consisting of daily doses of 1.5 to 8. grains of chaulmoogra oil. Improve ment gradually set in, and after two years of treatment the patient was free of symptoms with the exception of small scars upon the face. A slight area of anæsthesia on the elbow and slight thickening of ulnar nerve also remained. Later all symptoms disappeared except thickening of ulnar nerve. Lepra bacilli which were present in large numbers nine years previously could not now be demon

strated.

Mercurial Cream for In- There is a growing jections in Syphilis. tendency to treat syphilis, particularly severe syphilis, in its earlier stages by the intramuscular injection of mercury preparations into the buttocks. This method of treatment is and has been extensively employed in the army with great success, and Colonel Lambkin's cream of mercury used for the purpose is well enough known.

The main objection to the treatment is its painfulness: although, in order to get rid of syphilis rapidly and thoroughly, it is well worth while to submit to a certain amount of pain. This pain, however, is necessarily influenced to some extent by the volume of material injected. It is, therefore, like:y that the more concentrated the mercury the less bulky

will each dose need to be, and the less will the patient suffer, provided that the concentration does not itself have deleterious effects.

We are indebted to the Pharmaceutical Journal for a formula for mercurial

Liquid paraffin, sufficient to produce 100 parts by measure.

Five minims of the cream contain one grain of mercury.

The mercury is rubbed down with a portion of the wool-fat in a warm mortar until no globules are visible with a hand lens; the remainder of the wool-fat is then added. The chlorbutol is dissolved in a portion of the liquid paraffin by the aid of gentle heat, mixed with the woolfat and mercury, and made up to 100 parts by measure with more liquid paraffin. The whole is heated on a waterbath until just fluid, then strained through three or four layers of white gauze and stirred with a glass rod until cold.

It is essential that the wool-fat used ed with about twice its volume of water, should have been purified by being heatstirred well, strained through lint, the mixture being then allowed to cool in an ice chest. The cake of wool-fat separated is then scraped free from any brown deposit on both its surfaces. This purifying operation should be repeated until the fat is perfectly clean.-Hospital.

of discomfort and pain in the region of the corresponding kidney, either catheter becomes blocked, this, it is stated, can be readily replaced by a fresh one guided by a long mandrel, in accordance with the instruction of Albarran. On the fourth or fifth day, if no complications have occurred, the compresses are removed from the bladder and the operation wounds. closed by sutures. After another interval of one or two days the ureteral catheters are removed and the bladder is drained by a retained urethral catheter. The author has had occasion to prolong ureteral catheterism over nine days, but neither in this clinical experience nor in experiments on animals, in which the catheters were retained for 16 days, were any complications observed. The practice of continuous ureteral catheterism may be capable, the author suggests, of giving excellent results in the surgical treatment of vesical and of fresh vesico-vaginal fistulæ.

British Medical Journal.

nection, beginning with the nasal or nasopharyngeal disturbances, especially in shape of nasal hæmorrhage in nephritis. phritis. Mention is likewise made of the changes in the buccal cavity as well as the pharynx, namely, hæmorrhages, swelling, nutritional disturbances of the mucosa, such as anæmia and dry catarrh. Other less common complications in nephritis consist in tonsillitis, stomatitis and pharyngitis of the uræmic type, and membranous glossitis. The disturbances of the larynx and trachea include oedema, anæmia, uræmic asthma, uræmic aphasia. hæmorrhagic laryngitis and diphtheria.

Nasal disturbances are of common occurrence in the course of disease, especially of the female genital organs, appearing most frequently as hyperæmia, swelling and hæmorrhages; also as reflex neuroses. The author claims that menstru

ating women are predisposed to acute infectious disease of the buccal and pharyngeal cavity. Great importance attaches to the relations between laryngeal tuberculosis and pregnancy, which exerts an extremely unfavorable influence upon the affected larynx. F. R.

tion of vision necessitated by our more extended use of the eyes for close work in the complex civilization of the present day.

2. The normal child is born hypermetropic and without astigmatism. The myopic child is either defective from birth or has acquired myopia from the stress of eyestrain, usually through the "turn

stile of astigmatism." Astigmatism is not congenital, but is practically always acquired in the normal child during the early years of life by excessive strain upon the muscles of accommodation.

3. Kindergarten and primary work should be arranged so as to avoid strain. upon the muscles of accommodation of the eye in the plastic years of childhood. Hence sewing and all weaving exercises should be limited in amount, if not absolutely eliminated.

4. Systematic study should be only begun when the delicate and soft tissues of the child's eyes have attained sufficient formation to resist distortion on moderate use of the accommodation. This means, in my estimation, that prolonged, close work should not be allowed until the age of 10 or over. A child beginning systematic study at that age will, with suitable care, be able at 16 or 18 to acquire all the knowledge possible to its more precocious companion and will have the inestimable advantages of normal eyes and healthy physique.

5. No young child should be encouraged to compete with its companions for prizes. Mental and ocular overstrain are the inevitable results of such educational monstrosities. In the primary schools especially there should be no grading of the children.

6. A child incapable of the prolonged use of the eyes at the proper age should not be classed as culpably lazy. In the majority of cases there will be found uncorrected refractive error.

7. Inability to concentrate the mental attention and deficient powers of observation are often caused by bad visual memory resulting from eyestrain.

8. The symptoms and physical signs of evestrain in children can be easily recognized, and there is no more brilliant

August, 1908, J. C. Hancock discusses the various methods of treating the symptoms of trachoma by medicinal applications. He has reached the conclusion that there are few diseases, local or general, in which a longer list of remedies has been employed, but the more he has seen of trachoma the more he has been convinced that any patient presenting objective symptoms sufficient to permit of a diagnosis is a case for operation. It is his belief that the only way to cure trachoma is to rupture the granules and express their contents, and to follow these procedures for a number of weeks with instillations of a mildly stimulating antiseptic-the last to eliminate traces of infection in a germicidal way and by absorption small and deep granules not affected in the operation. The instrument. he prefers is the Jameson trachomatome, which does its work thoroughly, he says, without injury to the conjunctiva. He recommends that the eyelids should be subjected to a thorough squeezing after the operation in order to expel the contents of the granules.

Treatment of Pene- J. A. Donovan trating Wounds of the (Journal A. M. A., Eyeball. July 25) makes a plea for a better prognosis in penetrating wounds of the eyeball. He concludes:

I. Mild antiseptic cleansing-I to 5000 mercuric iodide (preferable), I to 2000 mercuric cyanide or I to 5000 mercuric bichloride or saturated boric acid. Argyrol in special cases.

2. Remove all magnetic foreign

bodies at once, also any or all that can be removed easier and safer now than later. Those remaining to be removed from time to time when the eye can most safely stand interference.

3. Enucleate at once only such eyes as have been totally destroyed. Even then it might often be better to wait till about the fourth day to avoid the possibility of any question arising later. Others should be cleaned, filled with salt so

Diffuse Interstitial Keratitis.

A. E. Davis read a paper (Journal 4. M. A., July 25) before the Section on Ophthalmology of the American Medical Association, of which the following are the conclusions:

1. Diffuse interstitial keratitis may occur as a result of acquired syphilis.

2. It usually occurs as a late secondary sign of the disease or during relapses in the tertiary stage of the general disease. Stephenson gives the average time

or cut off and got in the best possible condition.

4.

Cauterize infected wounds; stitch when lids will not hold edges in apposition; use atropin and dionin as indicated. Hot applications are always safe and usually preferable to cold.

5. Keep patient in bed at least a few days, longer if possible, remembering that detachment of retina may have occurred.

6. Never interfere with an eye until you feel reasonably certain you are now doing the best thing and that this is the best time to do it; otherwise always wait.

After 10 years of active practice, constantly dealing with these injuries in the mines, smelters, railroads and shops, by carrying out the above suggestions, he has yet to enucleate his first eye that was not destroyed at once or did not contain a foreign body, and so far, fortunately, he has never seen a case suggesting sympathetic ophthalmia where this line of treatment has been followed from the time of injury.

10.8 years after the primary sore. Loewinson has reported one case as early as three weeks after the appearance of a primary sore, while Ellett reports a case appearing as late as 23 years after the in

fection.

3. It almost invariably affects but one eye, although there are a few exceptions reported where both eyes were affected.

4. It runs a quicker and lighter course, as a rule, than the cases due to inherited syphilis, and is rarely harmful to the sight. It should be remembered, however, that Griffith has reported one case in which the sight was entirely lost. 5. True salmon patches occur but seldom in these cases.

6. It is difficult to make a clinical diagnosis between the syphilitic and the tuberculous forms of the disease, and even a differential pathologic diagnosis is not always conclusive.

7. The prognosis is favorable, though it should be somewhat guarded from the fact that sight has been lost entirely in

one case.