symptom. The stools are greasy and respond to the osmic acid test for fat, and oil globules are seen with the microscope. The fat may appear in the stools as lumps not unlike those of casein. A progressive loss of weight is soon or late a prominent feature. The condition is best prevented by starting the infant on low fat percentages. The increase should be gradual and never reach above four per cent. In the active management of such a case a calomel purge should be administered if vomiting is a permanent feature. The fat should be at once reduced to less than one per cent, and then only gradually and carefully increased, stools and condition of the stomach being carefully watched.

TREATMENT OF ENURESIS.

THURSFIELD (British Medical Journal, April 21, 1906) says that atropin used in the form of an extract, tincture, or as liquor atropin is the only drug from which he has had good results in the treatment of enuresis. He recommends ten minims of the tincture three times a day as an initial dose, and increases the amount week by week until the dose produces evidences of its action. It should be used over a long period, usually from three to six months, for permanent relief. The dose should be diminished gradually until it can be left off with safety. He also recommends the use of potassium citrate in conjunction with belladonna in the majority of cases, and in some cases where hyperacidity of the urine was the cause, he found the administration of potassium citrate alone very efficacious. He also speaks highly of urotropin well diluted.

TREATMENT OF CEREBROSPINAL MENINGITIS.

OSBORNE (New York Medical Record, February 17, 1906) says, regarding the treatment of this affection, that it consists in diminishing the congestion, in preventing or relieving the spinal or cerebral pressure, and in combatting the acute symptoms and complications as they arise. He says further that the administration of diphtheria antitoxin. in this affection is theoretically unsound and practically a failure. Spinal puncture is of benefit in some instances for the relief of pressure, but only in rare instances, he believes, is it indicated for diagnostic purposes. The sore throat should be treated with antiseptic gargles and sprays, and the conjunctivitis with solution of boric acid. If the pain. is not severe and the pulse good, bromides or chloral may be given; otherwise treat by wrapping the painful joints with cotton, applying heat, giving a calomel or saline purge, and administering morphin. The author believes that to quiet the cerebral excitement and delirium and to intensify the action of the morphin in these cases the administration of ergot intramuscularly or subcutaneously at six-hour intervals gives good results. The ice-cap and the spinal ice-bag are necessary, and if the temperature is subnormal or the surface of the body is cold, dry hot applications are of advantage. He is convinced that ice, ergot, and morphin will save many patients from death by this disease.

ORTHOPEDICS.

BY IRA DEAN LOREE, M. D., ANN ARBOR, MICHIGAN.

FIRST ASSISTANT IN SURGERY IN THE UNIVERSITY OF MICHIGAN.

EARLY OPERATIVE TREATMENT OF TUBERCULOUS OSTEITIS OF THE KNEE.

BERNARD BARLOW, M. D., of Buffalo, in the American Journal of Orthopedic Surgery for April, 1906. His report confines itself to three cases in which the focus of disease had not reached the joint, but was confined to the end of the femur. He advises excision of the diseased bone, and, if there has been prolonged contraction, division of the ham-string tendons.

The histories of the two patients which he presents are to substantiate his previously reported results in this line of work.

The first patient was a girl, nine years old, with flexion posture of forty-five degrees and a range of free movement of fifteen degrees. There was much enlargement of the inner condyle (Figure I) with pain at this point upon digital pressure. The tibia was partially subluxated

with abduction and some rotation outward. She had passed the stage of muscular spasm and night cry. After thoroughly cleaning out the area of disease the cavity was swabbed with a five-per-cent formalin solution, after which the periosteum and skin were repaired. A plasterof-Paris splint was applied as shown (Figure II). After four weeks the condition present was as indicated in Figure III. Figure IV shows the amount of flexion obtained after twelve months. Genu valgum

developed later as shown in Figure V. There was no return of the tubercular process, however, and the former condition was corrected by osteotomy, with results shown in Figure VI.

The second patient was a boy, three years of age. Disease had

progressed for three months when first seen. The joint had a typical posture with its enlarged inner condyle, night cry and pain through the day, with morning lameness. There was flexion posture of twenty degrees with very slight free movement. Treatment was the same as

before. It was necessary here to penetrate healthy epiphyseal tissue, Massage and passive motion were employed after the sixth week. Figures II and III show the joint eleven months after the operation with posture, growth and range of motion normal.

OPHTHALMOLOGY.

BY WALTER ROBERT PARKER, B. S., M. D.

PROFESSOR OF OPHTHALMOLOGY IN THE UNIVERSITY OF MICHIGAN.

EXPERIMENTAL INVESTIGATIONS ON THE INFECTION OF CORNEAL WOUNDS BY SALIVA.

HOTTA (Klin. Monatsbl. fur Augenheilkunde, September, 1905) has found that saliva may be brought in contact with corneal wounds by means of objects contaminated with saliva, such as fingers and handkerchiefs, or drops of saliva may come from the operator's mouth.

The writer's experiments were partly to determine (a) what organisms in the saliva, when in contact with a newly-made corneal wound, are most likely to produce a purulent keratitis, and (b) what form of wound, exposed to the microorganisms of the saliva, is most likely to give rise to purulent inflammation.

For his experiments rabbits, cats, and mice were used. Saliva was obtained from persons of different ages and positions. The lids were everted and the eye washed with 0.05 per cent sublimate lotion, then with physiologic saline solution.

A wound was made in the cornea:

(aa) Nonperforating.

(1) An abrasion by scratching the surface of the cornea with the point of a needle.

(2) A pocket, a wound made by a keratome between the corneal

lamellæ.

(bb) Perforating wounds made by a Graefe knife.

Saliva taken from a sterile Petrie dish, by means of a sterilized spatula, was carefully rubbed on the wound, or inserted into the pocket. In the case of perforating wounds care was taken not to introduce the spatula into the anterior chamber.

After twenty-four hours a cover-glass preparation and a culture were made from the secretion of the wound. The media used were neutral agar, glycerine agar, Loeffler's blood serum, and bouillon. All media were placed in an oven at 35° centigrade.

Results of ninety experiments:

(a) Always negative in thirty perforating wounds.

(b) Once positive in thirty abrasions.

(c) Always positive in thirty pocket wounds. In most of these cases there was iritis, hypopyon, marked circumcorneal injection and conjunctivitis.

In these thirty cases pneumococci were found eleven times (thirty-six per cent); streptococci seventeen times (fifty-six per cent); staphylococci nine times (thirty per cent); tetragenus was also seen five times. In six of the cases no culture was obtained.