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Chlamydia trachomatis was isolated from the urethra from 48 (42 per cent) of 113 men with non-gonococcal urethritis (NGU), four (7 per cent) of 58 without overt urethritis, and 13 (19 per cent) of 69 with gonorrhea. Postgonococcal urethritis (PGU) developed in 11 of 11 men who had C. trum antibody to C. trachomatisis developed. The immunotype specificity of chlamydial antibody corresponded to the immunotype isolated. Among culture-negative patients. chlamydial antibody prevalence correlated with the number of past sex partners and with previous NGU. Herpesvirus hominis, cytomegalovirus, T-mycoplasma, Mycoplasma hominis, other bacteria, and Trichomonas vaginalis were not implicated in NGU or PGU. Thus, the cause of chlamydia-negative NGU and PGU remains obscure. Endocervical chlamydia were found in sex partners of 15 of 22 NGU patients with and two of 24 without urethral chlamydial infection (p smaller than 0.001). Tetracycline treatment of both sex partners appears advisable.Chlamydia trachomartis was isolated from the urethra from 48 (42%) of 113 men with nongonococcal uethritis (NGU), 4 (7%) of 58 without overt urethritis, and 13 (19%) of 69 with gonorrhea. Postonococcal urethritis (PGU) developed in 11 of 11 men who had C. trachomatis. In 9 of 17 culture-positive seronegative patients with NGU or PGU, serum antibody to C. trachomatis developed. The immunotype specificity of chlamydial antibody corresponded to the immunotype isolated. Among culture-negative patients, chlamydial antibody prevalence correlated with the number of past sex partners and with previous NGU. Herpesvirus hominis, cytomegalovirus, T-mycoplasma, mycolpasma hominis, other bacteria, and Trichomanas vaginalis were not implicated in NGU or PGU. Thus, the cause of chlamydia-negative NGU and PGU remains obscure. Endocervical chlamydia were found in sex partners of 15 of 22 NGU patients with and 2 of 24 without urethral chlamydial infection (p0.001). Tetracycline treatment of both sex partners appears advisable.

The trachoma and LGV organisms, the human pathogens of the species C. trachomatis, cause oculogenital infections and disease syndromes of the eye and genital tract. The incidence of the most prominent disease, endemic trachoma with eye-to-eye transmission, is decreasing all over the world. At the same time there is increasing recognition of high-frequency venereal infections with trachoma organisms and of the genital disease and occasional ocular disease that they cause. Laboratory techniques for diagnosis and investigation are improving, but work with these interesting intermediate agents remains more difficult than that with many other microorganisms. Proper recognition of the diseases is important because specific therapy is available.

A new immunotype J is proposed for a group of Chlamydia trachomatis strains which are related to trachoma type C in the microimmunofluorescence typing test. Ten immunologically identical strains have been identified from four separate areas of the world. The strains were either isolated from the genital tract or from eye infection originating from the genital tract. They grow readily in HeLa 229 cell culture but poorly in egg culture. Whereas two-way cross-reactions were found between types C and J, tests with mouse antisera cross-absorbed with heterologous antigens showed that type J is completely separable from type C. The J strain caused typical follicular conjunctivitis in monkey eyes. Both humans and monkeys infected with J strains developed type-specific micro IF antibody patterns similar to immunized mouse antisera. C antisera showed broader and higher titer heterologous reactions than J antisera. Two immunologically identical strains, UW-61/Cx and 469/OC, related to both C and J, remain unclassified. They immunologically bridge the two types but are more closely related to type C immunologically and at the same time resemble type J epidemiologically and biologically.

Twelve Chlamydia trachomatis strains have been isolated from cervical and urethral swabs in a venereal disease study in Seattle that are identical immunologically in the micro-immunofluorescence-(micro-IF) typing test. These strains are closely related immunologically with the LGV type-L3 but easily separable from the other 12 TRIC and LGV types. Cross-absorption removed micro-IF heterologous antibody between the new strains and L3. A series of studies of biologic characteristics (infection of cell culture, mouse brain, and monkey eye) showed clearly that the new strains were not LGV but were similar to other TRIC strains. It is proposed that a new immunologic type be established—TRIC type-K.

A method of cell culture using HeLa 229 cells treated with DEAE-dextran was found to be successful in the primary isolation of trachoma-inclusion conjunctivitis (TRIC) organisms. The success of this method appeared to depend on the enhancement of infectivity by pretreatment of the cell monolayers with DEAEdextran and on centrifugation of the inoculum onto the cells. The method was shown to be as sensitive as that using the embryonated chick egg for isolation of trachoma organisms from experimental eye infections in monkeys, and was found to isolate a high rate of genital TRIC organisms from human cervical specimens, similar to the rate obtained in irradiated McCoy cells treated with DEAE-dextran.

Summary Twenty-nine trachoma virus strains isolated on Taiwan and nine trachoma strains and two inclusion conjunctivitis strains obtained from other areas of the world have been tested in mice for cross-protection against intravenous toxicity. Crude yolk sac suspensions of these TRIC viruses were used both for protection and challenge. Protection was produced by intravenous injection of one-third and then two-thirds a minimum lethal toxic dose 14 and 7 days prior to challenge. All 29 of the Taiwan trachoma strains fell into one of two cross-protecting groups designated as the TW-1 and TW-3 groups. Three trachoma strains from New Delhi protected against each other and members of the TW-3 group. Two trachoma strains from Apache Indians in Arizona cross-protected with the TW-1 group. A Saudi Arabia and a Gambia trachoma strain protected against each other but not against the other strains tested. Two trachoma and two inclusion conjunctivitis strains failed to cross-protect with any strain. Therefore, seven different cross-protecting types were demonstrated. It is concluded that the total number of different groups of TRIC virus strains in the mouse toxicity prevention test are not yet known, but that in a given geographic area (as exemplified by Taiwan with two groups) the number of different groups is limited.

Summary The results of serologic tests with Japanese encephalitis virus antigen and sera from humans on Taiwan and adjacent islands are reported. Seventy-one of 72 adult sera from various parts of Taiwan showed neutralizing antibody against JE virus. Neutralizing antibody was found in 32% of 120 sera from 7-year-old children. Tests with sera from the Taipei area show an increasing percentage of neutralizing antibody in children from 1 through 12 years of age. HI antibody tests on these children's serum taken before and after the 1958 encephalitis season showed 4% with fourfold titer rises and a similar percent with falls in titer. The children with antibody rises were 4 to 10 years of age. Similar studies in the nearby Pescadore Islands showed that infection was uncommon in children and that only half of the adults tested had neutralising antibody. A limited interpretation of these results is presented.

Summary A study of the most severe epidemic of Japanese encephalitis in recent years occurring on the island of Taiwan has been presented. The entire north and central portions of the Island, plus an administrative district at the southern end, were areas of high incidence of the disease. The over-all attack rate in 1961 was 7.15 per 100,000 population as compared with 2.91 for 1960 and 6.0 for the entire 5-year period of 1955–1959. The overall case fatality rate, however, was lower than during previous years. More than one-half of the total cases were reported between 11 July and 10 August 1961. Serological confirmation of the disease was first obtained in June and, during the course of the epidemic, was obtained from almost all administrative areas. The last serologically confirmed case occurred in early October, although sporadic cases were reported through early November. A higher percentage of clinically diagnosed cases of encephalitis were confirmed as JE by a four-fold rise in the hemagglutination-inhibition (HI) test (43%) than by the complement-fixation (CF) test (18%) in this study due to the earlier time of collection of convalescent sera. Single serum specimens with HI titers of 1:160 or greater or with CF titers of 1:16 or greater were considered presumptively positive for JE based on evidence presented in the text above.

Trachoma-inclusion conjunctivitis (TRIC) and lymphogranuloma venereum (LGV) organisms are closely related. Utilizing protection of mice from toxic death by prior immunization and more recently an indirect micro immunofluorescence technique, we have described six immunologic types, A through F, of TRIC organisms and three types of LGV. This report describes three new types of TRIC organisms, G, H and I. While H and I are almost completely unique immunologically, type G has cross-reactions with type F and appears to be an immunologic bridge between the previously unique F type and the B-, Ba-, D-, E- and LGV-related types. Strains of the three new types have been isolated almost entirely from the genital tract and biologically resemble the TRIC types D, E and F which have also been associated primarily with genital infection.

The usual concept of nuclear matter is discussed, and a generalization of this concept which allows a qualitative understanding of the effects of clustering phenomena is proposed. As an example of “generalized nuclear matter,” the properties of the ground state of a uniform extended system of structureless α particles are studied using the method developed by Wu and Feenberg for liquid He 4 . The Wu-Feenberg method requires the use of (i) a Bijl-Dingle-Jastrow wave function and (ii) the Kirkwood superposition approximation. The assumed α-α interactions fit the S -wave phase shifts up to a c.m. energy of 10 MeV. The results, in comparison with results from theoretical nuclear-matter calculations which entertain no clustering (both expressed in terms of the energy per nucleon as a function of the radius of the (average) volume per nucleon) are of value in making crude estimates of the percentage of the surface matter of a heavy nucleus which prefers to form into α clusters and in interpreting empirical values for the compressibility of nuclear matter.

22. Alexander, E. R. and Fresh, J. W. : Preven­ tion of anaphylactic death in the mouse toxicity prevention test for TRIC agents. Am. J. Ophth. 63 : 1462, 1967. 23. Wang, S. P. and Grayston, J. T. : Egg infectivity assay of trachoma virus. Proc. Soc. Exper. Biol. &Med. 115:587, 1964. 24. Thygeson, P. and Nataf, R.: Etiologic problems in trachoma. Rev. Int. Trach., 35:177, 1958. 25. Wang, S. P., Kenny, G. E. and Grayston, J. T. : Characterization of trachoma antigens protec­ tive against mouse toxicity. Am. J. Ophth. 63 : 1454, 1967.

The infectivity of trachoma-inclusion conjunctivitis (TRIC) organisms (TW-5) was enhanced by pretreatment of HeLa cell monolayers before inoculation with diethylaminoethyl (DEAE)-dextran (30 μg/ml) and poly-l-lysine (10 μg/ml) and inhibited by dextran sulphate (250 μg/ml), fetuin (4%), ovomucoid (5%), N -acetyl neuraminic acid (0.5%), and Cholera vibrio neuraminidase (100 U/ml). The infectivity of lymphogranuloma venereum organisms (434) was not affected by DEAE-dextran, fetuin, and neuraminidase, was slightly inhibited by poly-l-lysine, and was inhibited by dextran-sulphate, ovomucoid, and N -acetyl neuraminic acid. The study suggested that sialic acid residues on the cell surface may be specific receptors for TRIC organisms. The receptors for TRIC organisms (TW-5 and TW-3) could be specifically blocked with inactivated (56 C for 30 min) TRIC organisms at the ratio of one live to 100 inactivated TRIC organisms, but not by inactivated lymphogranuloma venereum (434) or influenza virus (A 2 /Jap 305).

We studied 204 women with acute pelvic inflammatory disease to delineate further the causes of that illness. Gonococci were recovered from 91. Gonococcal pili antibody rose or fell significantly in 12 of 18 patients with positive cultures and only two of 19 who had negative cultures and smears for Neisseria gonorrhaoea(P smaller than 0.005). N. gonorrhoeae was found in peritoneal exudate from eight of 21 patients with, and none of 33 without, cervical gonococcal infection. Among patients with severe disease, other bacteria were recovered from peritoneal exudates from five of 16 with, and 19 of 22 without, cervical gonococcal infection (P smaller than 0.025). Mixed anaerobic and aerobic bacterial peritoneal infection was common in nongonococcal pelvic disease. The most common species recovered were Bacteroides fragilis, peptostreptococci, and peptococci. Tuboperitoneal gonococcal infection probably causes pelvic inflammatory disease in most patients with cervical gonococcal infection, whereas polymicrobial tuboperitoneal infection probably causes most nongonococcal cases.A series of 204 women with acute pelvic inflammatory disease (PID) were studied to determine the microorganisms responsible for infection. Endocervical and blood cultures were performed. 91 of the 204 had gonococci recovered from cervical material. Among those whose cultures grew Neisseria gonorrhoeae, gonococcal pili rose or fell significantly in 12 of 18 patients with positive cultures and in only 2 of 19 who cultured negative (P .005). Peritoneal exudated bore N. gonorrhoeae in 8 of 21 patients with, and none of 33 without, cervical gonococcal infection. Other bacteria, including Bacteroides, peptostreptococci, and peptococci, were cultured from peritoneal exudates in 5 of 16 with and 19 of 22 without cervical gonococcal infection (P .025). When cervical gonococci are found, PID is probably caused by tuboperitoneal gonococci infection, whereas nongonococcal cases are probably caused by mixed, polymicrobial infections of the tuboperitoneum.

Discussion and SummaryCombined treatment with AB followed by exposure to CO2 protected a significant proportion of mice against lethal infection with JEV when treatment was started on the 4th day after inoculation, before disease was evident. (Variance ratio by analysis of variance for AB-CO2 treated mice vs untreated controls greater than 0.01%.) AB alone was much less effective. We have not shown that the passage of AB into CNS tissue was increased by CO2 treatment but this is the most reasonable explanation of our results in view of the adverse effect of CO2, and the limited protection by AB alone. When the first treatment was delayed until the fifth or sixth day, there was no protection and most patients with JE are not seen by physicians until one or more days after onset of encephalitis. Thus effective therapy of human JE by this method is not promising.On the other hand the experimental test was very rigorous. Intranasal inoculation of JEV is probably followed by invasion of the CNS via the olfacto...

It has been established by previous inves­ tigators that common laboratory animals are refractory to trachoma and that only pri­ mates contract the disease. After the etiologic agent became available through cultiva­ tion in yolk sacs of embryonated eggs, ex­ perimental trachoma in monkeys with the organisms propagated in eggs was reported by Thygeson and associates. They reported that the experimental disease was not ac­ companied by pannus, cicatrization or major involvement of the upper tarsus and, in these respects, it differed sharply from human trachoma. Inclusion conjunctivitis in man has been considered to be different from trachoma clinically, in that it affects mainly the lower conjunctivas, does not cause pannus or con.junctival scars and has a tendency to run a more acute but shorter course. In addition, it is epidemiologically different from tracho­ ma in that it is associated with genital infec­ tion. The organisms of inclusion conjunctiv­ itis can be cultivated by similar egg tech­ niques. Again, experimental eye disease can be produced only in primates and is report­ ed to be generally more severe than trachoma. As in the case of experimental trachoma, no pannus or scars have been re­ ported.

SummaryEye specimens from first grade school children on Taiwan were cultured in yolk sac of embryonated chicken eggs and in HeLa cell tissue cultures. Four viruses, morphologically and serologically related to psittacosis-lymphogranuloma venereum group, were isolated in yolk sac from 32 children with stage II trachoma, while negative results were obtained with similar cultures of 68 specimens from other stages of trachoma, conjunctivitis and uninfected eyes. These viruses are thought to be etiologic agents of trachoma. One adenovirus was isolated from 468 children with trachoma and 4 adenoviruses were isolated from 375 children with chronic conjunctivitis. Within limitation of age group studied, it is concluded that adenoviruses do not play an important role in trachoma syndrome on Taiwan.

Summary and ConclusionSera from 61 patients showed similar reactions with both sheep and goat rbc in the differential agglutination test for infectious mononucleosis. Twenty-seven sera caused positive differential agglutination with both sheep and goat rbc and reacted in the ox cell hemolysin test. No other sera reacted positively in any of the tests. Goat cells reacted with higher dilution of serum than sheep cells with both patient serums and with 100 normal serums. A positive reaction in goat rbc was of approximately 4-fold higher titer than with sheep rbc. Within limits of these investigations it is concluded that the differential agglutination test with goat rbc and the ox cell hemolysin test gives the same laboratory information for diagnosis of infectious mononucleosis as is obtained from the sheep rbc agglutination test.

Responding to the pressure of large numbers of trachoma-inclusion conjunctivitis (TRIC)-lymphogranuloma venereum (LGV) isolates from field studies requiring serotyping, we have developed a simplified, less-precise method that utilizes cell culture-grown organisms to produce mouse antisera which is tested agaist prototype TRIC-LGV antigens in the micro-immunofluorescence test. Cell cultures with as few as 5 to 15% of cells showing inclusions produced adequate antibody in mice 4 days after single injection. Knowledge of the reaction of prototype antisera with the antigens has allowed typing of most isolates tested from the pattern of cross-reaction of their antiserum.

SummaryOur method of egg infectivity assay for trachoma virus has been described. Because trachoma viruses grow more slowly in eggs (or are less lethal) than the related psittacosis viruses the highest dilutions which infect may not kill in 13 days. The egg infectious dose (based on demonstration of elementary bodies in dead eggs and those surviving 13 days) gave higher titers and more reproducible results than the egg lethal dose. Strain differences in egg pathogenicity were demonstrated. It took 5 infectious doses of the Bour and TW-3 strains to produce one lethal dose, while 80 infectious doses of the TW-1 strain equalled one lethal dose.

INAPPROPRIATE secretion of antidiuretic hormone has been implicated as the cause of the hyponatremia and renal salt-wasting associated with certain cases of intracranial and intrathoracic disease. Cases of traumatic, infectious, and neoplastic intracranial disease, and of neoplastic thoracic disease have been associated with the salt-wasting syndrome. 1-6 The following is a report of the simultaneous occurrence in a patient of an illness clinically indistinguishable from the Guillain-Barre syndrome and of an electrolyte disturbance marked by transient loss of renal sodium-conserving ability, plasma hypo-osmolality, and plasma hyponatremia. Immunologic features of this patient's illness suggested to us that the etiology of the polyradiculoneuropathy was hypersensitivity to viral antigens. Report of a Case A 32-year-old Taiwanese man, a virology technician at the US Naval Medical Research Unit No. 2 (NAMRU-2), was admitted to Taiwan University Hospital on Sept 16, 1961, with the chief complaint of walking disturbance and pain in the left

An outbreak of influenza occurred in August, 1958, among U. S. Marines stationed on Okinawa. The causative virus was studied by standard methods in throat swab specimens collected from 39 of the patients within 24 hours after onset, and a detailed vaccination history was obtained from each patient. Most of the men were afebrile within 24 hours, none had complications, and all were returned to duty after five days. The epidemic had some unusual features, and its source was not discovered, but clinically the cases closely resembled those observed in 1957, and the virus was clearly shown to be a member of the new Asian variant set of influenza A viruses. Almost all of these men had been vaccinated against the Asian variant strain not more than nine months before the epidemic. This epidemic in the Far East emphasized the possibility of a recurrent world-wide outbreak in the coming year.