was given. At this time the pulse was 140, respiration, 50. At 2 p. m. another dose of serum was given. At this time the pulse was 150, temperature 102, respiration 46. Two drachms of bromidia were given per rectum. At 2:15 a slight spasm similar to the previous attack occurred. At 2:45 a fourth dose of 10 c. c. of serum was given. Meanwhile Dr Allen saw the patient and confirmed the diagnosis. He suggested an intra-spinal injection of serum, which Dr Sanford gave at 4:30 p. m. The convulsions were becoming more severe and frequent, but were confined to the neck and chest muscles. At 6 p. m. she became unconscious and pulseless following a convulsion, and artificial respiration was resorted to. At 7:30 p. m. a general convulsion occurred and death speedily ended the most tragic occurence it has been my misfortune to witness. Previous to the last convulsion the pulse was 160, respiration 40. Whatever hypothesis one may form to account for the source of infection in this case, it must rest on pure conjecture. In the barnyard, some 30 feet from the house were kept two horses, a cow and about 75 chickens, and on the lawn about the house manure had been recently spread. There was more or less communication between the barn and the house. These are conditions, however, frequently met with, especially in the country, with no evil results. The relation between cause and effect is certainly not apparent. 1110 Euclid Ave.) Quotations from the Oculists' Report of the London County Council (SELECTED FROM THE REPORT OF THE MEDICAL OFFICER OF THE BOARD OF EDUCATION-EDUCATION COMMITTEE) BY LEIGH K. BAKER, M. D., CLEVELAND, O. That wide awake municipal body, the London County Council, publishes an annual report of its education committee dealing with school hygiene questions in that city and sends it to school sanitarians throughout the world. Their latest report contains 60 pages filled with interesting matter. Eight pages are devoted to vision. It seems that in 1900 London teachers began testing the visual acuity of children for distance and reading. In 1902 eight ophthalmic surgeons were appointed "School Oculists." These tested the children-"as regards visual acuity, and filled in a card for each child, giving its name, age, sex, grade, school, and visual acuity, right and left eyes alone, and also both together." Concerning the first year's work of these eye doctors it may be said that they examined 61,676 children. Of these they report 46,503 children as having good visual acuity, 9,454 as having fair and 5,719 as having poor visual acuity. Briefly, 33% were not up to standard. During last year the oculists advised the parents of 18,536 of the 27,933 reported defective by teachers, upon cards used for that purpose. "The preponderance of very bad vision (6/60 or worse) among the girls is marked. It is generally almost entirely due to spasm of the accomodation in these cases. It was also shown that there is an association between defective visual acuity and retarded position in the school, the group of children who are older than the average age of their standing presenting a considerable excess of visual defect when compared with the younger group." "The percentage with normal vision increases with every year of age and standard (grade), from the First reaching 80 per cent., in Standard (grade) VII." "The greater part of the defective vision is due to slight defect, which gives imperfect but fair vision, due probably to both mental and ocular conditions, and of the greatest importance educationally in the first half of school life." "Parents refuse to lose work, a half a day or more, for a hospital visit, and each case requires two or even three visits. A considerable proportion of the hospital work is thrown away by the patients refusing to spend the money for necessary glasses. Apart from hospitals, there is a want of provision for the treatment of defective vision. The field has been much exploited by quacks, "qualified opticians" and others but the need of a means of obtaining such help at a lower fee than the ophthalmic surgeon's two guineas is shown by the fact that of the class from which candidates are drawn for employment, under the Council (teachers, clerks, etc.), who were referred back for defective. visual acuity, 80% went to hospitals for advice." "Since January, 1904 the Oculists have reported on many general school matters. They have repeatedly called attention to the prevalence of near eye-working distance in school. This is the worst of school habits, and lies at the base of educational hygiene; it will be referred to in considering school work." "It is commonly supposed that almost every child with defective acuity requires glasses, but there could be no greater mistake; some can get no improvement from glasses, some will do better without glasses, a very small number are found with defective visual acuity and no refractive error, and in the course of one or two years ultimately attain normal vision. Viewed from a wide public health point of view, it ought not to be necessary for a considerable percentage of children to wear glasses. The rational treatment of most of these children should be an educational modification which avoids the necessity of glasses." * "There is a considerable number of children with permanently damaged or diseased conditions who are not blind, and not ever likely to benefit by the training as given in blind schools, who may be actually harmed by the ordinary school education * * This group is probably as large a group in totality as that of the blind, and, from the results to be obtained, much more worth education. * * * * Special schools, with modified tasks, are required for these children. The literary element being as far as possible eliminated from their work, and special attention given to fit them for tasks in which vision is not chiefly involved, but yet of subsidiary use." Notes. Essentially similar conditions were found in the Cleveland schools as well as in the schools of other American cities. It appears that the teachers examined the children first, using the test letters, for instance. Those reported defective by the teachers were then examined by the oculists. Experience elsewhere suggests that had oculists made the original examination, using the ophthalmoscope, a considerably larger per cent of children with pronounced hyperopia would have been discovered. Medical Teaching in Ohio There has recently been organized the Ohio Association of Medical Teachers, consisting of active and associate members, the former comprising the professors in the medical schools of the State, together with the members of the State Board of Medical Registration and Examination, and the latter including the teachers of chemistry and the biological sciences in the literary colleges. We learn that about fifty persons eligible to membership were present at the time of the organization, and that most of them joined the association then. On the very day of its formation, December 26th, the new organization proceeded to the consideration of weighty matters. The medical curriculum was the subject of papers by Dr C. C. Howard, of Starling Medical College, who dealt with the first two years of the course, and by Dr J. C. Oliver, of Miami Medical College, who spoke of the second two years. The other papers were on the general subject of the relations of the literary and medical colleges, especially on the advanced standing in a medical school that might properly be allowed in consideration of the student's having pursued the study of chemistry and biology in a literary college. They were presented by Dr R. P. Daniells, of Toledo Medical College; Dr A. Ravogli, of the Medical College of Ohio; Dr G. M. Waters, of Ohio Medical University; Dr F. C. Clark, of Starling Medical College, and Dr F. C. Waite, of the Medical Department of the Western Reserve University. In the evening there was a joint session with the Ohio College Association, and the papers then presented turned upon the same question of advanced standing, a question that was undoubtedly rendered more than usually prominent by the fact that the State Board of Medical Registration and Examination had passed this resolution: "That, after 1905, advanced standing which has been given for A. B. and B. S. degrees be not recognized by this board unless the candidate to whom it has been given has, during the academic course, done the science work comprised in the first year of the medical course." There can be no doubt, we think, that the stand taken by the board in the resolution is perfectly correct, and it was fortunate that in the joint session a member of the board, Dr E. J. Wilson, presented a paper upon the question of what scientific work in the literary course would be held by the board as satisfying the requirements of the resolution. It is highly desirable of course that the scientific work done in the academic colleges of the State should be practically uniform, and that it should satisfy the board's requirements for advanced standing in the medical schools. Such a result, it seems to us. can hardly fail to occur after so well planned a procedure as the organization of the Ohio Association of Medical Teachers and its joint session with the Ohio College Association. In other respects, too, much good must come from the movement.-New York Medical Journal. OFFICE, 260 EUCLID AVENUE Entered March 7, 1902, as Second-Class Matter, Post-office at Cleveland, Ohio, under Act of Congress of March 3, 1879. EDITORIAL The Blind Spot and Sympathetic Inflammation In the Ophthalmic Review for January 1906 is an article by Ramsay and Sutherland upon spindle shaped enlargement of the blind spot associated with congestion of the optic disk in patients suffering from sympathetic irritation or threatened sympathetic inflammation of the eye. Five cases are reported, four of them injuries and the fifth a case of phthisis bulbi. All were complaining in some respect of their good eye. While none of them showed symptoms of actual sympathetic inflammation, the optic nerve was hyperemic or congested in each and the field of vision taken with Bjerrum's screen instead of the ordinary perimeter showed a spindle shaped enlargement in the vertical dirction of the normal blind spot. After enucleation the subjective symptoms disappeared and the blind spot regained its normal size. "It seems highly probable" says the writer, "if not almost certain that the spindle like enlargement of the blind spot denotes active conjestion of the optic disk," and it is often difficult when there is no healthy fundus for comparison to determine whether the apparent conjestion of the optic disk is pathologic or not. "It seems highly probable" he thinks, "that under certain circumstances the spindle shaped enlargement of the blind spot may |