334

A further report was received from the committee ofmanagement of the same date and was adopted. The reportrecommended that the South-Eastern College, Ramsgate,should be added to the list of institutions recognised by theExamining Board in England for instruction in chemistryand physics.A list of books and other publications presented to the

library during the past quarter was received and the thanksof the College were given to the donors. The annual returnby the examiners of the results of the examinations for theLicence in the year 1905 was received and adopted.The PRESIDENT then dissolved the Comitia.

THE MORISON LECTURES.

THE first of these lectures was delivered in the hallof the Royal College of Physicians, Edinburgh, on

Jan. 24th, by Dr. W. Ford Robertson, pathologist to theScottish Asylums, the subject being "The Pathology ofGeneral Paralysis of the Insane." The lecturer firstremarked upon the prevalence and recent increase of

general paralysis. He said he intended to devote the timeat his disposal mainly to a consideration of the results of theinvestigations made by his colleagues and himself. After re-ferring to the current opinions regarding the pathology of thedisease and briefly describing the chief pathological changesthat were known to occur in the central nervous system,he proceeded to give an account of the researches that hadbeen carried out in the laboratory of the Scottish Asylumsand at Morningside and Murthly Asylums. Convinced thatthe syphilitic hypothesis did not fully account for the factsand that general paralysis was the result of some form ofactive bacterial toxsemia, he had set himself to endeavour tolocalise the seat of origin of the toxins and to ascertain theexact nature of the toxaemia. About the same time Dr.Lewis C. Bruce had made independent clinical observationshaving the same aim. In 1901 Dr. Bruce had published apaper in which he descrioed the results of observationsupon the temperature and the leucocytes, and in whichhe endorsed Dr. Macpherson’s opinion that the mostcharacteristic temperature in general paralysis was a

recurrent febrile attack every one or two weeks. Healso found that in the first and second stages the rises oftemperature were accompanied by leucocytosis, whilst in thethird stage there was often leucocytosis independently ofany rise of temperature. Dr. Bruce contended that these

phenomena pointed to the disease being directly due topoisoning by bacteria, the point of attack of which was

probably the gastro-intestinal mucous membrane. Thelecturer in a paper published at the same time had advancedevidence from the pathological side in support of the sameview. He found that there was constantly a severe degreeof chronic atrophic catarrh affecting the stomach or smallintestine, or both, and that the morbid changes appeared tobe associated with excessive development of bacteria in thealimentary tract.

Further evidence of the occurrence of a chronic toxasmiahad been found by Dr. Ainslie who examined numerousarteries from various parts of the body and found that acondition of chronic endarteritis was constant and oftenextremely well marked, though irregular in distribution,even in cases of general paralysis in which senility could beexcluded. About the same time Dr. D. Chalmers Watson hadadvanced very similar views regarding the pathogenesis oftabes dorsalis. In 1902 the lecturer, along with Dr.G. Douglas McRae and Dr. J. Jeffrey, had commenced abacteriological research. They found that a diphtheroidbacillus was specially prominent in the gastro-intestinal andrespiratory tracts in cases of general paralysis and that asimilar organism could frequently be isolated from the brain.They advanced the hypothesis that general paralysis of theinsane was the result of a chronic toxic infection from therespiratory and alimentary tracts, permitted by general andlocal impairment of the defences against bacteria and

dependent upon the excessive development of variousbacterial forms but especially upon the abundant growth ofa Klebs-LZ5ffler bacillus of modified virulence which gave thedisease its special paralytic character. In their later in-

vestigations Dr. McRae and he had simply been putting thishypothesis to the test and every step forward had been

attended with the elucidation of some fresh fact that hadrendered it more probable. He had himself made histologicalinvestigations which were confirmatory of the views advanced.In the course of these investigations the thread form of thediphtheroid organism was discovered. Along with Dr.T. Shennan he had carried out a short series of experimentalinvestigations. It was ascertained that the bacilli isolatedfrom cases of general paralysis were non-virulent to guinea-pigs. Rats fed upon bread mixed with unsterilised brothcultures of the bacilli developed nervous symptoms and diedin about ten days. Beyond question these animals presentedevidence of the occurrence of many of the morbid processesthat can be recognised in the nervous system of the generalparalytic but they survived too short a time to make it

possible for the complete histological picture to be de-

veloped. In four of the animals there was a wide-

spread invasion of the tissues by the filamentous formof the organism. He also referred to an experimentalobservation made upon a goat by Dr. Bruce which hadyielded results confirmatory of the view that this bacilluswas capable of producing toxic effects resembling those to beobserved in general paralysis. In May of last year he andDr. McRae had reported that they had found that diph-theroid bacilli were constantly present, often in very greatnumbers, in the genital tract of both male and femalegeneral paralytics. They had also found similar organismsin the same situation in many cases that were not cases of

general paralysis. In seven consecutive cases of generalparalysis combined with tabes dorsalis they had found theurine to be loaded with diphtheroid bacilli. They had nowobtained a growth of a diphtheroid bacillus from the brainpost mortem in nine cases of general paralysis out of 23in which cultures had been made from this organ. Morerecently they had examined the cerebro-spinal fluid removedby lumbar puncture from five cases of general paralysis. Inthe centrifuge deposit from three of these they had been ableto recognise bacilli which had very little affinity for stainingreagents but which nevertheless could not infrequently beseen to have the morphological characters of diphtheroidbacilli. They had also found that similar organisms couldbe observed in the fresh blood of general paralytics duringcongestive attacks. These and other similar observationshad raised the question whether diphtheroid bacilli were notfrom time to time gaining access to the blood and beingrapidly destroyed by phagocytic and lysogenic actions.Along with Dr. McRae he had investigated this point byexperimental methods.

CENTRAL MIDWIVES BOARD.

A MEETING of this Board was held on Jan. 25th at 6,Suffolk-street, London, Dr. F. H. Champneys being in thechair.A letter from the Clerk of the Privy Council was read

transmitting a copy of a resolution passed by the guardiansof the Lutterworth union suggesting the reduction from 20 toseven of the number of midwifery cases qualifying a

candidate to enter for the Board’s examinations. The

answer of the Board was that it did not approveof the suggested reduction. A communication was re-

ceived from Dr. A. J. Wallace asking for the opinionof the Board as to his right in certain circumstances torefuse to sign the certificate of instruction required underthe regulations from candidates entering for the Board’sexaminations. After some discussion it was determined thatit was outside the jurisdiction of the Board to decide whetheranyone was bound to certify and an answer to that effectwas directed to be sent to Dr. Wallace. A letter was thenread from Dr. T. Eustace Hill, county medical officer ofDurham, as to the extent of the exemption conferred byRule E 21. This rule provides that nothing in Section E ofthe rules framed under the Midwives Act " shall apply tocertified midwives exercising their calling in hospitals, work-houses, or Poor-law infirmaries under the supervision of aduly appointed medical officer." Section E contains the rulesfor regulating, supervising, and restricting within due limitsthe practice of midwives. The reply of the Board to Dr.Hill was to refer him to the Midwives Act and to the rulesframed under it in accordance with that part of Section 3 ofthe Act dealing with the duties and powers of the Board.