SEPT, I5, I928] 1KMEMORANDA. [ TH3BRZ 'R 439

Whieni seen on August 31st, 1927, tlhe left eve wAas fouindto be completely blinid, the cornea being replaced by adenise lelUcoina; the tension of the eve was very low. Thelriglht eye slhowed a clear cornea except at the lower andinnier quadrant, w-here anl old leucoma was present. Thissear lhad given w-a in the centre and the iris was protruding.No corneal ulceration was found, and there ;vas no oedemapf the .ewnj_untiva.- The anterior chamber- was slhallow and.tlhe tensiol pf the eye subnormal; the iris was exceiitric,showinlff the presence of aniteriol synechiae; vision was only3/60- The fuiiduis could not be seen, a red reflex only beingobtained; witlh a +20 lens strine could be seen in the lens;vitieotis opacities- were not found.

It wanas decided that an operation must be performed, andtlhisii-is coniducted according to the method described byAbadie.

Olperofion. (1) The corneal tissue over and around thestaphllylona. was -scarified with- a sharp scalpel. (2) A"bridge " flap of conjunctiva was got ready and prepara-to-6r stitches were' inserted. (3) The base of the staphylomawas incised .with a Graefe cataract knife. (4) The flap,j-liich covered the staphyloma eiitirely, was stitchled in posi-tion. The lens did not escape. The patienit did not take theainaesthetic well, and the operation had to be done quickly.Ten days after this-operation the scar again begani to

give way and the tension was still low, the conijunctivallap having appai-eitly slipped back. Cocaine n-as instilledmid the flap brought over again, after denuding the sui'facedf the cornea. The patient was kept at absolute rest witla: firm pad and bandage overi the eye foi- thiree weeks.graduated exercises were then begun, but the seai- againibegani to bulge, the anterior chamber was almost gone, andtie tension, .which had improved after the operation, againifulL A further, more radical, operation -as therefoi-eiecessary if-the eve was to be saved; this was cai-ried outttidcler rectal anaestliesia.*SeconiI Operatioi.-(1) The conljunictiva was dissected

back all irouniid the limbus and a purse-str-ing sututr einserted. (2) The cornea was scarified arouind tleistaplivloma. (3) The staphyloma was excised and twvo finecatgut sutuires were used to drawv the edges of the woulindin the corniea togetlher. (4) The base of the staphyloma wascut thlrouuhii with a Graefe knife. (5) The pulrse-stringsutur'e w:as tied, drawinig tlhe conjunctiva well over theeornea.A verv severe reaction followved this operation, aned- tle

eve toak teat days to quiieteni down; the scar w-hich resuiltedw-as fir-m, buit in spite of atropine beinig pP-essed the i riisw-as drawn over and vision wvas perceptioni of light only.Owling to the severe reaction and the irritable cond(iitioln

of his exe the patient w-as advised to go home for someweeks before an optical iridectomy was done.He was readnmitted on Januarv 2nd, 1928. It was theai

seen that a firm N-white scar had formed, the iris was briglhtan(l the eye quiet, the anterior chamber was deep anid thetenisioni nlearly niormal. A simple optical iridectomy- wasdonie. Two davs later a severe reaction set in with aneffusion of blood inito the aniterior chamber. The eye againslow1-ly qiiietened downi, but the vision was onily lhanid mo-e-ments. No red reflex could be obtained. The lymph anidblood clot in the aniterior chamber slowlv cleared up andthe vision improved dailv. The patient could soon counitfingers at tlhree feet anid could distinguish distant objectsfairll well.As the reactioni after a simple operation had been so

sharp it was considered inadvisable to do anvthing fulrtherfor the timie being as the boy could find his way aboutindependently, anid both he an;d his parents were satisfied.A mont-h1 later the mother wrote savinig, " The eve isim11provilng. He can see qutite wi-ell niow . . . lhe is ver-yhappy anid is ouit riding almiiost the w-hole da.'."

I wish to record my thanks to Dr. H. B. Owen, D.S.O., medicalsuperintendetnt, Muilago, whlo saw tiie patient in consultationi andwho shared withl me the anxiety of the case.

Mte ranita:MEDICAL, SURGICAL, OBSTETRICAL.TETANY INVOLVING THE RECTUS ABDOMINIS.

THE folloWillg case, which came to miiy notice recently,seems to be worthy of record, both on account of itsrarity anid of its somewhat abrupt terminationi.A married man, aged 53, of rather poor physique, complained

of symptoms of o-rdinary influenza-namely, cough, coryza, malaise,and backache of two days' duration. These symptoms did notinconvenience him so much as that during this time he hadexperienced agonizing pains in the upper abdomen, which cameon at any time during the day and night. He described themas just like a " stitch " or cramp. So severe were they thatsleep was impossible. Nothing seemed to relieve them, and they-disappeared after five to ten minutes, only to return. He hadnoticed that the attacks were induced more readily by stboping.His temperature was 99.40 F., pulse 100. The mucous memnbraneinside the nose was intensely congested and the nares patullous,*the result of chronic niasal catarrh. Nothing beyond a fewcatarrhal signs was present in the chest.While I was examining his abdomen he was seized suddenly

with one of these cramp-like attacks, and I was able to witnessthe course of events. In the epigastriumn there graduallyappeared two somewhat sausage-shaped swellings, extending trans-versely on either side of the mid-abdominal line. They wereslightly thicker towards the mid-line, tense, of board-like consis-tency, and there could be no doubt that they were the uppersegments of the rectu,- abdominis in spasm. He was in great painduring the attack. At the same time the skin over the abdomrenwas hyperaesthetic and he could not bear me to' touch him. Iwitnessed several attacks that night, each lasting from five toten minutes. The upper segments alone were affected and wentinto spasm synchronously; on one occasion, however, the lefthalf only was concerned. Further examination revealed hyper-excitability of the face, and tapping over the pes anserinuselicited firillary twitchings of the facial muscles on that sidenot quite amounting to spasm. I could find no other physicalsigns in the nervous system and no fibrillation in any voluntarymuscles, though his spare musculature seemed at first to suggestprogressive muscular atrophy. I ordered 10 grains of compoundspecacuanha powder with 10 grains of aspirin in powders, and asaline expectorant mixture. Two days later I saw the -patientagain; the. cramp had then, disappeared entirely and his influenzawas much better.

-Therle could be no doubt as to the n.ature of thesetoliic -spasms. Their gradual and orderly onset excluded

the ossil)ility of localized m}ioclonuts, for hiere the con-tractions are almost alwavs shock-like in their initensityaniid onset, and usuall iII-olVe the peripheral muscles ofthe limlibs. Mor0eoveri-, tlhere is ,frequently a h:istory ofmental deteriorationi or epilepsy; in this case both of thesewere al)sent. I am inielined to believe that I was witness-ingc, a case of tetaniv inivolving the rectus abdominis, anidthe presence of Chlvostek's signls tend to confirm tllis.

Tlhouglh cases of toxic tetaniy are rare, Frankl-Hockwartmentions its occurrence in acute specific fevers, of whichinfluenza is one. As compared with the number of casesassociated with infantile rickets and post-operative thyroid-ectomy, these toxic cases form a very small percenitage.For the rectus muscle to be inivolved alone seems alto-

gether uinique. I can find nio mentioni of a similar casein the literature.

Bristol. S. LERNER M.B., B.S.LoInd.

TRIPLE INTUSSUSCEPTION IN AN ELDERLYWOMAN.

-THE uiniusuial occurrence of a triple chronic initussusceptionoccurrinig in ani elderly womiiani seemis to be wortlhy ofrecord, particularly in view of the diagnostic difficulty andthe recovery follow-ing operationi.A married woman, aged 57, wvas admitted to mynv wards in the

Glasgow Royal Infirmary sufferinig from absolute constipation;constant vomiting, and' acute pain in t1le abdomen. She statedtha t she had not been well for a year o0 so, with graduallyincreasing constipation, the passage of slime by the rectum, andpain, particularly on the left side. Tlhe pain became' very severe,and the ccmstipation almost absolute; vomiting began, and slhewent to another hospital, where she was x-rayed and the abdomenwas examined, but nothing abnormal was found. A week latershe returned, and was examined under an anaesthetic, but againnothing was found, and she was sent home; the following dayshe came to the Royal Infirmary.On admission the abdomen was found greatly distended, so

that palpation was impossible. Peristaltic waves were frequentlyseen in spite of the distension. The tongue was very dirty; andthe breath foul; the temperature was 98° F., the pulse 88, and therespi-ations 26. Rectal examination was negative, and an enemayielded no result. Carcinoma of the large intestine was con-sidere'd the' probable diagnosis.

490 SEPT. 15, 1928] MEMORANDA.

The abdomen was opened, and since the large bowel was dis-tended it was incised, but without much relief.. An explorationwas therefore made, and a hard mass was felt which at firstwas thought to be a large impacted gall-stone. When this wasbrought to view it was found to be a triple intussusception ofthe small intestine. The two outer intussuscepta were very easilyreduced,- but there then remained a third small hard one,e vidently of considerable standing, and obviously irreducible.A short-circuit was therefore performed, and the patient madean uninterrupted recovery.

J. A. C. MACEWEN, M.B., C.M., F.R.F.P.S.,Surgeon, Glasgow Royal InfirniarY.

IHERNIA OF INTESTINE THROUGH A MESENTERICHOLE.-

THE following case seems worthy of record for its interestin regard to diagnosis and its peculiarity.A boy, aged 81, complained of sharp stabbing pains in the

lower abdomen and of sickness. The pulse was 110 and the tem-perature 99.80. The face was deeply flushed with circumoralpallor; the tongue was very coated and almost of the "whitestrawberry" type. On inspection of the abdomen nothingabnormal was noted, although the mother stated that she hadseen a definite swelling on the right side. There was pain onpalpation over the appendix region.Under anaesthesia a swelling as large as an adult's fist was

noted in the right iliac region. On opening the abdomen thecaecum was found to be -very much distended; the lower partof the ileum, caecum, appendix, and lower part of the-ascendingcolon had slipped, from behind forward, through a hole of abouttwo inches in the mesentery, becoming twice twisted on itself.The hole in the mesentery had smooth thickened edges and roundit were some enlarged glands. The part of the intestine involvedwas untwisted and pushed back through the. hole in the mesentery;the hole closed and the boy has made an uninterrupted recovery.Four years previously this boy had complained of

abdominal pain, and his father had been told, by acolleague that the condition was probably tuberculous.1 am indebted to Mr. Edmund, who operated, for per-mission to publish this case.Shrewsbury. JOHN WHITE, M.B., Ch.B.Ed.

FOREIGN BODY IN THE BLADDER.TIlE following must be- a rare accident, but should beborne in mind by those who are doomed to a " catheterlife " owing to enlargement of the prostate.An elderly man of more than average intelligence was admitted

to the Colony Hospital, Grenada, on December 4th, 1926, with a*history of having passed a rubber catheter on himself; the tipb-oke off when he tried to remove it. He had been carrying outthis form of treatment for several months and had had noprevious trouble.On admission the patient was in great pain and collapsed; be

was suffering from marked retention of urline with a bloodydischarge from the urethra. A metal sound was gently passedinto the urethra and was found to be held up. by a. resistantstructure at the neck of the bladder, The prostate was foundon examination to be considerably enlarged and very tender onpalpation per rectum.

I performed a suprapubic cystotomy, and a piece of rubbercatheter, about two inches long, jammed tightly in the urethraloi-ifice of the bladder, was removed. The prostate which wasmarkedly enlarged- and congested and bulging forward, appearedto surround it. There was a fair quantity of blood- in the bladder,which was drained. On December 9th a tiny fragment of rubberwas passed per urethram. Three days later there was a suddenand large haemorrhage from ihe prostate, which was only con-trolled with great difficulty. Intermittent haemorrhages followedfor six days, after which there was no more trouble. Drainagewas continued for some time afterwards, and on January 1st,1327, the, patient was discharged from hospital passing urine freelyper urethranm. He refused to' have prostatectomy' performed.My interpretation of this accident. is that, after passage

of the rubber catheter, the man had. spasm of the neck ofthe bladder and urethra, and in his hurry and fright hewrenched at the catheter against the contracting urethra.It is notorious that rubber deteriorates rapidly in thetropics, and no doubt the catheter in question was notin good condition.

Since writing the foregoing I have been interested toread Mr. A. Ralph Thompson's account of two similarcases on January 14th (p. 51), where fragmenlts ofcathleter formed the nuclei of vesical calculi.

V. L. FERGUSON,Chief Mledical Officer andl Resident

Sti Lucia, British West Indies. Surgeon.-

VON RECKLINGHAUSEN'S DISEASE ASSOCIATEDWITH FIBROMA OF THE APPENDIX.

THE following case illustrates an unusual condition of theappendix and emphasizes the fact that in von Recking-hausen's disease the distribution of the tumours is wideand variable, and by no means confined to the skin andsubcutaneous tissue. It has previously, been shown thatintra-abdominal neuro-fibromata can simulate the commonerabdominal affections.'A man, aged 47, is afflicted with neuro-fibromatosis, having

large numbers of nodular tumours, some sessile and somepedunculated; over the scalp, neck, face, trunk, and limbs. Thetumours vary greatly in size. The accompanying photograph givesa good impression of the appearance of the patient. In addition,there are numerous subcutaneous tumours and areas of pigmenta-tion on the back and lower limbs. A slight degree of hesitancyin the speech is noticeable, a condition said to Ioe characteristicohf 2hsdsaeHe consulted me on March

31st last on account ofabdominal pain,, and said thatfive days previously he beganto suffer from' intermittent'abdominal pain, which wascolicky in nature and notlocalized in any particulararea. The pain had continued,but' in the last forty-eighthours it had become localizedin the right side of the lowerabdomen, where he had sincefelt a tender swelling. Therehad been no vomiting, and thebowels had acted regularly,except for an attack of diar-rhoca on the second day. Histemperature was 970 F., pulserate 72, and respirations 20.

In the right iliac fossa anelongated mass was felt which

... og:f& .o.:

.. .

was distinctly tender on pal-pation; the abdomen moved fairly well with respiration.On the same day he was admitted to hospital, where an opera-

tion was performed by Dr. H. S. Jeffries. The abdomen wasopened- through a right paramedial incision. The mass was foundto be the appendix, which was much enlarged and closely adhcrentto the caecum from which it was dissected. There were no otheradhesions, and no other abnormality was found in the abdomen.On examination of the appendix after removal it was seen tobe about 21 inches long, and in places about 1- inches in diameter.It was of fairly hard consistency, and in one place a subperitonealnodule was .seen. The pathological report was to the effect thatthe appendix was surrounded by fibrous tissue in the form ofinnocent tumours of the type met with in neuro-fibromatosis;there was no sign of recent infection of the appendix itself.Before the operation the possibility of the case being fibroma

of the appendix was considered, though infection of the appendixcould not be excluded.

Petersfield, HIants. TREVOR HOEY, M.B., B.CIh.

ACCIDENTAL SNARING OF TWO SMALL STONESBY A CATHETER.

ON May 15th a male child, aged 1 year, was admiittel atnoon for stone in the urethra. When the patient wasbrought on to the operation table it was found that thestone had passed back into the bladder. A No. 3 lubbercatheter was tied in and the operation deferred to thenext day, owing to the temperature in the theatre beingtoo high for any but the most urgent surgery to beattempted. The catheter worked well during the night,and on the operation table one ounce of lotion was runinto the bladder through the catheter. The bladder. wasthen opened suprapubically. An assistant was asked toremove the catheter so that the interior of the bladdercould be properly palpated. He found some difficultyin doing this, and presently the nose or the catheterappeared at the meatus alongside the other end of theinstrument. Wheni the loop so formed was iulled] outit was found that two small stones-the larger one weigh.ing 3.5 centigrams and measuring 5.5 centimetres inlength and 3.5 centimetres in breadth-were caught in theloop and had been pulled by it through the urethra.No undue force was used in pulling out the catheter.There were no more stones in the bladder.

W. F. BRAYNE, B.A., M.B., Chi.B.,Lieutenant-Colonel I.M.S., Civil Surgeon, Mandalay.

Shouldice: Canadians Medical Association Journal. 1925.72 Osler: Principles and-PracticU of!edicine.

512 SEPT. I$, 1928] MEDICAL NEWS. THLBJ-RIAS

bv the rat-flea. Pulex -irritans, though not commnon, isfound in some parts of the tropics, such as the Panama"and in somiie of the southern Pacific Islands,2 to whichit was tiansporte(I years ago. Althoughl the geographical.distribution of P'ulex irritaas -is nearlI similar to that ofrheumatic fev-er, it would seem to be rulled out as a carrier-by certaini facts, one of which is that it is so common thatit would 1)e more likely to be the cauise of an epidemicdisease sulch as scarlet fever than of an endemic such asrlheumatic fever, although the geographical distribuitioni of-tlle tw-o is almost identical. The structure of Aschloff'sbodies is suiggestive- of -their ha-ving- been originated by aprotozoon, spirochaete, Rickettsia, or allied organism rathierthan by a bacilluis, but it cannot be said that Aschoff'sbodies are themselves pr'otozoa.

It would seem that, if the possibility of this rat-fleabeing the cause of rheumatic fever is accepted, one of theimportant things to be investigated is the relationi betweenthe rat and the -disease. There is said to be d? relationbetween throat infections and rheumatic fever; but thethiroat condition may be either a symptom or a frequientconlcomitanit of the disease, anid the cauise of the toonsillitismay eniter a houise thlroughi the samiie (tefective sanitaicondition as does the flea-l)earing rat.The workIhithlerto done on the environmental factors of

rheumatic fever has been extensive thoiugh general, andl thiecause has not yet been found. I agree with Dr. ArbourStephens that the hypothesis that there may be a connlexionbetween an insect and the disease is wrorthy ofinvestigation-I am, etc.;Harrow, Aug. 28th. J. TERTIIrS CLARKE.

Rit''irzitits atUb TaIttgn.+UNIVERSITY OF LONDON.

THE3 Coniiaught Hlal of Resideice (14. led1ford PlaCe, Loudon,AV.C.1), recenitly presented to the Unliversity of Loii(noni byH.R.I1. the Dnke of CoInniau,ght, wvill be rea(dy for students ofan1y of the colleges aind " schools" of the Utiveri'ty at the openingof the sessionI in October. Mr. W. S. Antguls, M.A., LL.B., hasbeeni appoinited warden1, anid Miss Bu1rniett iimatronl.

UNIVE1RSITY OF DUBLIN.SCHOOL OF PHYSIC, TRINITY COLLEGE.

THE Conmmittee of the School of Physic, Trinity College, inviteapplications for a Montgomery Lecturer ill Ophthalmology for theyear 1929. TLhe caiudidate must bea receuit grad(lnateof a recognizedIrish school of imledlicinie, must uinidertake to prosecute sttudy orresearclh for a period of niot less tihanl six milonitlhs in sulchiplace asthe Board may approve, and( muist, durinig lhis year of.office, giveani accounit of his research in a ptiblic lectnre or lectures. Theremunieratioii will be £150. Canidi(lates must send their apiplica-tioiis to the Registrar of the Sclool of Phy,sic, Trinity College,Dtnblini, niot later thian November 1st, aidid must state therein theworlk they prop)ose to iuntdertake aiid- thie l)lace wviere they intenidto cntrry it ouit. Applicationis should be accompanied by a state-iimenit of the applicant's qualificatioiis, and(I by a reprint of auypublislied work.

ROYAL FACULTY OF PHYSICIIAN& AND SURGEONSOF GLASGOW.

SAMUEL MICMAHON, M.B., Ch.B., was adimitted to the Fellowshipof the Facuiltv, after exainkration, oni September 3rd. As recordedelsewvhere (p. 507), thle lionorLary Fellowvship was couferred onSir Arthtir Keitlh.

THE introductory address before the Middlesex HospitalMedical School will be delivered at 3 p.m. on Tuesday,October 2ndl, in the Quieen's Hall, by Mr. A. E. Webb-Johnson,C.B.E., D.S.O., after which the prizes gained by students-during the previous year will be distributed by H.R.H. PrinceArthur of Connanght, and Princess Arthur of Connaught willpresent the Fardon Memorial medals. The annual dinnerwvill be held the same day at 7.30 p.m., at the Savoy Hotelwheni the chair wvill be taken by Prince Arthur of Connaught.THE atnnual dinnier of past and present students of UniversityCollege Ho:,pital in this the centenary year of the MedicalSchool vill be hekl at the Hotel Cecil, Strand, on f'riday,October 12th, at 7 p.m. Thci chair will be taken by SRurgeonRoar-Adtniral Gaskell, C.B., F.R.C.S., Medical Director.General R.N. -Tickets may be, had oni application to the'honorary secretary at the Medical School.

I DLIuin: Amer. Journ. Trop. Med., 1923, iii, 335.2 Buxton and Ilopkinson: Researches inl P'olyn?esia and Malaya.

DR. T. WATTS EDEN-will distribute the prizes at CharingCross Hospital Medical School on Thursday, October 4th,at 3.30 p.m., in the out-patients' hall of the hospital.THE annual dinner of past and present students of the

Royal Dental . Hospital of London will be held at theTrocadero (Empire Rooms) on Saturday, October 20th, at7 o'clock, under the chairmanship of Mr.- G. G. Campion.THE anniversary dinner of the Pharmaceutical Society of

Great Britain will be held at the Hotel Victoria, North-umberland Avenue, W.C., on Wednesday, October 3rd, at7 o'clock.THE seventy-third annual exhibition of the Royal Photo-

graphic Society of Great Britain opens at 35, Russell Square,W.C.1, on September 17th, and will continue until October 13th.Photomicrography is well represented, and the advancementin x-ray photography is illustrated by numerous exhibits.THE Fellowship of Medicine announces that four post-

graduate courses begin on September 17th, each lasting fortwo weeks. One in medicine, surgery, and the specialtieswill be given at the Westminster-Hospital, occupying thewhole of each day with lectures, demonstrations, andoperations. A course in orthopaedics at the Royal NationalOrthopaedic Hospital, and another in diseases of children atthe Queen's Hospital for 'Children, Bethnal Green, willsimilarly occupy the whole ,of each day.- The fourth courseis one in diseases of the eye, which will be held at theRoyal Eye Hospital, St. George's Circus, S.E., each-afternoona o'clock.V THE Home Office, in communiques dated September 5th,1928, gives notice that the Secretary of State proposes, afterthe expiration of forty days from that date-, to makeRegulation.s under Section 7 of the, Dangerous Drugs Act,1920, for controlling the mnanufacture, sale, possession, anddistribution of benzoyl-morphine, dihydro-oxycodeinone, anddihydro-codeinone. The Regulations will be in the termsof Provisional Rules, dated September lst, 1928, which, inaccordance with Section 2 of the Rules PLiblication Act, willcontinue in force in the mreantinme. Copies of the ProvisionalRules may be obtained on application to the Under Secretaryof State, Home Office, Whitehall, London, S.W.1. The HomeOffice also announces, in the London Gazette of September 4th,that the Secretary of State proposes to make Regulationsunder Section 3 of the Dangerous Drugs Act, 1920, applyingthe Raw Opiurm Regulations, 1921, as amiiended by the Regu-lations of 1922, 1923, and 1924, to coca leaves and Indianhemp.A PARTY of Canadian medical practitioners interested in

tuberculosis are at present travelling in Europe as the resultof scholarships offered by the SutI Life Assurance Comnpany.They have spent the last ten (lays in England, and havevisited Liverpool, Birmingham, Cardiff, Winchester, Alton,Midhurst, and London; next week will be spent in France,chiefly in Paris. Other places to be visited during theremainder of September and the whole of October inicludeFlorence, Romrie, Milan, Venice, Leysin, and, on the returnjourney to Canada, Cambridge, Edlinburghi, and Glasgow.The party is principally engaged in studying tuberculosisinstitutions of different kinds, it will attend the Conferenceof the National Union against Tuberculosis iu Romne at theend of this month and that -of the National Association forthe Prevention of Tuberculosis to -lie held in October-:inLondon. During their visit to the King Edward VII Sana-torium at Midhurst, Sir StClair Thomson gave a lanterndemonstration on his seventeen years' experience as larynugo-logist to the institution. Dr. Pratten (London, Ontario) statedthat every sanatorium in Canada had a laryngologist on itsstaff, and the larynx was now systematically examined inevery case.A COURSE of 56 lectures and demonstrations on diseases of

the alimentary system, organized by Professor F. Gallart yMon6s, will be held at the Hospital de la Santa Cruz y SanPablo of Barcelona from October 5th to-December 10th. Thefee is 100 pesetas.THE tenth French Congress of Orthopaedics will be held in

Paris under the presidency of Professor Nov6-Jusserand ofLyons on October 12th, when the following subjects will bediscussed:- sudden pathological dislocation of the hip, initro-duced by Ren& Le Fort of Lille; and surgical treatment offlat-foot, introduced by Allenbach of Strasbourg. Furtherinformation can be obtained fromn the general secretary, Dr.Paul Mathieu, 74 Rue Vaneau, Paris Vlle.MESSRS. J. AND A. CHURCHIL,L announce for early publication

The Practice of Refraction, by W. Stewart Duke-Elder, D.Sc.,M.D.; F.R.C.S., Asssistant Ophthalmnic Surgeon, St. George'sHospital; Diseases of the Blood, by A. Piney, M.D., ResearchPathologist, Cancer Hospital, London;i Recent Advances inffactMriDloq?,/, by J. H. Dible, MI.B., Ch.B., Professor-ofUEactem-iology, University of WVales; and Clinical ChemicalIPathology, by F. S. Fowweather, MY.D)., M.Sc., LJectureron Chemical Pathologyr, University of Ljeeds.

SEPT. r5, 19283 LETTERS, NOTES, AND ANSWERS. r TUDEiTrsE 513SEPT. 115, 19281 r~~~~~~~~~~~~~~~~~~~~~~~~~MEDICALJOURNAJL

WE are informed by Messrs. Bailliere, Tindall and Coxthat they have undertaken the distribution in this countryof TI'he Opiunm Problem, by Charles Terry and others, ofwhich a notice appeared in our issue of September 8th,page 450.THE July issue of the WVest African Medical Journal has a

strong clinical interest, the contributions including articleson traumatic rupture of the spleen, multiple pregnancy,quiinine intolerance, tetanus, village sanitation, leprosy, andthe Public Health and Medical Service in Nigeria. It will beremembered that this journal was inaugurated by the WestAfrican Medical Staff; and the directors of the MedicalResearch Institutes, at Accra an(d Lagos, together with thedirector of the Medical and Sanitary Service of Freetown,co-operate in its production. Copies of thie journal may beobtained from the Director of the Medical Research Institute,Lagos, Nigeria; the annual subscription is 20s.THE International Congress against Alcoholism held at

Antwerp from August 20.h to 25th was attended by about400 members from 32 different countries. The programmeincluded papers on alcoholism as an international problem,alcoholism in Russia, personal liberty anidl the alcohol question:,prohibition in the United States, the diagnosis of alcoholism,the Bratt system of liquid control in Swenden, the Belgianliqui(l laws of 1919, the action of alcohol on the offspring,alcohol an(d spas, alcohol and sunlight, welfare centres fordrinkers, and non-alcobolic beverages. The next congresswill be held at Warsaw in 1931, by invitation of the PolishGovernment.ACCORDING to the Journal of the e477rei-ican, MIedicaZ

Association (luring, the last three years there has been aprogressive decline in typhoicl fever in the great cities in thoUnite(d States with a population of mnore than 100,000. In1927 five of the eight geographical grouLps had typhoid deathrates under 2 per 100,000 aud the other three groups hadrates varying from 3.39 to 10.07.

All communications in regard to editorial business should bsaddressed to The EDITOR, British Medical Journal,. BritishMedical Association House, Tavistock Square, W.C.I.

ORIGINAL AR1TICLES and LETTERS forwarded for puiblicationare understood to be offered to the BRITISH MEDICAL JOURNALalone unless the contrary be stated. Corriespondents who wishnotice to be taken of their communications shtotuld authenticatethem with their namies, not necessarily for publication.

Authots desiritng REPRINTS of their articles publislhed its theBaRTisn MEDICAL JOURNAL mulst coIIImtmnicate withl tlhe FinaucialSecretary and- Businbss Manager, British MVIedical AssociationHouse, Tavistock Square, W.C.1, on receipt of proofs.

All communications with reference to ADVERTISEMENTS, as wellas orders for copies of tlhe JOURNAL, slhouild be addressed to theFinancial Secretary and Buisiness Manager.

Tbe TELEPHONE NUMBERS of the Britislh Metlical Associationand the BIrITISI NIEDICAL JOURNAL are IUSEUM 9861, 9GS, 986S,and 9S64 (internial exchange. four lines).

The TELEGRAPHIC ADDRESSESare:E-DITOR' of -the BRITISH MWICAL JOURNAL, Aitiology WVestcent.

Lonidoni.FINANCIAL SECRETARY AND BUSINESS MANAGBR

(A.dvertisements, etc.), Articulate WFextsewt,te London.MEDICAL SECRETARY, Meflisecrua Westcent, London.

The address of tle Trislh Office of the Britisht MTedical Associationis 16, Southl Frederick Street1 Dublin (telegrsams: Bacillus,Dublin; teleplhone: 62550 Dibliln), and of the Scottishi Office,7, Drumsheugh Gar-dens, Edinburgh (telegrams: Associute,Edinburgh; telephone 24361 Edintbuirgh).

QUERIES AND ANSWERS.

TREATME.NT OF CoeL BACILLURIA.I. M. S." asks for suggestions for the treatment of coli bacilltirinin a lady who has ha(l large (loses of antogeuols vaccinie, anid hastaken hexaminte, caprocol, aiid liexvl-resorciiol for lengthyperio(ds. She has also ha(l great quianitities of potassiuim citi-ate,potassium bicarbotiate, ati(i other alkalis, anid gallonis of Coli-trexdville, Vichy, antldistilled water, withoit the slighttest im-provemenit. The uirinie rnemains higlhly acid, alid gives a heavygrowtl of B. coli. Crystals of calciulm oxalate were preseit InIthe last specimen of urinie examine(l. Her gall-bladdler wasremoved two 'years agro, anid the B.--coli itifectioti was (letectedsix moniths later. She suffers from severe headlaches, but isotlherwise in good health.

SUNSTROKE IN GREAT BRITAIN.* W. J. B. S."'asks whliere information cani be obtainie(d about the

effects and treatment of the mildl sutistroke sometimes expe-rienced iu. Great Britain. Otie effect is thiat the patieltt is upsetby beinig out in the snui, tliotigh previous- to tire stroke this didnot ciuse the unpleasaut cephali¢ symptoms.

VAGINTSMUS.SUGGESTIONS in response to "C. A.'s" inquiry (September 8thb

p. 473) lhatve beeu received from several correspondents." J. A. C." regardls the case as essentially onie for treatment bypsychotherapy rather thati by surgical measuires. " R. M. L."'also believes that cases of this kind are usually of psychic origin,and advises consultationi with a me(lical psychologist with a viewto anialytioal treatmenit; in lhis opiniion hypnosis is unilikely toprove successftul, as- te cond(lition may have several deter-ninaiits. " W. H. M." suggests that artificial inseminiationuni(ler anaestlhesia immediately after a periodl wouil(d producecyesis aud cure the condition.

MOUTH-BREATHING.DR. W. E. IT. BULTL (Hunstalntonl) writes: In answer to " SchoolMed ical Offcer " (September 8th, p. 473), askinlg for a(lvice in thecurie of a chil(d who is a nmoutlh-br-eather, atnd inquiiring whetherthere is anyv apparatus whicht will cure this bad habit, I mayquote from a paper on "Oral sepsis" delivered before theLond(loi .Hlospital Medical Society oni October 30th, 1913, byMr. G. Nortlicroft, at that titmie senior (denital surgeon to theLonDdou.f-fospital: " And(l if aniy operation for adenioids is untder-takeni inistruict them in re-acqutiring the habit of nasal breathingby dlaily breathingi exercises, ani(l at night wearinig an anti-mouth-breatlinig metal valve, which keeps the month moist andcleau, and(i absoJutely prevents a reversiosi to oral breathinig.This apparatus will also be founid of great utility in the treat-ment of adlults, anid all rhinologists should advise its use.'

MR. WRIGHT LAMBEIRT, M.R.C.S., L.D.S., writes: Wheni I was astudenit at the itoyal Denital Hospital we tse(d to make alightwire framnle in the form of an internal denital splint, over whichwas stretchled thin sheet rubber, to correct the habit of mouth-breathing. The appliauce was wvorn during the night.

STATUS EPILEPTICUS."H. C. B."' writes: In the British Mledical Jouirnal of July 7th

(p. 40), in reply to a query by me the week before, Dr. L. Harris-Listonl advised giviLng hyoscine hydrobromide gr. 1/100 hypo-dermically for this condition. I have fouud this treatment ofthe uitmost value, anid I thlinlk it should be widely klnown. Thatthis is niot so at preseut is evi(lent from the fact that nio mentiouis ma(le of it in Mtiskeus's recenit book oln epilepsy or inDr. Collier's 1928 Lumleiaii Lectuires. Paraldehyde per rectum,stronigly recommeii(le(n by Dr. Collier, was quite without effectin my case, but I have had no other experience with it.

INCOME TAX.Coimmencement of Appointment.

" R. M. L. S." terminiated a short enigagement in the Royal Navyoni March 2nd, 1928, as from which date he commenced hospitalduties. Is he liatble for 1928-29, seeing that his income was taxedby deduction for 1927-28?

* Yes; the change in the nature of the appointment heldnecessitates a niew departure in the assessment of Iiis income,and he is liable to tax for 1928-29 on the amouut of his incomefor that year.

Research Scholarship."D. B." is the holder of a research scholarslhip of £150 for theyear 1927-28, but, owing to illntess, the scholarshiip is being heldover till this winter session. Is tbis income liable to tax?

* ** The exemption of scholarslhips from income tax wasprovi(led by Sec. 28 of the Finance Act% 1920, and applies to"income arisinig from a scholarship held by a person receivingfull-time inistructioni at a iuniiversity, college, school, or othereducatioinal establishment"; a "scholarship " is dlefined' asincludinig ani exhibitiou, buirsary, or other similar educationalen(lowment. On the wlhole, it is difficult to brinig a researchscholarsliip of the nature referre(d to within the conlition th'atthe hol(ler shall be " receiving full-time inistruction," especiallyin view of a (lecision in a recenit case (Heaslip v. Hasemer), whichsuggests that mere oversight of study does not constitute full-time instruction.

Expenses Incurred by Locumtenent."D. C." has been doiiig locumteneuis work dutintg the past year,

aiid iiiquires whether he can: deduct hotel expenses in makinghis return.

* The Income Tax Acts forbid the de(luction " of anydisbursemenits or expenses not being money wholly andexclusively laid out for the purposes of the . . . profession."Hotel expenses are in the maini " laid out " for private purposesanid seem strictly to qome vitliin thte above prohibition. But wehave beeni given to understaud that commercial travellers andother persous comp)elled by their vocation to move from onehotel to anlothe«r are allowved to dleduct some portion of theirexpenlses as represenltinlg the addtl(ional expend(iture caused bytlhe natulre of thleir wvork. Perhlaps " D. C."X can discuss thematter wvith his inlspector of taxes and obtainl some relief on thabbasis.