in age. The correction has been weaker than this more often than stronger. In certain occupations requiring a farther focus it has been much less.

Etiology of Ophthal- John Wharton mia Neonatorum. (Ophthalmic Review, December) has been making careful bacteriological examinations in series of 100 cases of ophthalmia neonatorum, and he gives the following conclusions:

(a) The majority of cases (in his series 75 per cent.) result from an infection with the gonococcus, and the inflammation is usually severe. Other organisms, notably the pneumococcus, may cause a milder form of inflammation.

(b) The source of infection is usually an abnormal secretion present in the vaginal tract of the mother. Especially is this the case among infants with gonorrhoeal ophthalmia, for leucorrhoea is frequently gonorrhoeal in origin.

(c) The absence of a vaginal discharge, a leucorrhoea, does not necessarily indicate the absence of gonorrhoea. A gonorrhoeal conjunctivitis may appear in the offspring of a mother who thinks she is quite healthy. The mother's history, certainly along the poorer classes, must not be relied upon, and a rigid prophylaxis should be observed in every confinement.

(d) Infection may rise as a result of an inoculation of the conjunctival sac with sputum, filth, etc.

Sidney Smith (Ophthalmoscope, March), says:

Ophthalmia neonatorum is caused in about two-thirds of all cases by the gonococcus, derived directly or indirectly from the maternal passages. Of the remaining cases, no inconsiderable proportion are associated with the pneumococ

all the cases are due to the pneumococcus. We may conclude, indeed, that, next to the gonococcus, the pneumococcus is the commonest micro-organism associated with ophthalmia neonatorum. For the first observation of this kind we are indebted to Victor Morax (Thèse de Paris, 1894), who described such a case in a baby aged 8 days. Since then cases have been reported by many writers. The cases, as a rule, are mild, seldom entail corneal damage, and sometimes present the peculiarity of improving more or less suddenly after lasting for four or five days. It has been suggested by Cramer (Centrabl. f. Gynäk., October 14, 1899) that in some instances the eyes of the baby may become infected by the saliva of the mother, nurse or friend. not denying this possibility-for which, indeed, there is some clinical evidence (Wharton)-it is more probable that the organism is commonly derived from the mother's genito-urinary organs.

While

Pathology of Hypo- Sidney Smith, in the pyon-Keratitis. course of a discussion on pneumococcus infections of the eye, at the Medical Society of London (Opthalmoscope, March), says:

Thanks largely to the experimental researches of Professor Leber, we are now well acquainted with the pathology of hypopyon-keratitis. The pneumococcus, derived either directly from a diseased lacrymal sac or conjunctiva or from a foreign body itself, or indirectly from the saliva or nasal secretion, gets access to the cornea through some abrasion, which is often so trivial as to excite neither the attention nor the solicitude of the patient. The breach of surface is essential; we know that pneumococci are unable to attack the intact epithelium of the cornea. Once in the substantia pro

pria, however, the organism spreads out laterally between the lamellæ, and proceeds to elaborate its toxins. Now, although Descemet's membrane is germproof, yet it appears to oppose no barrier to the diffusion of toxins. The latter, accordingly, are enabled to pass through the membrane, and in that way to reach the aqueous humour and the structures, as the iris, in contact with the humour. The toxins exercise a noxious influence upon the blood vessels of the iris, ciliary body and the parts about Fontana's spaces, whereby leucocytes are caused to migrate into the anterior chamber, where they become visible under the guise of a larger or smaller collection of pus (hypopyon). This process explains the fact (which is disputed by nobody who has undertaken the necessary investigations), namely, that the pus in the anterior chamber in cases of hypopyon-keratitis is free from bacteria. The only exception to this rule is to be found in cases where the cornea has already perforated. The older ob servers had noticed that in some cases a filament of pus appeared to connect the corneal infiltration on the one hand, with the hypopyon on the other. This appearance they interpreted as meaning that the pus in the chamber was due to a backward extension of the suppurative process going on in the cornea. We now recognize that, in point of fact, it is owing to a process of chemotaxis.

Bilaterality and One- Definite knowledge
Sidedness in External regarding the lia-
Eye Diseases.
bility of a disease to

extend to the second eye is evidently of considerable prognostic value, and also often aids in clearing up the ætiology and pathogenesis of the disease. W. Gradle (N. Y. Med. Journal) gives some instructive hints on this subject in a review

of the more important diseases which are typically either one-sided or bilateral.

Acute catarrhal conjunctivitis either attacks both eyes at once or in rapid succession. Only in the mildest instances usually can precautions prevent the second eye from being involved, so readily is the virus transferred from one eye to the other.

Gonorrhoeal conjunctivitis in the adult. is often one-sided in origin, and the second eye does not always become infected, even when no protective shield is worn. Ophthalmia neonatorum is always bilateral, although one eye may be more severely involved than the other.

Chronic catarrhal conjunctivitis is, as a rule, equally marked in both eyes, and where one-sided, a special reason must be sought in one-sided aetiology, such as stricture or infection of one tear sac or extropion of the lid on the same side.

Trachoma is usually bilateral, but one eye may show only slight inflammatory hypertrophy. Such one-sided immunity, even when not absolute, is permanent.

Episcleritis is commonly bilateral, although the second eye may be attacked. months after the first. Deep scleritic is much more apt to remain one-sided.

Diseases of the cornea caused by localized traumatism, followed by infection, are not likely to involve the second eye unless bilateral conjunctivitis is present to carry the germ. Dendritic keratitis and keratitis due to herpes zoster or herpes febrilis are always one-sided, but phlyctenular and scrofulous keratitis are usually bilateral.

Interstitial keratitis is always bilateral within a month or two of its onset if due to syphilis, and where limited to one eye is surely not syphilitic, but possibly tubercular.

Iritis is practically always bilateral when recent syphilis exists. Iritis due to

tertiary syphilis, whether gummatous or not, is often one-sided. There is no invariable rule regarding other than the syphilitic form of iritis, but a non-syphi

litic iritis is unlikely later to attack the second eye if the first eye runs a mild course, bilateral iritis being usually simultaneous if at all.

Vaseline Oil in the J. N. Roy, M.D., Dressing of the Radi- Montreal, Canada cal Mastoid Operation. (Laryngoscope, February, 1908). The author claims a distinct advantage in dressing the radical mastoid wound with an oily substance. He lays down the following rules for this new method of dressing: The radical operation done as usual; but the surgeon should choose by preference an autoplastic procedure which will allow him to sew together the lips of the wound behind the ear; and especially so if he has not to do with cholesteatoma. For complete hæmostasis the post-operative dressing should be slightly compressive, and iodoform gauze should be used. About the sixth day the gauze is taken out and the wound is carefully cleansed with hydrogen peroxide, then dried with cotton. Little strips of plain gauze about one and onehalf centimeters wide and about six centimeters long are dipped in vaseline oil; one end is introduced into the drum either by the canal or by the retro-auricular opening, and the other end remains outside the wound. The whole cavity must be carefully carpeted with this gauze, and the strips should overlap each other slightly. Upon this layer cotton is applied sufficiently saturated with liquid vaseline to be well packed in. In doing this packing, which must be fairly tight, it is necessary not to leave any dead spaces, so that to this end it is better to use little pledgets of cotton. A great deal

of care must be given to the external meatus and to the operative opening of the canal. It must be packed rather tightly on the one hand to prevent any subsequent narrowing, and on the other hand to maintain the apposition of the flap. When the cavity is well filled, the dressing is finished with dry cotton and a bandage. It is scarcely necessary to add that the vaseline, the oil and the cotton should be sterilized and that the surgeon should conform to the most careful asepsis. At first the dressings must be done every day, but when the secretion of the wound lessens, epidermisation is going on normally, they may be done every second day. The dressing should be removed. very slowly.

was a boy three years of age, who presented typical attacks of Jacksonian epilepsy in the course of the diseases mentioned in the superscription. No abscess was found by puncture of the temporal lobe, which was performed in connection. with the radical operation. Thereupon, during a repeated left-sided attack, the right motor region was exposed by means of a skin-periosteum-bone-flap (Wagner), but the suspected pus focus was not found by either puncture or incision. The patient died after another attack. At the

autopsy nine abscesses were demonstrated, each having about the size of a pea, and for the most part closely arranged around the upper end of the right central groove, at a distance of about 1.5 cm. from the upper margin of the exploratory skin-periosteum-bone-flap.

In connection with this case the author discusses the question of the possible otogenic origin of these abscesses, and upon the basis of a number of observations recorded in the literature the conclusion is reached that such a possibility is not at once excluded by the long distance from the pus focus in the temporal bone or by the multiple character of the abscesses. It is more probable, however, that they were of bronchiogenic origin. F. R.

Dr. C. R. Holmes, Hysteria of the Ear. Cincinnati (Paper read at the Meeting of American Laryngological, Rhinological and Otological Society, May, 1907). Dr. Holmes said in his paper that the classification of cases of hysteria naturally falls into five categories, viz.: (1) Cases in which there is no evidence of any disease of the ear; (2) cases in which a normal or abnormal ear is the seat of hesterogenic zones, as where certain sounds produce reflex phenomena in distant parts of the body; (3) cases in which there are abnormal appearances in the ear which can be explained, and which

the subsequent history of the case demonstrates as temporary nervous and vasular phenomena (e. g., angeio-neurotic œdem. atous patches, changes in color, etc.); (4) cases in which there are slight pathological changes in the ear-real, but in

sufficient or not of a character to account for the symptoms complained of; (5) cases in which the hysteria inflicts more or less damage upon the ear for the purpose of exciting sympathy or to induce. the performance of an operation by the aural surgeon.

The diagnosis often presented unusual difficulties, and it is unwise to make a hasty diagnosis of hysteria in cases where

the initial examination reveals no adequate cause for the symptoms complained of, occurring as they do so frequently in neurotic subjects. It is now well known that it is possible for a diseased ethmoid or sphenoid cell, or for an atrophied middle turbinate, to produce reflex disturb. ances in the ear so out of all proportion to the apparent local disturbance that the real cause of the ear trouble could be overlooked for a long time, even by careful observers. Should the diagnosis of hysteria be made in a patient with a normal ear, or with an ear with but very slight pathological changes, the patient should be referred at once to a neurologist. In those cases where there is more or less disease of the ear it becomes a matter of discrimination.

Bleeding Polyps of the Jorgen Moller Nasal Septum. (Arch. für Laryn. und Rhin., Bd. XX, Heft 1). The author reports two interesting cases of bleeding polyps of the nasal septum.

They occurred in connection with pregnancy. He cites Glas, who made accurate histological examination of 10 of these cases, and was able to determine that rhinitis anterior sicca stands in

causal relationship to the bleeding polyp. It appears that these growths in the majority of cases occur more often in women than in men, and from the records there seems to be distinct relationship to pregnancy. Wright reports an interesting case in which the growth recurred several times after removal in a pregnant woman. In this case the growth spontaneously disappeared after the woman. had been confined.

Hypertrophic Nasal Catarrh and Complications.

Bucklin (Arch. of Otology, Vol. 36,

No. 4). In order to demonstrate the atmospheric pressure in the respiratory tract the author devised a "respirometer"-a glass tube four feet. long and having a one-eighth bore. One end of this tube is placed in a glass of water, the other is held in the patient's mouth airtight; meanwhile the patient takes long, rapid, forcible inspirations through the nose. The height to which the water is raised in the tube determines how great a vacuum is formed in the respiratory tract at each forcible inspiration.

The test is made with each nostril closed in turn, and if there is present any occlusion in one or the other nostril it will be seen that the water rises higher when the side with the obstruction is tested.

The author claims that the vacuum created within the entire respiratory tract with each forcible respiration amounts to about 1-3600 pounds to the square inch for patients suffering from hypertrophic rhinitis, and with the obstruction reduced one-half the amount of oxygen inspired is doubled.

Treatment of Tracheal H. Herzog (Deutsch. Diphtheria by "Ecou- Med. Woch., No. villonage." 20, 1907). In 1896 Varoit and Bayeux described the term.

The author reports on a large amount of interesting material, having observed 1080 cases in which there were throat symptoms which could be positively accounted for by the stomach lesion.

He only used such cases in which the local symptoms in the throat were determinable positively by examination, and in which these symptoms were bettered or made worse as the stomach lesion either improved or grew worse.

The throat gave symptoms of pressure, sensations of burning, feeling of foreign body in the larynx, nervous cough, etc.

If this article has any value at all, it will account for some of the cases we occasionally see in which there seems to be no improvement in the throat condition under usual therapeutics, and in which there perhaps exists a stomach lesion.