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the lowest rate of recurrence was observed after

aseptic operations on stones in the ureter, andthe highest rate after nephrolithotomies in septiccases. Dr. Hellstrom concludes that recurrence ofstones after operations have been performed on themin the urinary tract is more common than surgeonshave been inclined in the past to confess. The causesof such recurrences are numerous. Their numbers

might be reduced were great care to be taken inlocating all the stones before an operation byskiagrams taken from a variety of different angles.The chances of the migration of a stone just beforean operation are such that the interval between thetaking of a skiagram and the operation should beas short as possible. It is also, of course, most

important to keep the urinary tract as sterile aspossible, and in this connexion Dr. Hellstrom refersbriefly to neosalvarsan as often having a surprisinglygood effect on staphylococcal infections of the urine.

VIDI

WHEN a student after a demonstration, whetherin the laboratory or dissecting room, or merelyon the blackboard, can say " I have seen" he isa long way on the road to be able to add " I canremember." Many teachers have excelled in illustra-tion of their words by effective diagrams, and at arecent meeting of the section of pathology of theRoyal Academy of Medicine in Ireland a plea wasentered by Prof. T. T. O’Farrell for more realistic

drawing on the blackboard. His words received

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direct endorse-ment trom ur.

McGrath, the

president ofthe Academy,who said that,while he him-self couldremember rcertain illus-trations of lec-tures which hehad attended,he could alsoremember thatit was oftendifficult to

recognise theappearance ofthe object fromthe usual out-line on theblackboard.The significant

word in Dr. McGrath’s comment was "outline,"because the force of Prof. O’Farrell’s plea forrealism depended upon his statement that actualitywould be better introduced into blackboard drawingby the employment of shading. Prof. O’Farrellpointed out the obvious fact that with a pencil upona white surface the lights are left untouched, theshadows being indicated at the depths required tobring out contours, whereas in drawing on the black-board the lights are chalked in, the blackboard

representing the shadows. But it is clear that amiddle term between the blackness of the boardand the whiteness of the chalk is needed to givedifferent shadows their appropriate depths, andProf. O’Farrell pointed out that if the middle termwas too light the drawing would be unduly pale, andif’,7,too dark it would have the mystifying appearanceof an over-exposed photographic print. His sugges-

tion was that the draughtsman on the blackboardshould establish the density of his middle tone,and then fill the spaces between the outlines withthis tone duly graded, leaving the surface of theboard for the deep shadows. He allowed that thedistribution of light and shade would thus becomea matter of judgment and practice, and many willfeel that he suggested a problem in draughtsmanshipwhich few lecturers, who were not well-taught artists,would be able to solve, except when dealing withcertain simple subjects. As a matter of fact theamount of information that can be conveyed bysimple outline in a form easy to recall, is very large,as the curves and drawings to illustrate statistics

sufficiently show. We have received from theKathleen Boland studio (Great Queen-street, W.C.2),a booklet entitled " Vidi " with some amusingexamples of this fact. In simple subjects nothingis gained by the addition of shade, and, indeed,the lessons in many discourses might be obscured

by elaborate drawing. But the addition of a

little shading often makes a picture much clearer ;for example, the marginal illustrations in Mr.Souttar’s " The Art of Surgery "gain much in clearnesswhere they are reinforced by shading. Prof. O’Farrellused the drawing of a head on the blackboard asan example where the proper placing of high lightsconsiderably added to the clearness of the picture,adding that experiment on the blackboard wouldhelp by training the observation in light andshade in the production of good photographs forpathological supplements. These illustrations willappear in the Irish Journal of Medical Science; wereproduce here a sketch of a skull which hehas sent us. The subject is one of real import-ance, for students can learn and remember valuablelessons from blackboard demonstrations. But tomake the drawings on the blackboard effectivemore is needed than a general idea on the part of thelecturer of what he wants to show; it is necessarythat he should feel certain that he is showing it.And where something more than outline is called for,something more than an elementary knowledge, ofdrawing may be needed. Prof. O’Farrell suggestsfor the teacher a range of accomplishment whichis not easy to acquire, but we are certain that for theelucidation of some subjects of medical interest itis worth acquisition.

PARIS CONGRESS OF THERAPEUTICS

IN the coming autumn there will be held in Paristhe first French congress of therapeutics under thepresidency of Prof. Maurice Loeper. Six subjectshave been chosen for discussion during the three days,Oct. 23rd to 25th-viz., (1) parenteral treatment ofpeptic ulcer ; (2) treatment of coli bacilluria ;(3) therapeutic associations ; (4) adrenalines ; (5)pyretic treatment ; (6) treatment of radiodermatitis.The congress will be held in three sections : Dr.Babonneix will preside over the section of medicine,Prof. Tiffeneau over the section of pharmacodynamics,and Prof. Strohl over the section of physiotherapy.The opening papers in each of these subjects are to beprinted in advance and circulated to all membersof the congress by Oct. 1st. Anyone who wishesto take part in the discussion of these reports or tocomment on them should apply before Sept. 10th toDr. G. Leven, 24, rue de Teheran, Paris (8). Paperson subjects not mentioned in the programme willonly be accepted subject to time being available.The entrance fee of Fr.100 (for students Fr.50)is payable to the treasurer, Dr. G. Doin, 8, place de1’Odeon, Paris (6). Cheap railway fares will be

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available for those attending the congress. A list ofhotels with a note of their prices will be sent to anymembers who desire it.

THE TREATMENT OF SQUINTBINOCULAR vision is a subject to which more

attention has been paid by ophthalmologists of lateyears than ever before. It has been treated frommore than one point of view : the developmental,tracing the gradual approximation of the visualaxes of the two eyes in animals, from rabbit to man,and with it the gradual increase in the overlappingof the two visual fields ; the physiological, dealingwith the actions of the external muscles of the eyeon the one hand and the inter-related functionsof accommodation and convergence on the other ;and the practical, which is essentially the determina-tion of the clinical methods by which the want ofharmony between these two functions, often thecause of nervous strain and sometimes of actualstrabismus, may be relieved. Dr. Dobson approachesthe subject from the physiological and practicalpoints of view.1 She gives concise explanations ofthe relations between accommodation and con-

vergence, of the various forms of heterophoria, and ofthe different grades of stereoscopic vision. Shemakes the reader understand that vision is not merelyan optical function but a cerebral one, and deals ablywith the physiological phenomenon of suspension ofvision which occurs in normal individuals, but incases of squint may go on to permanent suppressionof vision or "

amblyopia." She also introduces thereader to many of those methods of orthoptic trainingfor heterophoria and squint about which we haverecently heard so much. There is much in this

monograph that is valuable, but some of the methodsrecommended for the clinical examination of patientswill not meet with general acceptance, for example,the use of " dynamic retinoscopy." This methodof diagnosis is at variance with the usual procedurein that it purports to test the refraction of the eyewhile in a state of active accommodation. In

examining cases of convergent squint in hyper-metropic children, Dr. Dobson does, it is true, admitthe advisability of the ordinary procedure under

atropine, but she prefers to order glasses which onlypartially correct latent hypermetropia for distancewith a stronger correction for near vision. The

description of various instruments used in orthoptictraining is perhaps too short to enable the surgeonwho proposes to take up this branch of ophthalmicpractice to make his choice. For that he must seethem actually in use or test them himself. Thevalue of this work lies chiefly in helping the readerto think out the principles on which these instrumentsshould be employed.

THE STUDY OF LEPROSY

FOR more than 300 years Franciscan monks havetended the victims of leprosy in Manila, but it wasnot until 1906 that the modern colony at Culionwas established by the Philippine health service.In 1922 Dr. H. W. Wade became pathologist to thecolony, and he and his wife with the active supportof General Wood instituted a campaign in the UnitedStates which in 1925 brought in two million dollarsfrom over 50,000 subscribers to the Leonard WoodMemorial. About one-fifth of this money was spentin constructing the new leprosarium at Cebu, extendingthe equipment at Culion, and building a cabin cruiser

1 Binocular Vision and the Modern Treatment of Squint. ByMargaret Dobson, M.D.Lond., ophthalmic surgeon to the NewSussex Hospital for Women and Children, Brighton. London:Humphrey Milford, Oxford University Press. 1933. Pp. 107.10s. 6d.

to facilitate transport, all of which were handedover to the Philippine Government ; the remainderof the money was placed at the disposition of a medicalboard, of which Dr. W. H. Welch is chairman,interested in the general problems of health anddisease prevention. This board has set itself to bringabout an understanding of what the problem of

leprosy means throughout the world ; it organised ’

the international conference at Manila in 1931,1 oneact of which was an attempt to delete the offensiveword leper from the vocabulary. The board deter-mined that workers everywhere should know whattheir fellow investigators were doing; Dr. Wade,who was made medical director of research at Culion,went the round of leprosaria in 1931-32, while Dr.J. Rodriquez studied epidemiology at Johns Hopkinsbefore returning to the Philippines. Last year a newscheme of direct attack on the problem by highlytrained experts was designed and an advisory com-mittee with Dr. F. P. Gay as chairman was appointedto choose the experts and the problems they shouldinvestigate. During the current year Dr. J. A. Doull,Dr. M. H. Soule, and Dr. Gay are to visit the twostations in the Philippines to make a preliminarysurvey.

NITROHYDROCHLORIC ACID FOR HAY-FEVER

IT will be generally admitted that the desensitisa-tion method of treating hay-fever requires a gooddeal of experience if successful results are to beobtained. In expert hands quite a high proportionof cases may be expected to get relief, but in

general practice the results are very variable. Asused by some authorities, desensitisation treatmentrequires a skilled attendant, almost continuousobservation, and a good deal of fortitude from thepatient, over a period of some days. It is clear,therefore, that the difficulties of this treatmentcannot lightly be dismissed. In our current issueProf. H. Beckman, of Milwaukee, emphasises thesepoints and concludes that only about two-thirds ofhay-fever patients are relieved by desensitisation,even in expert hands. As an alternative line oftreatment he suggests a revival of the use of nitro-hydrochloric acid, proposed as long ago as 1893 byS. S. Bishop : a dose equivalent to about 8 minimsof the concentrated acid, diluted with 6 or 8 oz. ofwater, is taken three times a day after meals andonce upon retiring to bed. With this treatmentalone Dr. Beckman found that 69 per cent. of the518 cases reported to him obtained definite or com-plete relief from symptoms. Such figures certainlycompare favourably with those obtained by otherforms of treatment, although they cannot bringthe same degree of conviction as a series observedpersonally. Hay-fever is, of course, a condition inwhich it is notoriously difficult to draw conclusionsfrom the results of treatment, if only for the reasonthat the diagnosis from other forms of paroxysmalrhinorrhoea is not always easy. How the acid

therapy acts is difficult to understand ; such dosescould hardly affect appreciably the acid-base balanceof the body, as Dr. Beckman thinks possible. Butother authorities also recommend a trial of acid bymouth in hay-fever, and the treatment certainlyhas the merit of simplicity and few drawbacks. Dr.Beckman mentions the occasional occurrence ofdiarrhoea, but not the deleterious effect upon theteeth of prolonged administration. In a recent

paper Dr. E. C. Stafne 2 contends that decalcificationmay occur, usually beginning on the palatal surfaces

1 See THE LANCET, 1931, i., 876.2 Proc. Mayo Clinic, 1933, viii., 157.