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VALUE IN DISINFECTION.
472 deviation of the aorta, the large vessels, and inferior venacava. Of 195 deaths studied by Bachman, 116, or 59-4 per cent., were due to cardiac failure and 24 to tuberculosis. The usual symptoms are dyspnoea, due at first to pulmonary atelectasis and emphysema, and later to myocardial insufficiency, cyanosis, and oedema of the legs. Attacks of palpitation and pain may occur in crises. The pulse is not infrequently rapid and may be irregular. As the myocardial insufficiency progresses, dyspnoea, cyanosis, and oedema become more marked, the liver becomes enlarged, the excretion of urine is greatly diminished, and anasarca and ascites may ensue. The prognosis in patients with kyphoscoliosis depends mainly upon the reserve power of the heart. It is unfavourable when once the signs of myocardial insufficiency are established, and the end is frequently precipitated by intercurrent pulmonary affections. Dr. Boas’s patient was a woman, aged 29, in whom scoliosis was first noted at the age of 9, and had slowly and progressively become worse. For 10 years she had suffered from attacks of giddiness appearing every month, and for about five years from dyspnoea on exertion. Examination showed the case to be one of paroxysmal auricular fibrillation with symptoms of myocardial insufficiency. The issue of the case is not recorded.
the W.R. continuing positive, though he himself was in good health. Dr. Branson draws up rules as to the eligibility for insurance of lives who have had syphilis, and comes to the conclusion that those who have exhibited tertiary lesions, who have Argyll Robertson pupils, or leucoplakia of the tongue are ineligible, while increased rates must be charged for those who have had secondary manifestations and have been thoroughly treated for three years or more. He considers those who have been thoroughly treated in the primary stage and can produce evidence of negative W.R. three years or more after contracting the disease may be taken at ordinary rates. Some experienced observers would not entirely exclude cases of tertiary skin lesions, as many of these cases often live to a very considerable age. But all cases, even those giving a history of a primary sore only, should, we are convinced, be rated up. EDIBLE FUNGI. THE
latest
publication
of
the
Natural
History
Department of the British Museum is a Handbook of the Larger British Fungi,by Mr. John Ramsbottom, M.A., F.L.S., assistant in the Department of Botany. Types have been selected for description on the ground of their economic and biological interest. In dealing with the fleshy agarics the basis of selection LIFE ASSURANCE AND SYPHILIS. has been the edible or poisonous qualities of the THE bearing of syphilis upon life assurance is species, the term " edible " being used simply to discussed by Dr. W. P. S. Branson in the current imply that the fungus has been eaten without ill In this country only the field-mushroom number of St. Bartholomew’s Hospital Reports (vol. lvi., effects. (Psalliota campestris) and the horse-mushroom part 2.). Dr. Branson begins by inquiring into the incidence of syphilis among the insuring population, (P. arvensis) are commonly eaten, and for most and comes to the conclusion that the best estimate people the cultivated variety of the field-mushroom is a figure of about 10 per cent. He then discusses is the only edible fungus. Mr. Ramsbottom expresses the effects of syphilis as a lethal disease, and points regret that this is so, for many of our common toadout that it may kill as the result of (1) general paralysis stools are far more delicate in flavour than either of of the insane, (2) aortic aneurysm, (3) gummatous these. This conservatism of taste is a modern failing. disease of the cerebral vessels, (4) tabes dorsalis, Classical literature contains frequent reference to various edible and fungi, and the only way (5) epithelioma of the tongue, implanted on syphilitic in which to knowpoisonous a fungus is edible or whether leucoplakia, (6) suicide. Dr. Branson admits that there are other causes-one of the most common is poisonous is by being able to distinguish it in the same as one does other edible plants and to ascertain its cardiac failure from syphilitic disease of the coronary way record. There is, says Mr. Ramsbottom, no other way; the this increases and arteries, mortality and his handbook will serve its purpose if it popularises probably amongst syphilitics to a large extent. The author the safe use of a number of cheap and appetising food next takes up the period at which syphilis produces edible fungus contains roughly The products. fatal results and points out that general paralysis to 5 per cent. of protein nitrogen (of which probably and aortic aneurysm cause death between 30 and 50, 2 more than one-third is digestible), 5 per cent. of not while tabes, when it kills, as a rule kills late in life. 1 per cent. of fat, andto 1per cent. of He is not impressed with cerebral syphilis as a cause sugars, mineral matter. With this composition, fungi are a of death, but the statistics of the American Life Offices a showed that the mortality among syphilitics was complete food. fact established by the Fuegians, who on Cyttaria during a large part of the year. In live very high the first six years after infection, and death Central Europe, where the use of fungi as food is much Dr. was almost always due to cerebral syphilis. in Branson next discusses the question as to whether more widespread, coloured wall charts are posted an that children learn from treatment can cure syphilis. It is well known that the elementary schools, so the distinguishing marks of the poisonous syphilis has been cured by mercurial treatment as early age recommended by Jonathan Hutchinson, who noted the and non-poisonous varieties. occurrence of a second primary chancre after such treatment, and cases have been described of second infections after treatment with arsenic ; but it is probable that in the great majority of cases once syphilis has been contracted, whatever the treatment, it is always liable to recur. This is especially true when any secondary manifestations of disease have developed. Dr. Branson does not place extravagant confidence in a negative Wassermann result. The blood test may be negative whilst the cerebro-spinal fluid is positive, and it is no uncommon event for the blood to be negative to-day and positive in six months’ time. He says, however, that he considers a positive W.R. as a bar to life insurance. While agreeing with Dr. Branson that a negative W.R. is of no value as evidence of a permanent cure of syphilis, we are not so sure that a positive W.R. should be a total bar to life assurance. In a recent case a proposer, who had been perfectly well for seven years after contracting syphilis, was found to have a positive W.R., and in his anxiety to turn it into a negative one he had no less than 20 injections of neo-salvarsan in 12
VALUE IN DISINFECTION. THE Brazilian National Department of Health has reprinted an article from the Boletim Sanitario, No. 2, of 1923, with the view of impressing upon medical practitioners the futility of terminal disinfection in the prophylaxis of infectious disease. The gist of this article is that chemical disinfection of premises in which infectious cases have occurred can be of little value, seeing that the micro-organisms whose destruction is desired by that procedure are in number and virulence far less dangerous than those scattered through direct human agency or by means of recently infected articles. Moreover, many of these micro-organisms escape destruction by any means of terminal disinfection, whether by forma-lin spray or by disinfectant solution. Finally, the point is made that the employment of terminal disinfection Printed by order of the Trustees and sold at the British (Natural History), Cromwell-road, London, S.W.7. 7s. 6d.
months,I Museum Pp. 222.
473 large scale in all civilised cities has not diminished the infectious disease rate unless other prophylactic For these measures were simultaneously enforced. reasons, and on account of the great cost of chemical disinfection, the Brazilian Department of Health recommends the substitution for terminal disinfection of the simpler and less costly procedures of soap and water, scrubbing, and prolonged isolation and airing. In the case of dirty and dilapidated premises the usual measures of renovation are needed in addition. The Department holds that the suppression of chemical disinfection will have a good effect on the conduct of ignorant people who commit every sort of hygienic indiscretion in the course of infectious disease, confident in its redemption by the miraculous properties of the disinfectant apparatus. " People, not things, are the principal means for the distribution of disease germs, and simple measures of personal cleanliness have enormous prophylactic value." We have gladly summarised the contents of this estimable bulletin, the teaching of which coincides in a remarkable way with the lesson drawn this week by Dr. K. Simpson,
mentation three days before death was 55 mm. during the first hour. In this case there were 2 g. of urea per litre of blood. In another case of typhus there was an oscillation between 30 and 20 mm. during the first hour, while the blood-urea was 0’90 and 0-80 g. In a case of typhoid fever with a pronounced ataxoadynamic condition the quantity of blood-urea was 1-50 g. and the sedimentation 25 mm. during the first hour. With improvement in the patient’s condition a diminution in the blood-urea took place, and the rate of sedimentation fell to less than half during the first hour (11 mm.). Dr. Mironesco concludes that there is nothing specific in the variations in sedimentation of the red corpuscles in various acute infectious diseases, for though the rate of sedimentation is usually more rapid in typhus than in measles or than in most cases of typhoid fever, the acceleration is related not to the particular disease but to certain disturbances, especially the amount of urea in the blood.
on a
medical officer of health for the county
deputy of Croydon,
THE DECLINE OF VENEREAL DISEASE DENMARK.
borough
from the f1gures in regard to scarlet fever which have come under his immediate notice. Dr. Simpson regards as a worthy object of effort the creation of a healthier state of the naso-pharynx in school children. We recall attention to a recent decree of the Prussian Ministry of Health pointing attention in the same direction.
IN connexion with the
centenary
IN
celebrations of
Pasteur’s birthday, Prof. C. Rasch, of Copenhagen, was invited to contribute a paper on the subject of venereal disease and the campaign against it in Denmark. His small brochure, with the title " La lutte antivenerienne en Danemark," gives not only a very comprehensive review of what has been done in Denmark in the past, but it also shows what a remarkable effect modern methods of treatment have THE SEDIMENTATION RATE IN ACUTE had on the incidence of syphilis in the years 1921 and 1922. With regard to the past, Denmark has certainly INFECTIONS. been a pioneer in many directions. So soon as 1672 THE rate of sedimentation of human blood shows the treatment of venereal disease by quacks was considerable differences under various normal and forbidden. In 1788 free treatment for all hospital pathological conditions. Thus the rate of sedimentation cases of venereal disease was provided. As early as of woman’s blood which varies from 3-5 hours is 1859 were attached to the propagation of almost twice as rapid as in the case of man’s blood. this penalties ten years later its study was made and disease, On the other hand, sedimentation of the blood of the for medical students. In 1874 compulsory compulsory umbilical cord is extremely slow and always takes treatment for all cases of venereal disease was introlonger than 24 hours. During pregnancy an accelera- duced, and in 1900 Cred6’s method of dropping tion of the sedimentation rate takes place and increases silver nitrate into the eyes of the new-born was made as pregnancy advances until delivery. In pathological In all these matters Denmark led the obligatory. conditions the sedimentation rate is most accelerated and in 1906 various other provisions were made in inflammatory and febrile processes. The sedimenta- way, the comprehensive control of venereal disease. for rate tion is determined by estimation of the time a survey of the When Prof. Rasch was invited to required by the corpuscles of a specimen of citrated results, up-to-date, of the venerealgive disease campaign, blood to sink from a certain marked level in a testin cooperation with Dr. Svend Lomholt, addressed tube to another marked level. The sedimentation of he, to 130 heads of hospitals and similar the corpuscles is delayed by removal of fibrinogen, questionnaires and obtained information of great institutions, by narcotics, or by previously heating the plasma, statistical value. It appears that the hospital accomwhile the addition of gelatin or gum arabic accelerates modation in Denmark is greater than that of any it. Dr. Mironesco,1of Bucharest, has investigated the other civilised country, and apart from sanatorium rate of sedimentation of the red corpuscles in typhus, and beds, Denmark, with a population of typhoid fever, and measles with an apparatus made I only asylum has about 14,300 beds, many of which 3,300,000, according to the suggestions of Fahreus and Wester- are at the disposal of the subjects of venereal disease. gren. Pipettes were used 30 cm. long and 2-5 mm. But it seems to be rather ambulatory treatment with in diameter, and a solution of 3-8 per cent. sodium salvarsan and other specifics than hospital treatment citrate was employed to prevent coagulation of the that has the incidence of syphilis down with brought blood. The examination was made 1, 2, and 24 hours a run. In 1921 there were 1942 new cases of syphilis after the blood had been collected at a room tempera- in the whole of Denmark, as compared with 1578 in ture of 20-25° C. In the three diseases mentioned 1922. The number of new cases of congenital syphilis Dr. Mironesco was able to confirm the fact that sedi- in these two was 142 and 95 respectively. years mentation was accelerated in a more or less marked In 1912 Dr. Lomholt investigated the number of degree. Fluctuations in rate were most pronounced in recent cases of syphilis in Copenhagen, and he came the course of the first hour. In typhus, for example, to the conclusion that in this year there were about the rate of sedimentation was between 24 and 60 mm. 1300 such cases. A of these findings with comparison . during the first hour. The acceleration was less marked those of 1922 led him to the conclusion that the in cases of measles in the adult, in which during the incidence of had declined in this period by syphilis first hour there was an oscillation between 11 and about 33 per cent. The evidence of these figures is 20 mm. In typhoid fever the acceleration of sedithe impressions of most specialists with supported mentation was usually more marked than in measles whom Dr. by Lomholt has conferred, and it is notein the adult. It was also found that fluctuations in that the incidence of gonorrhoea has also sedimentation bearing a direct relation to the severity worthy shown a marked decline in the period 1910-1922. and course of the disease occurred not only in the same In the five-year period 1900-1904 there were 16 cases disease but also in the same patient. Thus in a case of blindness due to gonorrhoea, and in the ten-year of severe typhus which ended fatally the rate of sedithere were only four such cases. 1905-1914 period countries about 20 per cent. 1 Bulletins et mémoires de la Société médicale des hôpitaux de Yet in other Continental are still due to gonorrhoea. blindness of all cases Paris, July 5th, 1923, No. 23. of
’,
the W.R. continuing positive, though he himself was in good health. Dr. Branson draws up rules as to the eligibility for insurance of lives who have had syphilis, and comes to the conclusion that those who have exhibited tertiary lesions, who have Argyll Robertson pupils, or leucoplakia of the tongue are ineligible, while increased rates must be charged for those who have had secondary manifestations and have been thoroughly treated for three years or more. He considers those who have been thoroughly treated in the primary stage and can produce evidence of negative W.R. three years or more after contracting the disease may be taken at ordinary rates. Some experienced observers would not entirely exclude cases of tertiary skin lesions, as many of these cases often live to a very considerable age. But all cases, even those giving a history of a primary sore only, should, we are convinced, be rated up. EDIBLE FUNGI. THE
latest
publication
of
the
Natural
History
Department of the British Museum is a Handbook of the Larger British Fungi,by Mr. John Ramsbottom, M.A., F.L.S., assistant in the Department of Botany. Types have been selected for description on the ground of their economic and biological interest. In dealing with the fleshy agarics the basis of selection LIFE ASSURANCE AND SYPHILIS. has been the edible or poisonous qualities of the THE bearing of syphilis upon life assurance is species, the term " edible " being used simply to discussed by Dr. W. P. S. Branson in the current imply that the fungus has been eaten without ill In this country only the field-mushroom number of St. Bartholomew’s Hospital Reports (vol. lvi., effects. (Psalliota campestris) and the horse-mushroom part 2.). Dr. Branson begins by inquiring into the incidence of syphilis among the insuring population, (P. arvensis) are commonly eaten, and for most and comes to the conclusion that the best estimate people the cultivated variety of the field-mushroom is a figure of about 10 per cent. He then discusses is the only edible fungus. Mr. Ramsbottom expresses the effects of syphilis as a lethal disease, and points regret that this is so, for many of our common toadout that it may kill as the result of (1) general paralysis stools are far more delicate in flavour than either of of the insane, (2) aortic aneurysm, (3) gummatous these. This conservatism of taste is a modern failing. disease of the cerebral vessels, (4) tabes dorsalis, Classical literature contains frequent reference to various edible and fungi, and the only way (5) epithelioma of the tongue, implanted on syphilitic in which to knowpoisonous a fungus is edible or whether leucoplakia, (6) suicide. Dr. Branson admits that there are other causes-one of the most common is poisonous is by being able to distinguish it in the same as one does other edible plants and to ascertain its cardiac failure from syphilitic disease of the coronary way record. There is, says Mr. Ramsbottom, no other way; the this increases and arteries, mortality and his handbook will serve its purpose if it popularises probably amongst syphilitics to a large extent. The author the safe use of a number of cheap and appetising food next takes up the period at which syphilis produces edible fungus contains roughly The products. fatal results and points out that general paralysis to 5 per cent. of protein nitrogen (of which probably and aortic aneurysm cause death between 30 and 50, 2 more than one-third is digestible), 5 per cent. of not while tabes, when it kills, as a rule kills late in life. 1 per cent. of fat, andto 1per cent. of He is not impressed with cerebral syphilis as a cause sugars, mineral matter. With this composition, fungi are a of death, but the statistics of the American Life Offices a showed that the mortality among syphilitics was complete food. fact established by the Fuegians, who on Cyttaria during a large part of the year. In live very high the first six years after infection, and death Central Europe, where the use of fungi as food is much Dr. was almost always due to cerebral syphilis. in Branson next discusses the question as to whether more widespread, coloured wall charts are posted an that children learn from treatment can cure syphilis. It is well known that the elementary schools, so the distinguishing marks of the poisonous syphilis has been cured by mercurial treatment as early age recommended by Jonathan Hutchinson, who noted the and non-poisonous varieties. occurrence of a second primary chancre after such treatment, and cases have been described of second infections after treatment with arsenic ; but it is probable that in the great majority of cases once syphilis has been contracted, whatever the treatment, it is always liable to recur. This is especially true when any secondary manifestations of disease have developed. Dr. Branson does not place extravagant confidence in a negative Wassermann result. The blood test may be negative whilst the cerebro-spinal fluid is positive, and it is no uncommon event for the blood to be negative to-day and positive in six months’ time. He says, however, that he considers a positive W.R. as a bar to life insurance. While agreeing with Dr. Branson that a negative W.R. is of no value as evidence of a permanent cure of syphilis, we are not so sure that a positive W.R. should be a total bar to life assurance. In a recent case a proposer, who had been perfectly well for seven years after contracting syphilis, was found to have a positive W.R., and in his anxiety to turn it into a negative one he had no less than 20 injections of neo-salvarsan in 12
VALUE IN DISINFECTION. THE Brazilian National Department of Health has reprinted an article from the Boletim Sanitario, No. 2, of 1923, with the view of impressing upon medical practitioners the futility of terminal disinfection in the prophylaxis of infectious disease. The gist of this article is that chemical disinfection of premises in which infectious cases have occurred can be of little value, seeing that the micro-organisms whose destruction is desired by that procedure are in number and virulence far less dangerous than those scattered through direct human agency or by means of recently infected articles. Moreover, many of these micro-organisms escape destruction by any means of terminal disinfection, whether by forma-lin spray or by disinfectant solution. Finally, the point is made that the employment of terminal disinfection Printed by order of the Trustees and sold at the British (Natural History), Cromwell-road, London, S.W.7. 7s. 6d.
months,I Museum Pp. 222.
473 large scale in all civilised cities has not diminished the infectious disease rate unless other prophylactic For these measures were simultaneously enforced. reasons, and on account of the great cost of chemical disinfection, the Brazilian Department of Health recommends the substitution for terminal disinfection of the simpler and less costly procedures of soap and water, scrubbing, and prolonged isolation and airing. In the case of dirty and dilapidated premises the usual measures of renovation are needed in addition. The Department holds that the suppression of chemical disinfection will have a good effect on the conduct of ignorant people who commit every sort of hygienic indiscretion in the course of infectious disease, confident in its redemption by the miraculous properties of the disinfectant apparatus. " People, not things, are the principal means for the distribution of disease germs, and simple measures of personal cleanliness have enormous prophylactic value." We have gladly summarised the contents of this estimable bulletin, the teaching of which coincides in a remarkable way with the lesson drawn this week by Dr. K. Simpson,
mentation three days before death was 55 mm. during the first hour. In this case there were 2 g. of urea per litre of blood. In another case of typhus there was an oscillation between 30 and 20 mm. during the first hour, while the blood-urea was 0’90 and 0-80 g. In a case of typhoid fever with a pronounced ataxoadynamic condition the quantity of blood-urea was 1-50 g. and the sedimentation 25 mm. during the first hour. With improvement in the patient’s condition a diminution in the blood-urea took place, and the rate of sedimentation fell to less than half during the first hour (11 mm.). Dr. Mironesco concludes that there is nothing specific in the variations in sedimentation of the red corpuscles in various acute infectious diseases, for though the rate of sedimentation is usually more rapid in typhus than in measles or than in most cases of typhoid fever, the acceleration is related not to the particular disease but to certain disturbances, especially the amount of urea in the blood.
on a
medical officer of health for the county
deputy of Croydon,
THE DECLINE OF VENEREAL DISEASE DENMARK.
borough
from the f1gures in regard to scarlet fever which have come under his immediate notice. Dr. Simpson regards as a worthy object of effort the creation of a healthier state of the naso-pharynx in school children. We recall attention to a recent decree of the Prussian Ministry of Health pointing attention in the same direction.
IN connexion with the
centenary
IN
celebrations of
Pasteur’s birthday, Prof. C. Rasch, of Copenhagen, was invited to contribute a paper on the subject of venereal disease and the campaign against it in Denmark. His small brochure, with the title " La lutte antivenerienne en Danemark," gives not only a very comprehensive review of what has been done in Denmark in the past, but it also shows what a remarkable effect modern methods of treatment have THE SEDIMENTATION RATE IN ACUTE had on the incidence of syphilis in the years 1921 and 1922. With regard to the past, Denmark has certainly INFECTIONS. been a pioneer in many directions. So soon as 1672 THE rate of sedimentation of human blood shows the treatment of venereal disease by quacks was considerable differences under various normal and forbidden. In 1788 free treatment for all hospital pathological conditions. Thus the rate of sedimentation cases of venereal disease was provided. As early as of woman’s blood which varies from 3-5 hours is 1859 were attached to the propagation of almost twice as rapid as in the case of man’s blood. this penalties ten years later its study was made and disease, On the other hand, sedimentation of the blood of the for medical students. In 1874 compulsory compulsory umbilical cord is extremely slow and always takes treatment for all cases of venereal disease was introlonger than 24 hours. During pregnancy an accelera- duced, and in 1900 Cred6’s method of dropping tion of the sedimentation rate takes place and increases silver nitrate into the eyes of the new-born was made as pregnancy advances until delivery. In pathological In all these matters Denmark led the obligatory. conditions the sedimentation rate is most accelerated and in 1906 various other provisions were made in inflammatory and febrile processes. The sedimenta- way, the comprehensive control of venereal disease. for rate tion is determined by estimation of the time a survey of the When Prof. Rasch was invited to required by the corpuscles of a specimen of citrated results, up-to-date, of the venerealgive disease campaign, blood to sink from a certain marked level in a testin cooperation with Dr. Svend Lomholt, addressed tube to another marked level. The sedimentation of he, to 130 heads of hospitals and similar the corpuscles is delayed by removal of fibrinogen, questionnaires and obtained information of great institutions, by narcotics, or by previously heating the plasma, statistical value. It appears that the hospital accomwhile the addition of gelatin or gum arabic accelerates modation in Denmark is greater than that of any it. Dr. Mironesco,1of Bucharest, has investigated the other civilised country, and apart from sanatorium rate of sedimentation of the red corpuscles in typhus, and beds, Denmark, with a population of typhoid fever, and measles with an apparatus made I only asylum has about 14,300 beds, many of which 3,300,000, according to the suggestions of Fahreus and Wester- are at the disposal of the subjects of venereal disease. gren. Pipettes were used 30 cm. long and 2-5 mm. But it seems to be rather ambulatory treatment with in diameter, and a solution of 3-8 per cent. sodium salvarsan and other specifics than hospital treatment citrate was employed to prevent coagulation of the that has the incidence of syphilis down with brought blood. The examination was made 1, 2, and 24 hours a run. In 1921 there were 1942 new cases of syphilis after the blood had been collected at a room tempera- in the whole of Denmark, as compared with 1578 in ture of 20-25° C. In the three diseases mentioned 1922. The number of new cases of congenital syphilis Dr. Mironesco was able to confirm the fact that sedi- in these two was 142 and 95 respectively. years mentation was accelerated in a more or less marked In 1912 Dr. Lomholt investigated the number of degree. Fluctuations in rate were most pronounced in recent cases of syphilis in Copenhagen, and he came the course of the first hour. In typhus, for example, to the conclusion that in this year there were about the rate of sedimentation was between 24 and 60 mm. 1300 such cases. A of these findings with comparison . during the first hour. The acceleration was less marked those of 1922 led him to the conclusion that the in cases of measles in the adult, in which during the incidence of had declined in this period by syphilis first hour there was an oscillation between 11 and about 33 per cent. The evidence of these figures is 20 mm. In typhoid fever the acceleration of sedithe impressions of most specialists with supported mentation was usually more marked than in measles whom Dr. by Lomholt has conferred, and it is notein the adult. It was also found that fluctuations in that the incidence of gonorrhoea has also sedimentation bearing a direct relation to the severity worthy shown a marked decline in the period 1910-1922. and course of the disease occurred not only in the same In the five-year period 1900-1904 there were 16 cases disease but also in the same patient. Thus in a case of blindness due to gonorrhoea, and in the ten-year of severe typhus which ended fatally the rate of sedithere were only four such cases. 1905-1914 period countries about 20 per cent. 1 Bulletins et mémoires de la Société médicale des hôpitaux de Yet in other Continental are still due to gonorrhoea. blindness of all cases Paris, July 5th, 1923, No. 23. of
’,