters has been less carefully studied,although the presence of such organisms has beenrecognised as collateral evidence of pollution. Inthe sea the drift of this vast population of feeblymotile organisms, conveniently known as plankton,determines the movements of the fish which feed onit, for the plankton is to the sea what the grass is tothe land. The United States Public Health Servicehas been conducting researches on the more intimate

1 Bull. Off. Int. d’Hyg. Publ., March, 1931.

mechanism of sewage pollution, and in a recent reportxC. T. Butterfield, W. C. Purdy, and E. J. Theriaulthave described the influence of typical plankton onthe biochemical oxidation of organic matter. Havingprepared dilute dextrose-peptone solutions whichcould be readily and accurately reproduced, andwhich could be kept, when sterile, for long periodswithout absorbing the oxygen of the air dissolved inthem, they studied the effect of inoculation withvarious bacteria. These in all cases multipliedrapidly and absorbed oxygen until in about two daysa limit of both bacterial population and oxygenabsorption was reached, this state being sooner

and more definite with pure culture than with mixed

organisms. A technique having been devised wherebycolpidium, a small paramecium-like organism, couldbe washed and kept free from bacteria, cultures ofthis were introduced into the dilute (5 mg. per litreand sterile dextrose-peptone medium in which theydid not multiply, although they throve fairly well in amedium a hundred times the strength, showing thata certain concentration of food was necessary if theywere to be kept alive on a slop diet. When introducedinto solutions seeded with bacteria the result was verydifferent. The bacteria increased as before, but as the-protozoa also increased their numbers fell off to afairly steady figure and both kinds of organisms livedtogether, oxygen absorption going on steadily as itdoes in naturally polluted water. It seems thereforethat in this, as in similar cases among the higher-animals, a balance of vegetable and animal life, offood collectors and food consumers, is reached. The-

only stable communities are complex ones, the

predatory members of which, by taking their tollof the others, enable them in the mass to live success-fully and to fulfil their natural functions, which inthis case, from an economic standpoint, is the collectionof putrescent colloid and other matter for oxidation.Protozoa, it would therefore seem, are useful membersof biological filters, and their presence is vitallynecessary in activated sludge.

THE GROWTH OF VISUAL PERCEPTION INCHILDREN.

IT has been frequently suggested both by physio-logists and psychologists that perception is subjectto laws of its own ; that, in fact, these are veryelementary compared with the appreciations of theexternal world in which fully fledged intelligence isin operation. The work of the Spearman school,which has given an impulse and new direction to themathematical assessment of general intelligence (orrather the function " g "), has led to the explorationof the whole process of cognition by means of graduatedtest material. With this guiding principle of methodin the forefront of the investigator’s mind, the specialabilities in man were investigated separately andcorrelated with such particular functions as imagina-tion, and with the processes involved in practice,fatigue, and perseveration. It is inherent in theSpearman theory that perceptual experience whichfalls within the laws of cognition should also beobedient to the same laws of the mind, as the higherprocesses of cognition-that is, the eduction of rela-tions and the eduction of correlates.

Prof. W. Line,2 working in the school of Spearman,has come to the conclusion, from carefully calibratedtests, that it is futile to use separate tests for perceptual

1 U.S. Treasury Dept. Public Health Reports, 1931, xlvi.,393-426.

2 Monograph Supplement XV., Brit. Jour. of Psychol., 1931,12s. 6d.