The prominence given to the intravascular use of antiseptics has hardly been in accord with the results achieved by this method.

The injection of formalin in various amounts and strengths has been given an extended trial in the treatment of pulmonary tuberculosis, and is claimed to have produced beneficial results. Similarly Baccelli has injected corrosive sublimate intravenously in the treatment of syphilis, cerebro-spinal meningitis, and acute rheumatism in man. In animals he has used intravenous injections of corrosive sublimate in the treatment of aphtha epizootica. In this disease he claims that the intravenous injections of corrosive sublimate are of undoubted use in terminating an attack of the disease.

A multiple-tube technique based on peptone water incubated at 44 °C for 24 h followed by detection of indole was found to be sensitive and specific for the detection of Escherichia coli in oysters and mussels. The method has the advantage of providing rapid results and is both less expensive and less time-consuming than other MPN techniques.

1. The problem of assessing nutritional state

This paper emphasizes the need for measurement in diagnosis and recognizes two distinct problems, those of:

(a) Diagnosing specific diseases in the sense of distinct pathological conditions.

(b) Assessing general malconditions where there is no sharp dividing line between the normal and the subnormal.

It suggests a programme of research designed to overcome some of the difficulties inherent in (b) in the case of nutritional assessment.

2. Establishing general health standards

The first requirement is the scientific standardization of the elements making up the concept of health and good physique. This is a complex matter requiring all the help which statistical procedures can give. Moreover, we must check the reliability of the assessors and the indicators which they use before we can place any reliance on results purporting to relate to the population studied.

Provisionally we begin by collecting a battery of indicators of general health; each is then given a graded assessment for each child (and the assessment is repeated to obtain its reliability), and by employing the statistical device of factor analysis we can determine what combination of symptoms will give the highest agreement with the criterion of general health abstracted from these individually imperfect measures. We are actually making explicit the stages which are normally telescoped in the method of ‘general impression’ (which is the method usually adopted in assessing general health, state of nutrition, etc., despite evidence of its unreliability). In this method a number of individual characteristics are fused together without ensuring that different observers will attach equal importance to the signs or even that they will take into account the same ones. The emphasis to be given to each symptom in the final mark is determined statistically by its agreement with the aggregate result. Some indicators may give results so unrelated to the others that they must be eliminated. Other tests, whether physiological, functional or anatomical, may later be added to the battery to reinforce it. A point of practical importance is that some readily assessable symptom or index may be found which gives results in close enough agreement with those of the standard battery to enable it to be used as a substitute, thus shortening the task of diagnosis without appreciably lessening its accuracy.

An alternative criterion could, as we have seen, be the weighted combination of doctors' assessments, for by weighting the results according to each doctor's agreement with his colleagues we were able to increase the agreement between the team result and the hypothetical true mark. However, since the ordinary methods of assessment are unreliable, even the pooled results of the team do not give as good a standard as the standardized battery of tests.

A third standard is sometimes possible in the form of an objective accurately measurable physiological laboratory test or anatomical index. If this is inconvenient to apply generally, any single symptom or pool may be tested by correlation with it to see if the agreement is close enough for practical purposes.

3. Study of more specific nutritional defects

Factor analysis can be used to discover and assess more limited similarities than those covering the whole range of observers or test symptoms. For example, the doctors tended to show group affinities (depending possibly on their different emphasis in diagnosis) in addition to their somewhat low general conformity. Applying similar analytic methods to the study of symptoms, we might isolate specific nutritional deficiencies or it is possible that group factors may be revealed corresponding to the effects of recent or early adverse nutritional conditions respectively.

Whilst the examples of analytic techniques have here been applied to illustrative cases in nutritional and general health assessment, they are equally applicable to other fields of medicine, in particular to endocrinology and to the study of predisposing conditions of disease.

My thanks are due to Prof. Burt and Dr E. H. Wilkins for their suggestions for modifying my original draft. However, this in no way commits them to agreement with the views expressed here.

[Note added in Proof.] Since writing this article I have had an opportunity of correlating and analysing some results of nutritional surveys involving clinical and biochemical signs of malnutrition. The evidence so far obtained indicates a rather weak general factor for clinical signs identifiable with general nutritional state. I hope to be able to give the full results when the material becomes available for publication.

Growth agglutination and growth inhibition tests were established for the diagnosis of Brucella abortus infection. The former involves the agglutination of living organisms while the latter is a bactericidal test. Using mouse, guinea-pig, rabbit and bovine serum it was shown that the growth agglutination test is approximately ten times, and the growth inhibition test one hundred times, more sensitive than the conventional tube agglutination test. It is suggested that these techniques may be of assistance in diagnosing bovine brucellosis in situations in which the tube agglutination test results are suspected of being falsely negative.

White rats reared from the age of 30 days to 275 days under vita glass, and properly fed, do not grow at a different rate from those reared under ordinary glass.

The offspring of these rats, kept in the same environment, grow at the normal rate when compared with controls born and reared under ordinary window glass.

A short discussion of these results is given in the text.

Addendum. The temptation to use an artificial source of ultra-violet rays having proved irresistible, a further experiment was performed with 20 males, 10 under vita glass and 10 under window glass. These were exposed to the radiation of a Hanovia quartz mercury vapour lamp on alternate days, at a distance of four feet from the burner. The growth curves are shown on Chart V, and the lengths of exposure have been entered on this chart: it will be seen that the results are the same as with natural sunlight.

1. Immunity cannot be completely explained by antigen-antibody reactions, even if the term ‘antibodies’ be made sufficiently elastic to include various obscure properties which are exhibited, in vivo, in the actively immune animal. Various other factors have to be considered. One of these is the influence of stimuli upon the vital capacities of bacteria.

2. Transmissible bacterial autolysis appears to be due to a stimulus acting upon the growing bacterial cell and leading to the splitting off of a certain number of daughter-cells which are non-viable, and consequently undergo autolysis.

3. Transmissible autolysis is not due to a stimulus sui generis but is no more than a particular incident in the general phenomena of bacterial variation.

4. The secretions of bacteria in pure culture may stimulate, control, or retard their growth and may lead to the production of variants.

5. When introduced into the animal body, bacteria encounter stimulants of animal origin which may be either favourable or unfavourable to their growth and are to be distinguished from the stimulants attributable to the bacteria themselves.

6. One aspect of the differences between natural immunity and natural susceptibility may be interpreted as due to differences in the stimuli inherent in the particular animal species and to consequent differences in their effects upon the particular bacterial species.

7. Similarly, when no better explanation is available, the acquired immunity (active or passive) of a susceptible animal may be interpreted as a change of the animal's stimulant action from one which was favourable (or indifferent) to the growth of a bacterium to one which is adverse, i.e., a stimulant to the reproduction of daughter-cells which are non-viable in the animal body.

8. Leucocytes are one of the sources of material possessing two kinds of properties, viz., (a) stimulant action on the growth capacities of cells (both bacterial and animal) and (b) enzyme action on the constituents which living and dead cells possess in common. The older researches on the characters of leucocytic extracts were occupied with (b), though they may occasionally be linked up with (a), since there are some indications that their leucocytic material was also acting as „lytic substance.”

9. In some cases it must remain, for the present, an open question whether demonstrable antibacterial action is attributable to some more or less obscure enzymes or to what I have termed „stimuli.”

10. A stimulus may be a substance which is also an antibody, and its stimulative properties may be highly specific. But it would be absurd to assume that for each special kind of stimulative effect there is a special and chemically distinctive kind of stimulus. Both stimuli and antibodies usually possess a wide range of different combining affinities which cannot be explained on the „mosaic” theory that each different combination is due to the presence (in the stimulus or antibody) of a different chemical group.

11. A stimulus, as distinct from a food, causes the bacterial cell to function in a particular way but is not incorporated as part of the structure of the cell. This convenient distinction, however, does not imply that there is necessarily a sharp line of demarcation between a stimulus and a food.

Tuberculosis (TB) in children is a critical public health issue. In Bohol, Philippines, we found a high tuberculin skin test (TST)-positive prevalence (weighted prevalence = 6.4%) among 5476 children (<15 years) from 184 villages, with geographically isolated communities having prevalence as high as 29%. Therefore, we conducted a geospatial and hot spot analysis to examine the association between villages with high TST-positive prevalence (⩾6.5%) and access to medical care (distance (in kilometres and minutes of travel time) to the municipal Rural Health Units (RHU)), access to healthcare resources (distance to Provincial Health Office (PHO)) and socioeconomic determinants of health. Hot spot analysis revealed significant clusters of TST-positive prevalence in villages farthest from the PHO. Based on univariate analysis, the following variables associated with high prevalence were included in the multivariate model: minutes of travel time to the PHO, distance to the PHO, island villages and total deprivation based on socioeconomic indicators. In the final model, only distance to PHO in minutes was significant (P = 0.005). When evaluated further, greater than 1-hour drive significantly increased risk for TST-positivity (P = 0.003). Distance to healthcare resources likely increases the risk of TB transmission within the community. Expanding TB control efforts to geographically isolated areas is critical.

Whether the vaccine virus is filterable or not has been the subject of experiment and discussion for many years and since Negri's results published in 1905, from which he deduced that the virus was filterable, numerous experiments dealing with the subject have been made by many workers.

1. A new series of compounds has been found which markedly inhibits the growth of Mycobacterium tuberculosis and M. smegmatis.

2. These substances are strongly haemolytic against human red blood cells.

3. The effectiveness of the antibacterial and haemolytic actions depends upon the length of the alkyl chain.

4. The antibacterial and haemolytic actions are reduced by human serum.

To assess the relative importance of ulcerative and non-ulcerative sexually transmitted disease in the transmission of HIV, a seroprevalence study was conducted on 2210 patients at the sexually transmitted diseases (STD) clinic of the S. Maria e S. Gallicano Hospital in Rome, between 1989 and 1994. Among male patients, by univariate analysis, strong predictors of HIV infection were homosexuality, sexual exposure to a HIV-positive partner, hepatitis B virus infection, and positive syphilis serology. An increased risk was estimated for patients with past genital herpes (odds ratio (OR) 3·86, 95% confidence intervals (CI) 0·40–18·2), and primary syphilis (OR 5·79, 95% CI 0·59–28·6). By multivariate analysis, a positive association was found with homosexuality (OR 6·9, 95% CI 2·9–16·5), and positive syphilis serology (OR 3·5, 95% CI 1·3–9·2). An adjusted OR of 2·41 was calculated for current and/or past genital herpes. These results, although not conclusive, suggest a role of ulcerative diseases as risk factors for prevalent HIV infection, and indicate that positive syphilis serology is an unbiased criterion for identifying individuals at increased risk of HIV infection.

1. “Antigens” of varying sensitivity may be prepared by coating a dispersion of gum benzoin with saponin.

2. Using suitable dispersions so prepared a zone of precipitation is observed which is more extended for specific than for normal sera. Differentiation is more pronounced as the region of the isoelectric point of the globulin is approached.

3. Precipitation is effected by the ions of salts present in the solution discharging the negative antigen suspension which has been sensitised by the protein of the serum.

4. The mechanism of sensitisation is described.

5. Both albumins and globulins can protect or sensitise gum benzoin suspensions, the effect depending on an appropriate dilution. This effect occurs qualitatively irrespective of the hydrogen ion concentration of the medium. Quantitatively the position of the zone of precipitation and its extent is contingent on the reaction of the medium.

6. The euglobulin fractions of normal and of luetie sera deprived as far as possible of their lipoids can be differentiated both by the Wassermann test, and by precipitation tests.

7. Delipoided euglobulins from horse serum will yield a Wassermann positive reaction when used in certain concentrations. In more concentrated solutions an anticomplementary effect is exhibited.

8. Evidence is presented for the view that the euglobulins of specific sera differ rather in their composition or state of aggregation than in quantity from the euglobulin of non-specific sera.

9. The changes in sensitising power and in the Wassermann reactivity of euglobulin caused by repeated freezing or exposure to ultra-violet light run a parallel course.

10. Attempts to change the Wassermann properties of normal sera are briefly described.

This study examined the epidemiological and clinical characteristics of measles in Wenzhou, China. From 2000 to 2010, a total of 13271 measles cases were reported in Wenzhou, with epidemics occurring every 3-4 years. Forty-five per cent of the cases were aged <1 year and 27·2% were aged >14 years. Of 2262 hospitalized measles cases, 66·3% were diagnosed with pneumonia, and three cases died from respiratory failure. The number of measles cases of infants requiring hospitalization increased from birth to age 8 months and declined thereafter. Measurement of serum measles antibody levels in normal infants indicates that over 80% of infants in Wenzhou may be susceptible to measles by age 6 months. The existence of a sufficient pool of unvaccinated children and the decreased level of passively transferred measles antibodies in infants from vaccinated mothers contributed to the sustained transmission observed in Wenzhou.

The prevalence of Chagas disease has decreased in the Americas region due to vector control measures. However, non-vectorial transmission through blood transfusions and organ transplantation has gained importance in recent years. Screening among blood and organ donors are essential to reduce Trypanosoma cruzi transmission and could provide information to estimate population prevalence. We conducted a cross-sectional study on the prevalence of immunoglobulin G (IgG) antibodies against T. cruzi in healthy blood donors, solid organ donors and heart transplant recipients from 2012 to 2019. We found a total of 99 357 IgG T. cruzi results during the study period. The cumulative seroprevalence in healthy blood donors was 0.13% (95% confidence interval (CI) 0.10–0.15), in organ donors was 0.53% (95% CI 0.06–1.92) and in heart transplant recipients was 3.03 (95% CI 0.07–15.75). Seroprevalence trend in healthy blood donors showed annual increase between 2012 and 2015, decreasing in the following years. No trend was seen in organ donors neither heart recipients. Adjusted rates did not show difference by sex and age among blood donors. No significant increases in seroprevalence T. cruzi were found during the study period. T. cruzi transmission remains low.

It has been found that carcinogenic tar acts upon the lymph glands of the rat in converting them into more or less pronounced haemolymph glands.

1. Organisms biochemically resembling the metadysentery bacilli of Castellani (1927) or sensu largo B. coli anaerogenes of Lembke (1896) have been recovered locally from the urinary passages of man.

2. These organisms were found in cases of enteric-like fevers, pyelitis and cystitis.

3. Similar to Dudgeon's slow lactose-fermenting bacilli of the urinary tract, they have been shown to possess marked haemolytic action for red blood corpuscles.

4. Serologically, they appear to fall into at least two groups of bacilli.

5. They are believed to be pathogenic.

Foot-and-mouth disease virus isolates of types O, A and SAT 2, from diseased animals in herds routinely vaccinated twice a year were compared antigenically with the vaccine strains in the complement-fixation, neutralization and radial immunodiffusion tests. It was found that strains which had readily infected vaccinated cattle had R values against the vaccine strain in the complement- fixation and radial immunodiffusion tests of 30 or less, while strains causing primary outbreaks with little spread had R values of 30–40. Threefold differences in humoral neutralizing antibody concentration between the field variant and the vaccine strain in sera from vaccinated animals were likely to be significant in terms of protection.

We investigated the potential effects of COVID-19 public health restrictions on the prevalence and distribution of Neisseria gonorrhoeae (NG) genotypes in our Queensland isolate population in the first half of the year 2020. A total of 763 NG isolates were genotyped to examine gonococcal strain distribution and prevalence for the first 6 months of 2020, with 1 January 2020 to 31 March 2020 classified as ‘pre’ COVID-19 restrictions (n = 463) and 1 April 2020 to 30 June 2020 classified as ‘post’ COVID-19 restrictions (n = 300). Genotypes most prevalent ‘pre’ restrictions remained proportionally high ‘post’ restrictions, with some significantly increasing ‘post’ restrictions. However, genotype diversity was significantly reduced ‘post’ restrictions. Overall, it seems public health restrictions (9–10 weeks) were not sufficient to affect rates of infection or reduce the prevalence of well-established genotypes in our population, potentially due to reduced access to services or health-seeking behaviours.