178

were then examined they were irregularly thickenedwith many granules attached and the maximal thicknesswas 167 A greater than the original mean diameter.The interpretation of these findings is that there has.been a deposition of homologous antibodies on the

flagella which takes place unevenly and does not form acomplete film. Similar results were obtained whenmixtures of specific sera with Bact. typhosum and Bact.pa1’atyphosum A were examined. When, however, a

suspension of Bact. typhosum was mixed with a heterolo-gous serum the flagella were only faintly visible and thebacterial cells had sharply defined walls, whereas in

typhoid-antityphoid serum mixtures the cell-walls arefuzzy and appear to be surrounded by fine streamers.The loss of definition in cell-wall outline is explained bya deposition of antibody molecules along its margin.’Since the size of certain antibody-globulin molecules isalready known 2 it would appear that accurate measure-ments could show definitely whether the thickness ofdeposited antibody on an antigen surface was related tothe size of the antibody molecule. Something of thissort has indeed been shown with tobaeco mosaic virusmolecules and homologous rabbit antiserum.3 Thereare difficulties, because the antibody-globulin moleculesof rabbit antiserum are elongated and may arrangethemselves radially to the antigen molecules or they maylie flat against an antigen surface, the arrangementdepending among other things on the concentration ofserum. These observations are still at an early stage,but it seems probable that a systematic study of depositsand of the orientation and distribution of antibodymolecules on fine antigenic surfaces may yet explainsome of the puzzles of antigen-antibody reactions.

POSTURE AND SLEEP

MEN and animals have been so long at sleeping that weshould by now have recorded anyuniversalrulesgoverningthe attitudes of sleepers. Yet there is still disagreement

about the facts, as our correspondence columns haverecently shown. Dr. F. Schütz4 4 finds that different

sleepers take up characteristic postures, and seldom varythem. He notes the preference of patients with anginafor the left side, and has observed further that patientswith affections of the liver or gall-bladder include aremarkable proportion of people who habitually sleep ontheir abdomen. Dr. W. N. Leak 5 mentions that a

preference for sleeping on the left side, associated withnocturnal polyuria, may be a sign of mild cardiac

inefficiency ; but Dr. F. B. Parsons will have none of it,6and quotes the work of Johnson, Swan and Weigand asevidence that we have no fixed postures in sleep but tossabout far more than we think. Today Dr. Joah Batesweighs in (p.186) with a few brisk assertions from Adler.Johnson and his colleagues in America attached a pen tothe part of the bed which yields to the sleeper’s move-ments ; the pen wrote on a strip of moving paper and everygross movement of the sleeper produced a spike. Children,university students, 112 healthy people and 70 patientsin hospital were investigated by this tell-tale device,which showed that the average sleeper moved between20 and 45 times a night, the movements ranging betweensingle limb movements and complete changes of posture.Nevertheless 20 or 45 movements a night seem a lotto those of us who fancy we hardly stir, and the value ofthe experiment perhaps depends on whether the victimsknew the record was being made or not. The sleepingmind, if all they say of it is true, would not have beenabove tinkering with the record by spurring the dreamerto unwonted aetivitv. The American workers also took

2. Neurath, H. J. Amer. chem. Soc. 1939, 61, 1841.3. Anderson, T. F. and Stanley, W. M. J. biol. Chem. 1941, 139, 339.4. Lancet, 1941, ii, 774.5. Ibid, 1942, i, 26.6. Ibid, p. 91.7. Johnson, H. M., Swan, T. H. and Weigand, G. E. J. Amer. med.

Ass. 1930, 94, 2058 ; and see Lancet, 1930, ii, 198.

moving pictures of some of their moving sleepers, but astheir method entailed a 100 watt lamp over the bed, ataffeta bandage over the eyes and no blankets the sleepershad some excuse for kicking. Something may perhapsbe allowed for the temperament of sleepers, and heredomestic animals offer a fair field for experimentalobservation. Most cats are still sleepers, resting hourafter hour with limbs tucked away in flexion, and nothingbut the rhythmic bellows’ action to show the watcherthat the creature lives. Many dogs on the other hand arerestless hair-trigger sleepers, always on the brink ofwaking, haunted by strenuous dreams. If there is any-thing in the idea of physiological types humans maydiffer as much. A matron of a London hospital, askedto inquire into sleep and posture, set her night nurses towatch the patients. Those who had taken drugs, whohad raised temperatures, or who were immobilised byany surgical appliance were ignored and convalescentsonly were watched. The nurses found that sleepingpatients rarely made gross movements ; they actuallyturned over only two or three times in a night and theyhalf wakened to do that. It thus seems doubtfulwhether. Johnson and his colleagues have said the lastword about sleepers, at any rate about those on this sideof the Atlantic.

MENINGOCOCCAL OPHTHALMIA

OPHTHALMIA neonatorum with its purulent reactionwas at one time regarded as being exclusively due to thegonococcus ; but it is now known to be caused by variousorganisms, the staphylococcus being at least as significantas the gonococcus. Similarly, purulent conjunctivitisin children and adults also has a multiple 2etiology ; andin this the meningococcus plays a little-recognised part.Metastatic conjunctivitis, serous or purulent, may ofcourse develop in a patient with meningococcalmeningitis ; but the meningococcus may also be foundoccasionally in the conjunctival sacs of apparentlyhealthy people, and may sometimes give rise to a

primary meningococcal conjunctivitis. The infection mayproduce a serous or a mucopurulent response, or even apurulent conjunctivitis resembling that caused by thegonococcus. This happens seldom, judging by the

scanty-usually single-cases reported ; but it is prob-ably commoner than is generally believed, since on

superficial examination the gonococcus and the

meningococcus-both gram-negative diploeocei-areeasily confused. Acute purulent conjunctivitis due toeither responds well to sulphapyridine, but the differential.diagnosis is not altogether an academic exercise.F. Clifton and S. M. Laird have given a useful remiuder 1that purulent ophthalmia is an epidemiological as well asa therapeutic problem. The danger of an epidemic ofmeningitis originating from a purulent conjunctivitis,particularly under Army conditions, cannot be ignored.

MANY hospitals will remember the generosity of SirEDWARD MEYERSTEIN, a member of the Stock Exchange,who died last Sunday, for his gifts had a discerningquality. At one time it might be a radiological depart-ment, at another an athletic ground for the students, or a,swimming-bath for the nurses. To the Middlesex .

Hospital it meant the completion of a cherished buildingscheme.

1. Jour. R. Army Med. Cps, 1941, 77, 318.

MEDICAL HoNorrRS.—The Royal Naval Volunteer Reserveofficer’s decoration has been awarded to Surgeon CommanderJ. A. Kerr, M.D. Glasg., who in civilian life is MOH forGrimsby. The King has given permission to Dr. H. C.Sinderson to wear the insignia of the second-class (civildivision) of the order of Al Rafidain, conferred on him by theKing of Iraq. Dr. Sinderson is dean of the Royal MedicalCollege of Iraq.