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she appeared to be too ill to sit up. The wound does notlook so healthy; several slouglis have separated. There isno sign of abdominal tenderness. After this the patientbecame gradually weaker, could with difficulty be persuadedto take food, and the laboured breathing increased. Shedied four days later.

VccroA’y.—There was a large patch of croupous pneu-monia at the left base, and general broncho-pneumonia,with some pleurisy. The right lung was normal. In theabdomen there was no sign of peritonitis. A piece of ileumabout twelve inches from the ileo-caecal valve was firmlyadherent to the abdominal wound. The femoral ring onthe right side, through which the piece of strangulatedintestine had descended, was completely closed, and therewas no piece of intestine or omentum adherent to it.Rermr7s by Mr. BRUCE CLARhE.--This case affords a

good illustration of the value of flushing out the peritoneum,and of the completeness with which it can be effected whenso large an amount of faecal matter has been poured into it,as well as of the possibility of dealing successfully with soserious an accident as rupture of the intestine during thecourse of an operation for strangulated hernia. Had notan attack of pneumonia supervened, there seems everyprobability that complete recovery would have taken place.

EYE AND EAR HOSPITAL, BALTIMORE, U.S.A.THE TREATMENT AFTER CATARACT OPERATIONS.

(Under the care of Dr. JULIAN J. CHISOLM.)THIS account of a method of treatment after the operation

for cataract cannot fail to be of interest to our readers,differing as it does from that employed in this country.

This hospital was opened for the treatment of patientstwelve years since. During this period 1050 cataract opera-tions have been performed. Up to 1886 there was nothingspecial in the treatment differing from that pursued else-where. The patients were treated in dark rooms, withboth eyes heavily bandaged, and were confined to bed withthe usual bodily restraints in such general use. Four yearsago modifications in the after-treatment were introduced,until now the course so successfully carried out is altogetherdifferent from that pursued in most special hospitals. Thefirst absolute change is that the eyes are no longer bandaged,and only one eye is closed. Notwithstanding the manyarguments on the subject, it is found by experience, inupwards of 400 cataract extractions, that the use of theuncovered eye does not interfere with the thorough andrapid healing of the cut cornea of the eye operated upon.The patient is, therefore, allowed to enjoy the great comfort<of using this eye as he did prior to the operation. If themovements of this eye, when put to its ordinary duties, didnot disturb the healing process in the cornea of the other,then the use of the arms and legs should not do so.

Experience has shown this to be a natural and safe con-clusion. It has done away with all bodily restraints andbed treatment. Simultaneously with the liberty allowedto patients was the admission of more light into the sickchamber. Instead of closed shutters, an ordinary windowshade, to exclude sunlight, is found by far the betterfor the patient, to say nothing about the comfort tothe attendants. All of these radical changes in the after-treatment of cataract cases had been brought about fromthe adoption of a simple dressing for the eye operated upon.It consists of a piece of soft silk isinglass adhesive plaster aninch and a half long and one inch wide. After the operationfor cataract extraction is completed, now without iridectomy,

, a per cent. solution of eserine is instilled, and both eyesare closed. The adhesive strip is put over the closed lids ofthe eye operated upon, its length extending from just underthe brow to the cheek. It is made damp by a few drops ofwater, and in its limp condition, aided by a few strokes of ashell spoon, it adapts itself perfectly to the irregularities ofthe lid surface, fixing every lash down upon the cheek. Beingan inch wide, it leaves exposed the angles of the lids, per-mitting the escape of secretions, and also allowing somedrops of eserine to be instilled at bedtime. The plaster isdiaphanous, so that the condition of the lids can be deter-mined at the daily visits, without disturbing the adhesivedressing. When the adhesive strip dries, which it does ina few minutes, by its firm hold it has converted the twolids into one continuous septum, a natural mould over thewounded eyeball, supporting and sustaining the perfect

adjustment of the lips of the corneal wound as no otherdressing can. The other e3-e can now be opened for usewithout fear of disturbing the one that is shut in. Anevery-day familiarity has established so much confidence inthe efficacy of this dressing that the patient is literallyturned loose to follow out pretty much his own incli-nations. He walks unaided from the operating-room andhis chamber. He lies on the bed or sits up accordingto his own wishes. He goes to bed when the propertime comes, making his own toilet, unaided by theattendants. He partakes of the regular solid meals of thehospital diet table. He walks and talks at will, using theuncovered eye as he did prior to the operation. By the fifthday, and sometimes on the fourth, the strip of plaster ap-plied at the time of operation is removed, and after that theeye is left uncovered. A few drops of a 1 per cent. solutionof atropia are daily instilled to break up any adhesions whichmay have formed between the iris and the capsule of thelens. Smoked glasses and brow shades are not now used inthe hospital since the abandoning of dark rooms. Most fre-quently, when patients are discharged from the hos-pital on the fourteenth day after operation, they goout into the street without protection, smoked glassesbeing seldom required. The experience of the pastfour years in this hospital has conclusively shown thatmost of the sensitiveness of eyes operated upon forcataract is caused by the exclusion of light and thetreatment in dark rooms. Healthy eyes submitted to thisconfining treatment will show the same weeping when thebandages are removed as those operated upon. Sinceabandoning dark rooms and confining compresses redweeping eyes are rarely seen in the hospital wards. Thegreat success of this non-restraining treatment is well shownin the fact that last year out of 116 cataract extractions,made as patients applied for operation in every varied con-dition of general health, only two eyes were lost. Suchgood results were not secured at the hospital in former yearswhen the most careful restraining treatment was carefullycarried out.

Medical Societies.EPIDEMIOLOGICAL SOCIETY.

Enteric Fever in India. ’

AT an ordinary meeting held on May 14th, Sir ThomasCrawford, K.C.B., M.D., President, in the chair,Surgeon-Major R. PRINGLE, M.D., read a paper on

Enteric Fever in India, treating successively of (1) itsincrease, (2) the causes of this increase, (3) the remedies,and (4) the probable consequences. The first question tobe decided was, he said, whether this increase were real orapparent-i.e., due to the incorrect diagnosis and nomen-clature of cases of malarial fever, occurring for the mostpart among young soldiers recently arrived, imprudent ormtemperate, and remittent fevers assuming a continued type.This last was, indeed, the conclusion of the Sanitary Com-missioners, but it reflected gravely on the knowledge andability of medical officers of great experience at largemilitary stations, and could not be allowed to pass un-challenged, especially since the lay press, adopting theviews of the Commissioners, had expressed itself verystrongly on the supposed incompetence, negligence, or

worse, of the medical service generally. Thus the Pioneer,in an article entitled" The Confusion of Fevers," com-menting on the fact that in the garrisons at Meerut andLucknow, of equal strength, there were last year fifty andfifty-one cases of fever respectively, with five deaths at eachplace, but that while the whole at the former, only thirteenat the latter were returned as enteric, assuming that theconditions were identical, charged the medical officers with" inventing enteric cases out of their own imaginations,"whereas this proportion of malarial and enteric cases wasprecisely what anyone acquainted with the very differentsanitary conditions of the two places would expect. Theincrease of enteric fever was, he maintained, real andindisputable, and its cause to be found in the almostuniversally polluted water supply. Young men, indeed,were there, as here, more susceptible to enteric fever ; butto assign youth as the cause was as irrational as it wouldbe to do so were a number of unvaccinated infants, exposedto small-pox, to contract that disease. The water-supply

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in most places was execrable ; yet, in spite of warnings andremonstrances, little or nothing had been done to improveit, though the conditions of the disposal of excreta weresuch as to render them hotbeds of fever should the diseasebe once introduced. Thus, at the important sanatorium ofMussooree, he had represented this in vain for many years ;in 1865 he saw the first case of enteric fever, and in thefollowing year his predictions were more than realised; butit was not till 1883 that, as an elected member of themunicipality, and with no encouragement from the Govern-ment, he was able to obtain a water-supply unequalled inany other Indian town, and that without any addition tothe local taxation. The station selected to exhibit theother side of this picture was the Military Hill Sanatoriumof Chuckrata, about forty miles from Mussooree, which wascold and bleak, and without anything to recommend it excepta magnificent water-supply 1000 feet above the station ;but, incredible as it might appear, this had been neglected,and the water was carried by hand from a tank below thebarracks, without any pretence at purification, though itreceived the surface drainage, excreta, and filth from thedwellings above. Even an alarming outbreak of fever in1888 had not induced the authorities to avail themselves ofthe absolutely pure water-supply close at hand, or even tocollect the rain-water from the iron roof, which was nowwasted. During the twenty years that he had been sanitaryofficer in the Agra district he had maintained a constantsupervision of the roadside wells, and his example had beenfollowed by others, with the happiest results; but thematter had never been taken up in earnest by the Govern-ment, and it was most unsatisfactory to read that out-breaks of enteric fever at Meerut, Fyzabad, and otherplaces " could not be attributed to any local conditions," orthat "the causes were unascertained," when they musthave been evident to the veriest tiro in practical sanita-tion. It had been urged by those who refused to reco-gnise in foul-water supplies the chief factor in the propaga-tion of the disease that the natives themselves, who had noothers, did not suffer from enteric fever. He admitted thatthey might be less susceptible than Europeans, but thediagnosis was very difficult with them, their complexionrendering all exanthemata obscure, and they succumbedearly to fever before any obvious lesions could be developed;but he had seen them die by thousands of an epidemicfever, probably enteric, since the characteristics of all otherswere wanting. Thus, in 1879, out of a population of fourmillions in the districts of Meerut, Aligarh, Etah, andBulandshahr, half a million perished, while miscarriageswere so numerous among women as seriously to affect thebirth-rate. The remedies, he insisted, were obvious-viz.,the provision of pure water-supplies from mountain streamsor deep wells at all military stations, with strict control ofthe wells and tanks used by the native population, and moreattention to general sanitation. The examples of Chuckrataand Roorkee, once one of the healthiest stations in theNorth-West provinces, on the one hand, and of Mussooreesince 1883 and Calcutta since 1870 on the other, were abso-lutely conclusive; while the almost complete immunityenjoyed by the children in the schools at Mussooree showedthat youth per se was not a cause of enteric fever. Whensuspicious sources could not be avoided, as by soldiers onthe march, the water should be boiled. The consequencesof this persistent apathy and neglect to provide pure waterhad been that one " sanatorium " after another had becomea focus of fever. Murree presented one of the most recentand terrible examples, and the annual loss of life among asoldiery better and more costly than ever would far out-weigh any expenditure which prevention for all time couldpossibly involve.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

MAY 9TH.

MR. H. ARMSTRONG, PRESIDENT, IN THE CHAIR.Plumbism and Water-s2rly. -Mr. JOHN BROWN, of

Bacup, read a paper on this subject, in which he calledattention to the fact that while in London cases of plumbismwere almost invariably consequent on working in lead, andill effects were rarely if ever seen to follow the use of thatmetal for service pipes and cisterns, it was quite otherwisein Yorkshire, where in towns supplied with moorlandwater lead poisoning was of very frequent occurrence,assuming at times an epidemic character. Many deaths

formerly, and even now, certified as due to urremic con-vulsions, epilepsy, meningitis, &c., were, he believed, in-correctly diagnosed. Thus, in a small block of housesfour such had been returned within a few months ;.he found a number of cases of lead palsy, and thewater highly charged with lead. The water in theseplaces was very soft., of but 2&deg; or 3&deg; of hardness, with littleorganic matter or chlorine, highly aerated, and had always.an acid reaction, due in some instances perhaps to sulphuricacid, but mostly, he believed, to some organic acid. AtBacup and Shemeld the water contained also much ironderived from the pyrites, to which Mr. Allen attributed thepresence of the sulphuric acid, which he was rather inclinedto explain by the oxidation of the sulphurous acid in theair. From numerous experiments, which he described withmuch minuteness, he had come to the conclusion that thechief agent in the solution of the lepd was not the acids,but the oxygen. Thus plumbism was far more frequent.in winter, when the temperature of the moorland sur-

face water was not over 40&deg; F., than in summer, when,having, unlike spring water, the same temperature asthe air, its power of holding gases in solution was less.Delivery under pressure, especially when interrupted,favoured aeration, and was followed by lead poisoning.The reservoirs were not stocked with fish, as was always.done when water was drawn from rivers containing sewage,and when, notwithstanding the quantity of organic matterin it, it had little or no action on lead pipes. These facts,.too, completely disproved Mr. Power’s notion that bacteriaplayed a part in the solution of lead, for moorlandwater, especially in winter, was remarkably free from,such organisms. Lead occurred in water as a hydratein solution and a carbonate in suspension. The pre--sence of iron or of lime increased, while that of alka-line or earthy carbonates diminished, its solvent power.Passed through carbon filters, which absorbed sometimes aamuch as six-sevenths of the oxygen, moorland water ceasedto act on lead. Borings into the millstone grit yieldedabundance of water containing perhaps not more than one-sixteenth of the oxygen in that from the moors, and was per--fectly safe; but if the moorland water were used at all itshould, he maintained, be filtered through carbon, or at leastthrough " sandrock," and the reservoirs be stocked withfish.&mdash;Mr. WYNTER BLYTH expressed his belief that theorganic acid in question was acetic, and Mr. CASSAL main-tained that the oxidation of sulphides was a well-known fact,.both speakers criticising the chemical procedures and con-clusions of the author. -Dr. COR)’IELD said that he had had alarge experience of the waters of the Hasting sands, softand acid, and containing a bicarbonate of iron. They dis-solved iron, lead, zinc, and tin with surprising rapidity, ycompelling him to have recourse to slate or stoneware forcisterns, and to wrought-iron pipes coated while fresh fromthe foundry with Dr. Angus Smith’s varnish. He believedthat the chemically pure lead, now imported from silver-yielding countries cheaper than the impure metal produced’at home, was more easily dissolved by both acid and oxygen,though he attached more importance to the acid.

Photogruphic G’aacra.-Dr. SYnES exhibited a new formof the "kodak" photographic camera, which he believedwould be very useful to medical officers of health in repre-rsenting the actual state of insanitary premises. Besidesthe perfection of its mechanism, it presented an entirelynew feature in the substitution for glass plates as a vehiclefor the bromide of silver film of a flexible sheet wound offone spool on to another. Fifty larger or a hundred smallerpictures could then be taken in rapid succession withoutonce opening the camera ; while for those whose time wasotherwise engaged the company would undertake the deve-loping, printing, and mounting at a moderate charge.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

T7te Urticaria of Infancy and Childhood.-Hay -Piet7er and!Paro.zys7nccL "zzee;;izr.-Ieart llitrry.

A MEETING was held on May 2nd, H. Campbell Pope"M.D., in the chair.

Dr. COLCOTT Fox read a paper on Urticaria of Infancy.He contended that, considering the great frequency of the-affection in this country, the subject received a totallyinadequate exposition in the text-books. He held that theaffection was not to be regarded as a concurrence of two