CENTRAL MIDWIVES BOARD.

334 received from the committee of date and was adopted. The report recommended that the South-Eastern College, Ramsgate, should be added to the list of institutions recognised by the Examining Board in England for instruction in chemistry and physics. A list of books and other publications presented to the library during the past quarter was received and the thanks of the College were given to the donors. The annual return by the examiners of the results of the examinations for the Licence in the year 1905 was received and adopted. The PRESIDENT then dissolved the Comitia. A further

report

management of the

was

same

THE MORISON LECTURES. THE first of these lectures was delivered in the hall of the Royal College of Physicians, Edinburgh, on Jan. 24th, by Dr. W. Ford Robertson, pathologist to the Scottish Asylums, the subject being "The Pathology of The lecturer first General Paralysis of the Insane." remarked upon the prevalence and recent increase of general paralysis. He said he intended to devote the time at his disposal mainly to a consideration of the results of the investigations made by his colleagues and himself. After referring to the current opinions regarding the pathology of the disease and briefly describing the chief pathological changes that were known to occur in the central nervous system, he proceeded to give an account of the researches that had been carried out in the laboratory of the Scottish Asylums and at Morningside and Murthly Asylums. Convinced that the syphilitic hypothesis did not fully account for the facts and that general paralysis was the result of some form of active bacterial toxsemia, he had set himself to endeavour to localise the seat of origin of the toxins and to ascertain the exact nature of the toxaemia. About the same time Dr. Lewis C. Bruce had made independent clinical observations having the same aim. In 1901 Dr. Bruce had published a paper in which he descrioed the results of observations upon the temperature and the leucocytes, and in which he endorsed Dr. Macpherson’s opinion that the most characteristic temperature in general paralysis was a He recurrent febrile attack every one or two weeks. also found that in the first and second stages the rises of temperature were accompanied by leucocytosis, whilst in the third stage there was often leucocytosis independently of any rise of temperature. Dr. Bruce contended that these phenomena pointed to the disease being directly due to poisoning by bacteria, the point of attack of which was probably the gastro-intestinal mucous membrane. The lecturer in a paper published at the same time had advanced evidence from the pathological side in support of the same view. He found that there was constantly a severe degree of chronic atrophic catarrh affecting the stomach or small intestine, or both, and that the morbid changes appeared to be associated with excessive development of bacteria in the

alimentary

tract.

Further evidence of the occurrence of a chronic toxasmia had been found by Dr. Ainslie who examined numerous arteries from various parts of the body and found that a condition of chronic endarteritis was constant and often extremely well marked, though irregular in distribution, even in cases of general paralysis in which senility could be excluded. About the same time Dr. D. Chalmers Watson had advanced very similar views regarding the pathogenesis of tabes dorsalis. In 1902 the lecturer, along with Dr. G. Douglas McRae and Dr. J. Jeffrey, had commenced a bacteriological research. They found that a diphtheroid bacillus was specially prominent in the gastro-intestinal and respiratory tracts in cases of general paralysis and that a similar organism could frequently be isolated from the brain. They advanced the hypothesis that general paralysis of the insane was the result of a chronic toxic infection from the respiratory and alimentary tracts, permitted by general and local impairment of the defences against bacteria and dependent upon the excessive development of various bacterial forms but especially upon the abundant growth of a Klebs-LZ5ffler bacillus of modified virulence which gave the disease its special paralytic character. In their later investigations Dr. McRae and he had simply been putting this hypothesis to the test and every step forward had been

attended with the elucidation of some fresh fact that had rendered it more probable. He had himself made histological investigations which were confirmatory of the views advanced. In the course of these investigations the thread form of the diphtheroid organism was discovered. Along with Dr. T. Shennan he had carried out a short series of experimental investigations. It was ascertained that the bacilli isolated from cases of general paralysis were non-virulent to guineapigs. Rats fed upon bread mixed with unsterilised broth cultures of the bacilli developed nervous symptoms and died in about ten days. Beyond question these animals presented evidence of the occurrence of many of the morbid processes that can be recognised in the nervous system of the general paralytic but they survived too short a time to make it possible for the complete histological picture to be developed. In four of the animals there was a widespread invasion of the tissues by the filamentous form of the organism. He also referred to an experimental observation made upon a goat by Dr. Bruce which had yielded results confirmatory of the view that this bacillus was capable of producing toxic effects resembling those to be observed in general paralysis. In May of last year he and Dr. McRae had reported that they had found that diphtheroid bacilli were constantly present, often in very great numbers, in the genital tract of both male and female general paralytics. They had also found similar organisms in the same situation in many cases that were not cases of general paralysis. In seven consecutive cases of general paralysis combined with tabes dorsalis they had found the urine to be loaded with diphtheroid bacilli. They had now obtained a growth of a diphtheroid bacillus from the brain mortem in nine cases of general paralysis out of 23 postwhich cultures had been made from this organ. More in recently they had examined the cerebro-spinal fluid removed by lumbar puncture from five cases of general paralysis. In the centrifuge deposit from three of these they had been able to recognise bacilli which had very little affinity for staining reagents but which nevertheless could not infrequently be seen to have the morphological characters of diphtheroid bacilli. They had also found that similar organisms could be observed in the fresh blood of general paralytics during congestive attacks. These and other similar observations had raised the question whether diphtheroid bacilli were not from time to time gaining access to the blood and being rapidly destroyed by phagocytic and lysogenic actions. Along with Dr. McRae he had investigated this point by experimental methods.

CENTRAL MIDWIVES BOARD. of this Board was held on Jan. 25th at 6, Suffolk-street, London, Dr. F. H. Champneys being in the chair. A letter from the Clerk of the Privy Council was read transmitting a copy of a resolution passed by the guardians of the Lutterworth union suggesting the reduction from 20 to seven of the number of midwifery cases qualifying a candidate to enter for the Board’s examinations. The of the Board was that it did not approve answer A communication was reof the suggested reduction. ceived from Dr. A. J. Wallace asking for the opinion of the Board as to his right in certain circumstances to refuse to sign the certificate of instruction required under the regulations from candidates entering for the Board’s examinations. After some discussion it was determined that it was outside the jurisdiction of the Board to decide whether anyone was bound to certify and an answer to that effect was directed to be sent to Dr. Wallace. A letter was then read from Dr. T. Eustace Hill, county medical officer of Durham, as to the extent of the exemption conferred by Rule E 21. This rule provides that nothing in Section E of the rules framed under the Midwives Act " shall apply to certified midwives exercising their calling in hospitals, workhouses, or Poor-law infirmaries under the supervision of a duly appointed medical officer." Section E contains the rules for regulating, supervising, and restricting within due limits the practice of midwives. The reply of the Board to Dr. Hill was to refer him to the Midwives Act and to the rules framed under it in accordance with that part of Section 3 of the Act dealing with the duties and powers of the Board. A

MEETING