SUMMARYA panel of 10 monoclonal antibodies was used to subgroup 326 strains ofLegionella pneumophilaserogroup 1. All but two strains could be classified into three major subgroups named after their representative strains Pontiac 1, Olda and Bellingham 1. Of the 50 isolates from patients, 44 representing 32 separate incidents were of the Pontiac subgroup. This subgroup was also found in 16 of 18 buildings epidomiologically associated with Legionnaires' Disease. In contrast, strains of the Olda subgroup predominated in buildings where no infections had occurred. In 9 of the 11 incidents where isolates were available from at least one patient as well as from the suspected environmental source, the monoclonal antibody reaction patterns of strains from patients were identical to those of one or more of their environmental counterparts.

The observation of more than four polymorphonuclear cells (PMN) per high-power field (hpf) in gram-stained smears of urethral secretions was found to differentiate patients with urethritis from patients without urethritis. A urethral discharge was present in 78% of patients with nongonococcal urethritis (NGU). Dysuria without demonstrable urethral discharge and with fewer than four PMN/hpf did not appear to fit into the NGU spectrum. NGU is now defined to include men who have negative urethral cultures for Neisseria gonorrhoeae with a urethral discharge and/or more than four PMN/hpf in their urethral smears. The findings of more than four PMN/hpf in the urethral smears of 22%of asymptomatic sexually active men with more than one sexual partner (polygamous controls) suggests that asymptomatic NGU is not uncommon. Chlamydia trachomatis was isolated significantly more frequently from the NGU study group than from the control group (P less than 0.001). This study adds Corynebacterium vaginale (Haemophilus vaginalis), group B streptococci, and yeasts to the list of sexually transmitted microorganisms that are not etiologic determinants of NGU.

Riley, Day, Greeley, and Langford (1949) described the clinical features of a disturbance of the autonomic nervous system manifested by skin blotching, fluctuations in blood pressure, erratic temperature control, disturbances of the swallowing reflex, hyperhidrosis, and diminished or absent lacrimation. Additional signs of neurological involvement included incoordination, relative insensitivity to pain, diminished deep tendon reflexes, emotional lability, and disturbances of the gastrointestinal tract with episodes of severe vomiting.While this widespread involvement of the nervous system was evident clinically, attempts to elucidate the histopathology and pharmacopathology have met with only partial success. The aetiology and pathogenesis of this condition remains obscure. Aring andEngel (1945a, 1945b) reported clinical and pathological studies in a patient who had 'hypothalamic attacks' and at necropsy an old cystic lesion was found in the thalamus. These authors postulated repeated paroxysms of hypothalamic overactivity because of disruption of corticohypothalamic association tracts described by Magoun (1939) which coursed through a cystic degenerative lesion of the dorsomedial and lateral nuclei of the right thalamus. The clinical descriptions of the 'hypothalamic attacks' are those of dysautonomia.In a more recent necropsy study of a typical case of dysautonomia, Cohen and Solomon (1955) found the pons and medulla grossly smaller than normal due to alterations in the reticular formation. No aetiological clues could be found. These authors believed that the pathological changes had occurred in tracts similar to those described by Magoun (1939) The two cases in siblings reported here are significant in that the abnormalities described by Cohen and Solomon (1955), and to some extent by Aring and Engel (1945a), were present. In addition, changes in the dorsal longitudinal bundle in the brain-stem, spino-thalamic tracts of the cord and medulla, ascending dorsal columns, and spinocerebellar tracts were found. Also included in the report is a detailed study of significant changes in autonomic ganglia and peripheral nerves. MATERIALS AND METHODSThe brains of both cases and the spinal cord of case 1 were fixed in 10% neutral formalin. Other tissues were fixed in both Zenker's solution and 10% neutral formalin. An extensive dissection was carried out on case I and eyes, muscles, lacrimal glands, tongue, vagus, peroneal, femoral nerves, brachial plexus, and autonomic nerve chains were all sampled and placed in both fixatives. Autonomic ganglia from the coeliac plexus and the thoracic and pelvic regions were taken. The brain in case 2 was coronally sectioned and embedded in both celloidin and paraffin. The brain and spinal cord in case 1 were similarly cut and embedded only in paraffin. The brains and cord were sectioned subserially and stained using multiple histopathological techniques (Weil, haematoxylin and eosin, Holzer, Nile blue sulphate, Luxol fast blue, Bielschowsky, and Bodian preparations). Tests for melani...

A B S T R A C T Despite the fact that gonorrhea is our most common reportable infectious disease, little is known about natural and acquired resistance to Neisseria gonorrhoeae. With the chimpanzee model, which mimics human gonococcal infection in signs, symptoms, and host response, a natural resistance to gonococcal challenge was found. One aspect of this natural resistance became evident when the cervix and oral pharynx resisted more gonococci than the urethra. Natural resistance was also shown when environmental factors were found to influence resistance to gonococcal pharyngitis. In addition to natural resistance a postinfectionacquired immunity to the gonococcus was demonstrated. Following gonococcal pharyngitis, this anatomical location successfully resisted more gonococci than were initially resisted. Similarly, more gonococci were successfully resisted in rechallenging the urethra. These findings are related to the clinic situation and suggest possible new approaches to gonorrhea control.

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