examination absolute confirmatory signs. of the diagnosis were obtained.

The grandfather of the little patient died at 64 years of age of cancer. The The grandmother died at 60 years of "dropsy." She had had 16 pregnancies, five of them resulting in miscarriage. Six of her children had died, three of them in infancy. Of the five living children the oldest is the father of four children, three of whom died at a young age. The second lost a child at three years. The third is said to have had the nose "eaten" by syphilis. The fourth is an avowed syphilitic. The fifth is the little patient in question.

To prove in this case the transmission of the disease to the third generation it

citis.

was necessary to exclude acquired syphilis in the mother, in the little patient herself and also in the father, as hereditary syphilis can at times acquire the disease. This proof the writer has apparently been able to furnish. He also excluded with reasonable certainty all causes of keratitis other than syphilitic. Furthermore, antisyphilitic treatment of the keratitis. produced a complete cure.

From a consideration of all the facts presented the writer claims that his patient was one of hereditary syphilis transmitted to the third generation.

The writer refers to three other similar cases of interstitial keratitis occurring in syphilis of the third generation, namely two reported by Stryeminski and one by Neumann.

(Medical describes

Renal and Ureteral Cal- Erdman culi Complicating or Record) Simulating Appendi- his mode of operation thus: When, as most usual, the stone is in the ureter, it is a decidedly simple matter to approach it either by the transperitoneal through a Deaver or Kammerer incision, removing the appendix, palpating the course of the ureter, and finding the location of the stone. Then by a narrow extraperitoneal dissection from the outer margin of the incision one rapidly reaches the site of the stone, the ureter and stone being held transperitoneally and pushing upwards. Then through the retroperitoneal dissection the ureter is incised over the stone, the stone expelled, and the uretral wound sutured or not, a small drain put down to the trauma in the ureter. The peritonæum is then sutured and the

muscles and skin sutured to the emergence of the drain. There is no necessity of suturing the wound in the ureter. The author prefers the transperitoneal localizing method, as it is rapid; one can hook the fingers under the ureter and push it up without contusing it, as is done with the usual instruments required in the retroperitoneal method. In the retroperitoneal method one must make a very long incision and dissect up a large amount of the pelvic and abdominal anatomy before arriving at the site of the stone. When the stone is situated high in the abdomen. or is in the hilum of the kidney, the incision is either the oblique lumbar or the incision of Israel. One need not hesitate in either of these operations, provided the renal association is not infective, to explore the appendix through a nick in the peritonæum, and remove it, as it is readily

tastitic process was evidently referable to furnuculosis in five cases, and to a large carbuncle in one instance. One patient had previously suffered from a panaritium of the thumb, while another had had a sore heel (from a tight-fitting shoe), which led in the first place to suppuration of the lymphatic glands, the symptoms of para-nephritis developing at a later date. In another case the disease appeared in immediate connection with physical overexertion. The interval between the onset of the affections which constituted the cause of the disease, and the first signs of the metastatic process, was a variable one, usually between three and seven weeks.

One of the patients presented a symptom of especial importance for the inflammation of the retroperitoneal fatty tissue, consisting in flexion of the thigh. The examination of the urine yielded no information of value for the diagnosis. Only in two cases the presence of intra

renal abscesses was shown at the time of

the operation; in the remaining cases no definite indications of the renal origin of the abscesses could be demonstrated, although some of the abscesses had only reached a moderate circumference at the time of the surgical exposure, and were closely adjacent to the surface of the kidney.

The staphylococcus pyogenes aureus was found in six of the cases. The author in conclusion refers to two cases which indicate with a certain degree of probability that small metastatic foci in the kidney, including those of a purulent character, may undergo a spontaneous F. R.

cure.

demonstration may be situated in some part of the body far removed from the eye itself. Yet this objection applies to a certain extent to other tests so far advanced, even to the popular subcutaneous injection method. In the latter, the local ocular reaction sometimes demonstrable adds to the proof of the cause of the local disease, but observations have shown that this phenomenon occurs rather infrequently, as indicated by the reports of Stock, who in 45 positive results met with 7 instances in which there was a local reaction.

The limited number of observations on

the part of the authors to date renders definite conclusions as to the positive value of the Calmette conjunctival reaction in the diagnosis of obscure eye diseases as yet quite impossible. Sufficient encouragement, however, has been obtained to lead us to continue our experimentation in this line. That the discovery of Calmette offers a clear, intelligible, trustworthy and convenient method of diagnosing the presence of tuberculous foci in the body we have every reason to believe.

Oxide of Copper in the Cornea.

Edwin G. Ruch (Archives of Ophthalmology, March) reports the case of a lady struck in the eye by a spark from a trolley wire as she was driving her automobile alongside a street car which was running under a number of intersecting wires. Dr. Ruch explains these accidents. as follows: As the wheel of the trolley pole runs over the plates of which the switches and hangers are made, there is always some combustion. Ordinarily this is slight and invisible, but under poor or interrupted contact copper is detached, immediately oxidized and thrown off in brilliant sparks. The substance of these

sparks when they strike the cornea always becomes deeply imbedded, although there does not usually seem to be much tendency to ulceration. The resulting ciliary injection, pain and photophobia are intense, until every vestige of the oxide of copper is removed. It is smooth, and often almost buried beneath the epithelial cells of the cornea.

Interstitial Keratitis Arnold Knapp (ArAfter Calmette's Test. chives of Ophthalmology, March) reports a case of typical tuberculous keratitis in a previously healthy eye following the use of Calmette's ophthalmo-reaction. The installation of the tuberculin solution produced severe local and general manifestations, which, unfortunately, demonstrate that the ophthalmo-reaction cannot be regarded as altogether and always harmless.

Blindness Following Martin Bartels (ArOrbital Abscess. chives of Ophthalmology, January, and German edition of same, Vol. LVI, No. 3) has been investigating the anatomical basis of blindness following orbital abscess, and comes to the following conclusions:

I. Blindness with orbital abscess may be caused by retrobulbar necrosis of the optic nerve, due to thrombosis of the pial vessels, and thrombosis of the central vessels in parts.

2. Through formation of a collateral circulation both central vessels may regain their potency before and behind the thrombotic occlusion; consequently, in spite of the thrombosis of the central vessels, the vessels on the papilla may appear to be normally filled. 3. The outer ocular muscles and nerves may remain normal in spite of prolonged orbital abscess.

Otitic Meningitis.

Dr. Arnold Knapp, New York (Archives of Otology, August, 1907). According to recent statistics it has been shown that uncomplicated otitic meningitis occurs as often after acute as after chronic purulent otitis. Knapp claims that in 29 out of 52 cases meningitis followed disease of bone. The diseased bone was situated in 11 at the tegmen of the antrum and tympanum; in 16 at the posterior surface, the superior edge or the apex of the petrous pyramid; in 22 the infection extended through the labyrinth, generally along the internal auditory meatus. In a few the path of extension could not be determined. These figures show that the meninges are first infected, in nearly three-fourths of the cases, in the posterior cranial fossa, and in slightly over one-fourth of the cases in the middle cranial fossa. Meningitis may be serous or purulent. According to Heine, purulent meningitis may be classified into encapsulated, acute progressive and general. Diagnosis is frequently difficult, as no single symptom is characteristic. Kernig's sign is perhaps the most constant. Lumbar puncture is unquestionably of great value in diagnosis, though its findings are not infallible. Prognosis is unfavorable in purulent meningitis in the majority of cases, and not until the last few years was there hope of recovery in these cases. Cases have been reported during the past few years in which recovery from purulent meningitis has occurred following operative intervention. Macewen, Jansen and Lucae have all reported cases of otitic meningitis successfully operated upon where

circumscribed purulent collections within the dura were drained. Cases of cures have also been reported by Hinsberg and by Kuemmel. Held and Kopetzky recently reported a case of purulent meningitis cured by operation. Operative treatment is more hopeful than formerly held, especially when the infection is through the middle fossa. Ballance is quoted as laying down the principles of treatment as suppressing the source of infection, giving free exit to the suppurative exudation and administering appropriate antitoxin. Friedrich was one of the first to urge active operative measures in the treatment of meningitis, and suggests incision of the dura at the site of the infection and making a counter-opening in the spine by laminectomy for drainage. The prospect of successfully dealing with the localized intrameningeal infection depends somewhat on which fossa is first invaded. The broad exposure of the infected meningeal area, if it is situated in the middle cranial fossa, is simple; in all successful cases the operation was performed in this region. The conditions in the posterior cranial fossa, where most meningeal infections begin, are much more complicated. The area can be rendered accessible, however, by the removal of the posterior surface of the petrous pyramid to the internal auditory meatus, sacrificing a portion of the labyrinth. Incision of the dura in this region also gives access to the cisterna magna, that distented portion of the subarachnoid cavity, which would, of course, replace lumbar puncture. The author dwells on the necessity of early and thorough elimination of the primary focus and early recog