No abstract

CONCRETIONS IN A LACRYMAL CANALICULUS is in some other countries, as to the evolution of the disease. But in 1905 I adopted a-definite scheme of classification of the stages of trachoma which enabled us to appreciate the need for different modes of treatment in different stages. This classification was published first in 1912 (Report of the Ophthalmic Section of the Department of Public Health, Government Press, Cairo, p. 7), after a trial in Egypt for seven years. It is still used in all hospitals and schools in Egypt. Before treatment it is advisable to make certain that' the conjunctival change is really due to trachoma by observation of early pannus vessels with the corneal loupe or slit-lamp. There-is no doubt that in some people trachoma is a very mild disease, requiring very mild treatment, and this is more frequent in some countries, such as India, than in others, such as Egypt. Equally witlh Wright I regret that there has been no marked improvement in the methods of treatment during the last 30 years. 6. Lieut.-Col. Wright says, "In view of the fact that there is such widespread interest in the problem (of the aetiology of trachoma) and that the recent literature indicates a more concentrated effort, it may not be out of place to suggest that an attempt be made to abstract the international literature and present it under the different headings of investigation in an orderly and abbreviated form available to future investigators in any of the different fields for easy reference." As President of the International Organization against Trachoma I am glad to inform him that Dr. Wilson, the Director of the Memorial Ophthalmic Laboratory in Egypt, has consented to undertake this task, as his contribution to the annual meeting of the Organization, which will take place at the time of the International Congress of Ophthalmology in December, 1937. CONCRETIONS IN A LACRYMAL CANALICULUS CAUSED BY ACTINOMYCES* BY A. CHARLOTTE Ruys, M.D. AMSTERDAM Dr. A. Hagedoorn who observed the patient and made the diagnosis sub,blied the clinical data. A COUNTRY woman, 30 years of age, suffered from epiphora and discharge for more than 2 years. A little swelling and redness was noticed at the site of the right lower canaliculus. On pressure A paper read before the Ophthalmological Society of Holland, December 16, 19,4. 385 copyright.

his faculties for the service of his profession and expected others to do the same. He gave all the remarkable energy, unsurpassed skill, and exquisite gentleness he possessed fully and freely to his work. He made no excuses for himself and would accept none from his subordinates. He was never completely satisfied with any operation, always thinking he might have done something a little better, ever striving after an ideal which none could reach. He Blair (1931 ;, Kauffmann (1931), Ruys (1934), andLeifson (1935). Eberthella typhosa /In the isolation of E. typhosa from faeces and urine the results with Wilson and Blair's old standard medium (glucose-bismuth -sulphite -phosphate-iron -sulphate-agar) exceeded those obtained with the culture medium of L. Muller (tetrathionate broth), which is often spoiled by the growth of proteus bacteria. The Wilson medium is highly selective; so it is possible to make rather heavy inoculations, giving a better chance of success. Some difficulties in the preparation of the medium were overcome when we used ferrous sulphate crystals precipitated in alcohol ; the solution contained so little ferric salts that it was perfectly clear. Also, we employ only freshly prepared media. After pouring the mixture into Petri dishes it is allowed to evaporate and cool without covering. Without further drying the medium is ready for use; it should not be stored.A few drops of the faeces suspension are smeared on the surface. Besides this we always mix some of the fluid medium in dishes with 1 c.cm. and 4 c.cm. of the faeces suspension, a method also recommended by Wilson (1938). In most cases these pour-plates are superfluous, but sometimes they give a positive result which could not be obtained otherwise. In one case, only once were both pour-and smear-plates positive, but the pour-plates alone yielded typhoid colonies on four occasions. Neither by the Endo plates nor by the Muller broth could typhoid bacilli be isolated. Wilson-Blair positive 57 Table I indicates that it is not sufficient to rely on Wilson and Blair's medium alone. As the tetrathionate broth was not very satisfactory I tried Kauffmann's medium, which consists of tetrathionate broth, bile, and brilliant-green. It is recommended by that author as an improvement on the plain Muller broth. The results are recorded in Table I1. For over a year I also tried Kauffmann's medium in comparison with the previously mentioned media, but, * In experiments on the swarming of B. proteus in agar media the inhibiting effect of Esbach's reagent was first pointed out by I)imitrijevic-Speth (1929).

The main still unexplained aspect of the epidemiology of poliomyelitis is the question, whether for the genesis of epidemics only the spread of the viruses and the immunity status of the population are responsible or whether there are other factors necessary to start an epidemic. The preference of the disease for the summer and autumn months in epidemics as well as in the interepidemic periods is well known. In this polio season also the viruses circulate more widely in the community. This could be demonstrated by Fox e. a. (1) in the healthy families which were under constant supervision for the presence of polioviruses. From sewage polioviruses could be isolated only in summer and autumn (Kelly e. a.) (2).The poliomyelitis accident in Idaho (3) caused by the Cutter vaccin containing live virus did not grow out to a large scale epidemic presumably because it happened in the unfavourable month of April.There can be two explanations for the seasonal predisposition for poliomyelitis epidemics :1. Climatic conditions could favour the spread of the viruses and thereby the frequency of the disease; 2. the weather could influence the resistance of the host or the aggressiveness of the parasite.With these problems in mind a study was made of the spread of the poliovirnses and the immunity status in the families of poliomyelitis patients. MaterialFrom Dec. 1956--Sept. 1958 266 cases of poliomyelitis were notified in the Netherlands of whom 53 (20%) were nonparalytic. Our study was limited to 104 patients of whom 15 suffered from a non-paralytic form (15%). These patients belonged to 101 families and in 74 the diagnosis was confirmed by

No abstract