- Email: [email protected]
THE NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN.
NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN.
1683
rigidity of the affected parts. Occasionally there may be with an outbreak of small-pox which, we are not surprised hemiplegia. The knee-jerks are frequently lost at first but to find, has occurred in Battersea, the local health committee later they return and may even be exaggerated. As regards reported recently that cases have been traced to previous mental symptoms, Dr. Bailey points out that a large pro- cases of the disease which have been treated by the medical portion of patients who die never emerge from the coma practitioners in attendance as cases of disease other than immediately succeeding the injury. The most characteristic small-pox." From the statement of the medical officer of mental state is one of semi-coma or stupor with delirium. health it appears that in one case a patient was kept under The patient lies still, resents being disturbed, and if dis- observation, though not isolated, for four days before it was turbed becomes restive and irritable. There is frequently decided that notification was necessary, while in another, developed a muttering hallucinatory delirium which may, which was described as "a very difficult case to diagnose," especially in alcoholic subjects, require watching and the true condition was not recognised for an even longer time. Sudden impulses to get out of bed On the strength of these facts, at the meeting of the mechanical restraint. and to rush out of the room are very common. Memory of council on May 27th, several members insisted that events for an hour or for a day or two prior to the accident the names of the medical men concerned should be Some of the reasons adduced in support of may be entirely lost. Dr. Bailey cites two cases in one of published. One gentleman which the memory of events during the half-hour preceding this proposition are worth recording. declared that " he had no compunction for the doctors ; a railway accident, and in the other of the incidents of four days preceding the fall from a horse, were abolished. The they had none for the anti-vaccinators." Another "hoped duration of serious mental symptoms is variable. Some that they would take the reasonable step of publicity, so that in mind and they might have a reasonable hope that these offences would coma from the initial lucid patients emerge free from any trace of mental affection. Others continue in not be repeated." A third instanced the depravity of his own medical adviser, against whom he launched the crushing a state of semi-coma and delirium for days and weeks and in a few cases cerebral and mental disturbances persist long indictment : " He’s never been paid yet." Undue harshness As regards prognosis was deprecated by the chairman of the health committee after physical strength is regained. the combined statistical records of Heer, van Nes, Phelps, who regretfully admitted that"whatever their calling they and the writer give 494 cases with a mortality of 57 per were all in error sometimes ; he was himself sometimes as a and eventually it was decided by 27 votes to 16 cent. Death in the majority of instances is directly due to the injury, thus, 62 per cent. of the deaths occurred within 24 not to publish the names. We are, however, left in some hours and 95 per cent. within five days. Those dying after doubt as to the part which the suggestion that publication longer periods developed either pneumonia or meningitis. would lay the council open to legal proceedings played in As regards the ultimate prognosis with reference to mental bringing about this happy ending. Possibly, if Battersea life 15 out of 29 patients were traced by Dr. Bailey and councillors had any practical experience of the difficulty of their conditions were carefully studied. The following cases diagnosing small-pox they would be a little more charitable ; In Case 1 the patient was but however that may be we protest strongly against the are extracted as typical instances. a boy aged seven years at the time of injury (April, 1901). disgraceful attempt to pillory local medical men to which, He recovered in a few days. At present (1903) he goes to under the pernicious influence of the anti-vaccination virus, school. ’’ He is slightly more irritable and boisterous than so many members of the council committed themselves. formerly and often becomes uncontrollable." He has no fits. Case 4 was that of a boy aged five years at the time of THE NATIONAL SOCIETY FOR THE PREVENTION the accident (September, 1901). He recovered but has ever OF CRUELTY TO CHILDREN. since then been nervous, irritable, and subject to headaches. THE annual report of this society has just been published. He has no fainting or convulsive fits. Case 6 was a girl We learn from it that the progress of the society during the at time 13 the of the years aged injury (December, 1901). has been on the whole very satisfactory. The There are no untoward symptoms in this case. Case E past year number of cases inquired into during this period in England, was that of a man, aged 26 years, who had fractured thE and Ireland (a separate report is issued for Scotland) base of the skull in August, 1901. For 12 days he was in Wales, has reached the considerable total of 34,945. This fact
bricklayer,"
He made an excellent recovery. A alone ought to constitute a sufficient vindication of the he has slight ptosis and excess of one knee-jerk society’s existence if such were necessary. At the same There is amnesia for the events of four days preceding the it is encouraging to find in the speech of the time injury. He is free from headaches or fits and his characte chairman, Lord Ancaster, at the annual meeting a is unchanged. Two other cases cited by Dr. Bailey showe statement that the number of prosecutions instituted after recovery a greatly increased susceptibility to alcohol the society has diminished. On the other hand, by ’ Insanity is rare, concludes Dr. Bailey, after fracture of th that the convictions obtained have been note base of the skull as compared with fracture of the vault c This apparent paradox is more numerous than previously. the skull. The mental conditions occurring in the lattE r the fact that the method always preferred by by explained class of cases are proposed to be dealt with in a subsequer t the society’s agents where it is available-that of warning paper. delinquents-has proved in many cases an effectual preventive against the practice of cruelty. Consequently the BATTERSEA BLUSTERINGS. term prosecution has become narrowed in its meaning THE borough council of Battersea is a body in no need d and it now includes a larger proportion of those inveterate forms of tyranny which can only result in a of advertisement but we may nevertheless call attention to o It is gratifying to learn on the its methods of pursuing the campaign against vaccination n punitive sentence. same and incidentally express our sympathy with the unfortuiauthority that the attitude of the judicial nate general practitioners whose lot happens to be cast st bench is becoming increasingly friendly to the proin the district ruled by that corporation. Lord Alverstone has spoken in Ld cedure of the society. Those, and ’s high praise of its work, which, in the language of they are probably many, who remember the council’s attitude towards His Majesty the King at the time of the another eminent judge, has been carried on with great ie Coronation will be prepared to learn that it displays scant nt prudence and forbearance and without needless and officious courtesy in its dealings with such comparatively humble interference. We can cordially indorse these expressions of persons as members of the medical profession. In connexion approval. Financially, the society, though not affluent, is in
a
state of semi-coma.
,
present
.
f we
-
1684
THE RELATION OF CHOLELITHIASIS TO PANCREATITIS.
solvent condition. After meeting last year’s expenses it umbilicus. In the right flank was moveable dulness. A twocould show a credit balance of ;E266. The assurance of its inch incision was made along the outer border of the right a
On opening that all funds intrusted to the managing com- rectus muscle at the level of the umbilicus. employed exclusively to the best advantage of the peritoneum some clear fluid escaped. The omentum was suffering children requires no confirmation. Those who are studded with small opaque yellowish-white patches. The conversant with the history and the administration of the gall-bladder was distended and there was a large stone in the cystic duct. It was pushed back into the gall-bladder society can have no doubt upon this point. The head of the and cholecystectomy was performed. it not but was hard felt enlarged. Recovery pancreas PLAGUE IN BERLIN. A piece of omentum which was removed for followed. who A YOUNG Austrian medical man named Milan Sachs examination proved to be the seat of fat necrosis. was studying bacteriology in Berlin has just died as the result of an unusual accident. While injecting a rat with a culture of the bacillus of plague he wounded his hand TOXIC AMBLYOPIA AND OTHER LESIONS DUE and contracted plague by inoculation. A hospital attend. TO THE USE OF WOOD ALCOHOL. .ant who nursed Dr. Sachs during his illness has since ,e IN the Philadelphia Medical Journal of May 9th Dr. J. W. been unwell but is now believed to show no symptoms Sherer gives an account of the dangers due to the consumpof plague. All the persons who came into contact tion of methyl or wood alcohol in the case of five persons, with Dr. Sachs in any way after his illness declared four of whom had taken part in the festivities of a national itself are rigidly isolated in the Charite Hospital. It holiday, the celebration of the event being marked by the will be remembered that more than four years ago a similar Lr free consumption of cheap alcohol largely consisting of accident occurred in Vienna and unfortunately resulted in n wood spirits. The host, a man aged 32 years, provided himseveral deaths. An account of this occurrence will be found d self on July 4th with a considerable quantity of cheap crude in several numbers of THE LANCET, commencing with the of which he himself and his guests, three in number, espirits issue of Oct. 22nd, 1898, p. 1080. on the Within 24 hours he
president
mittee
are
partook freely suffered from
"
,
following day.
and attacks of vomiting, headache and THE RELATION OF CHOLELITHIASIS TO and vertigo, sweating partial paralysis, and stiffness of the PANCREATITIS. which lasted for three legs days. About 24 hours after the THE New York Medical Journal of May 16th contains an11 debauch his vision began to fail and he could only dimly important paper by Dr. Joseph Wiener, jun., on the relationaperceive large objects outside the central part of the field of of cholelithiasis to pancreatitis. Anatomical facts lead vision. In the centre of the visual field there was total to the conclusion that a close relation must exist between absence of sight (central scotoma) in both eyes. The pupils affections of the common bile-duct and of the pancreas. A reacted to light and accommodation and ophthalmoscopic .stone which obstructs the common bile-duct near the papilla examination showed that the fundus in both eyes was of Vater must obstruct the duct of Wirsung. If the pan- redder than normal and considerably mottled. The sense creatic secretion cannot enter the intestine microbes may, r of colour perception was entirely lost. The characteristic make their way from the duodenum and multiply and set upÞ lesions ] of the eye produced by the drinking of methyl or pancreatitis. Moreover, the obstructed secretion may bewood alcohol and of drugs containing methyl alcohol have forced backward into the parenchyma of the gland produc- been described by Professor G. E. de Schweinitz and an ing injurious effects. Opie has collected 32 cases in whichaccount of the same was published in an annotation i THE LANCET of June 7th, 1902 (p 1615). Dr. Sherer pancreatic lesions and fat necrosis were associated within cholelithiasis. In one case a calculus had found its way intoadds that the second man who took part in the drinkirg the pancreatic duct and caused suppuration. In 26 out of the debauch was less severely affected. He suffered from 32 cases there was fat necrosis. In 1889 Thayer reported rnausea, dizziness, vomiting, and headache. His eyesight the case of a man, aged 60 years, who in the last 16 monthsbecame dim and this dimness lasted for a few days and I of life had repeated attacks of pain in the left hypo- tthen began to improve until in three weeks’ time vision chondrium and epigastrium followed by jaundice. Hewas quite normal. The third man drank more deeply than became collapsed and died. At the necropsy the thickened his h companions, with the result that he had several attacks of gall-bladder was found to contain over 100 calculi. The vvomiting and became very prostrate ; he grew delirious and common bile-duct was dilated to the size of the little finger comatose, C, in which condition he died within a period of .and in the duodenum was a stone of the size of a hazel nut. 48 4 hours. The fourth man became totally blind in two or The pancreas was large and reddish-brown and there was three tl days and his sight has never been restored since then. necrosis of the surrounding fat. In 1896 Kennan reported The T fifth case referred to by Dr. Sherer was that of a woman the case of a woman, aged 36 years, who was suddenly seized w who swallowed a "small medicine-glassful" of methylated with vomiting and pain in the upper abdomen which were spirits in order to obtain relief from pain attending mensf followed by collapse. Death occurred in 48 hours. At the st struation. Her condition became worse and she suffered fr, necropsy a stone of the size of a pea was found projecting from dizziness, vomiting, and severe headache soon after from the papilla and other tones were found in the gall- ta taking the spirits. At the end of 24 hours her sight bladder and common duct. The pancreas was enlarged, in- be began to fail and on the third day she could only dimly Dr. and surrounded local peritonitis. tensely congested, by recognise large objects in the margin of the field of Wiener relates the following case. A woman, aged 41 years, vision. vii Central vision was absolutely lost. The pupils the mother of three children, was suddenly seized with violent re, reacted to light and to accommodation. Dr. Sherer states th a search through medical literature revealed 25 cases pain in the upper abdomen on Jan. 28th. On Jan. 30th the that pain had increased and become colicky. The whole abdomen of toxic amblyopia due to wood alcohol. In all of these was tender and the right rectus muscle was somewhat rigid. as in the five cases reported by himself, the los ca: cases, Appendicitis was diagnosed. In the evening, when Dr. of central or macular vision was complete in character and Wiener first saw the patient, the face was pale and anxious ; generally permanent in duration. The pathological process the pulse was 120, somewhat irregular, soft, and com- is .a retrobulbar neuritis of the optic nerve, affecting chiefly thE axial bundle of nerve fibres arising from the macula pressible ; and the temperature was 102.5°. The epi- the lutea. The perception of red is lost first and then gastrium and right hypochondrium were tender and the right lut rectus muscle was somewhat rigid at the level of the the dimness of sight progresses until central vision is nausea
1683
rigidity of the affected parts. Occasionally there may be with an outbreak of small-pox which, we are not surprised hemiplegia. The knee-jerks are frequently lost at first but to find, has occurred in Battersea, the local health committee later they return and may even be exaggerated. As regards reported recently that cases have been traced to previous mental symptoms, Dr. Bailey points out that a large pro- cases of the disease which have been treated by the medical portion of patients who die never emerge from the coma practitioners in attendance as cases of disease other than immediately succeeding the injury. The most characteristic small-pox." From the statement of the medical officer of mental state is one of semi-coma or stupor with delirium. health it appears that in one case a patient was kept under The patient lies still, resents being disturbed, and if dis- observation, though not isolated, for four days before it was turbed becomes restive and irritable. There is frequently decided that notification was necessary, while in another, developed a muttering hallucinatory delirium which may, which was described as "a very difficult case to diagnose," especially in alcoholic subjects, require watching and the true condition was not recognised for an even longer time. Sudden impulses to get out of bed On the strength of these facts, at the meeting of the mechanical restraint. and to rush out of the room are very common. Memory of council on May 27th, several members insisted that events for an hour or for a day or two prior to the accident the names of the medical men concerned should be Some of the reasons adduced in support of may be entirely lost. Dr. Bailey cites two cases in one of published. One gentleman which the memory of events during the half-hour preceding this proposition are worth recording. declared that " he had no compunction for the doctors ; a railway accident, and in the other of the incidents of four days preceding the fall from a horse, were abolished. The they had none for the anti-vaccinators." Another "hoped duration of serious mental symptoms is variable. Some that they would take the reasonable step of publicity, so that in mind and they might have a reasonable hope that these offences would coma from the initial lucid patients emerge free from any trace of mental affection. Others continue in not be repeated." A third instanced the depravity of his own medical adviser, against whom he launched the crushing a state of semi-coma and delirium for days and weeks and in a few cases cerebral and mental disturbances persist long indictment : " He’s never been paid yet." Undue harshness As regards prognosis was deprecated by the chairman of the health committee after physical strength is regained. the combined statistical records of Heer, van Nes, Phelps, who regretfully admitted that"whatever their calling they and the writer give 494 cases with a mortality of 57 per were all in error sometimes ; he was himself sometimes as a and eventually it was decided by 27 votes to 16 cent. Death in the majority of instances is directly due to the injury, thus, 62 per cent. of the deaths occurred within 24 not to publish the names. We are, however, left in some hours and 95 per cent. within five days. Those dying after doubt as to the part which the suggestion that publication longer periods developed either pneumonia or meningitis. would lay the council open to legal proceedings played in As regards the ultimate prognosis with reference to mental bringing about this happy ending. Possibly, if Battersea life 15 out of 29 patients were traced by Dr. Bailey and councillors had any practical experience of the difficulty of their conditions were carefully studied. The following cases diagnosing small-pox they would be a little more charitable ; In Case 1 the patient was but however that may be we protest strongly against the are extracted as typical instances. a boy aged seven years at the time of injury (April, 1901). disgraceful attempt to pillory local medical men to which, He recovered in a few days. At present (1903) he goes to under the pernicious influence of the anti-vaccination virus, school. ’’ He is slightly more irritable and boisterous than so many members of the council committed themselves. formerly and often becomes uncontrollable." He has no fits. Case 4 was that of a boy aged five years at the time of THE NATIONAL SOCIETY FOR THE PREVENTION the accident (September, 1901). He recovered but has ever OF CRUELTY TO CHILDREN. since then been nervous, irritable, and subject to headaches. THE annual report of this society has just been published. He has no fainting or convulsive fits. Case 6 was a girl We learn from it that the progress of the society during the at time 13 the of the years aged injury (December, 1901). has been on the whole very satisfactory. The There are no untoward symptoms in this case. Case E past year number of cases inquired into during this period in England, was that of a man, aged 26 years, who had fractured thE and Ireland (a separate report is issued for Scotland) base of the skull in August, 1901. For 12 days he was in Wales, has reached the considerable total of 34,945. This fact
bricklayer,"
He made an excellent recovery. A alone ought to constitute a sufficient vindication of the he has slight ptosis and excess of one knee-jerk society’s existence if such were necessary. At the same There is amnesia for the events of four days preceding the it is encouraging to find in the speech of the time injury. He is free from headaches or fits and his characte chairman, Lord Ancaster, at the annual meeting a is unchanged. Two other cases cited by Dr. Bailey showe statement that the number of prosecutions instituted after recovery a greatly increased susceptibility to alcohol the society has diminished. On the other hand, by ’ Insanity is rare, concludes Dr. Bailey, after fracture of th that the convictions obtained have been note base of the skull as compared with fracture of the vault c This apparent paradox is more numerous than previously. the skull. The mental conditions occurring in the lattE r the fact that the method always preferred by by explained class of cases are proposed to be dealt with in a subsequer t the society’s agents where it is available-that of warning paper. delinquents-has proved in many cases an effectual preventive against the practice of cruelty. Consequently the BATTERSEA BLUSTERINGS. term prosecution has become narrowed in its meaning THE borough council of Battersea is a body in no need d and it now includes a larger proportion of those inveterate forms of tyranny which can only result in a of advertisement but we may nevertheless call attention to o It is gratifying to learn on the its methods of pursuing the campaign against vaccination n punitive sentence. same and incidentally express our sympathy with the unfortuiauthority that the attitude of the judicial nate general practitioners whose lot happens to be cast st bench is becoming increasingly friendly to the proin the district ruled by that corporation. Lord Alverstone has spoken in Ld cedure of the society. Those, and ’s high praise of its work, which, in the language of they are probably many, who remember the council’s attitude towards His Majesty the King at the time of the another eminent judge, has been carried on with great ie Coronation will be prepared to learn that it displays scant nt prudence and forbearance and without needless and officious courtesy in its dealings with such comparatively humble interference. We can cordially indorse these expressions of persons as members of the medical profession. In connexion approval. Financially, the society, though not affluent, is in
a
state of semi-coma.
,
present
.
f we
-
1684
THE RELATION OF CHOLELITHIASIS TO PANCREATITIS.
solvent condition. After meeting last year’s expenses it umbilicus. In the right flank was moveable dulness. A twocould show a credit balance of ;E266. The assurance of its inch incision was made along the outer border of the right a
On opening that all funds intrusted to the managing com- rectus muscle at the level of the umbilicus. employed exclusively to the best advantage of the peritoneum some clear fluid escaped. The omentum was suffering children requires no confirmation. Those who are studded with small opaque yellowish-white patches. The conversant with the history and the administration of the gall-bladder was distended and there was a large stone in the cystic duct. It was pushed back into the gall-bladder society can have no doubt upon this point. The head of the and cholecystectomy was performed. it not but was hard felt enlarged. Recovery pancreas PLAGUE IN BERLIN. A piece of omentum which was removed for followed. who A YOUNG Austrian medical man named Milan Sachs examination proved to be the seat of fat necrosis. was studying bacteriology in Berlin has just died as the result of an unusual accident. While injecting a rat with a culture of the bacillus of plague he wounded his hand TOXIC AMBLYOPIA AND OTHER LESIONS DUE and contracted plague by inoculation. A hospital attend. TO THE USE OF WOOD ALCOHOL. .ant who nursed Dr. Sachs during his illness has since ,e IN the Philadelphia Medical Journal of May 9th Dr. J. W. been unwell but is now believed to show no symptoms Sherer gives an account of the dangers due to the consumpof plague. All the persons who came into contact tion of methyl or wood alcohol in the case of five persons, with Dr. Sachs in any way after his illness declared four of whom had taken part in the festivities of a national itself are rigidly isolated in the Charite Hospital. It holiday, the celebration of the event being marked by the will be remembered that more than four years ago a similar Lr free consumption of cheap alcohol largely consisting of accident occurred in Vienna and unfortunately resulted in n wood spirits. The host, a man aged 32 years, provided himseveral deaths. An account of this occurrence will be found d self on July 4th with a considerable quantity of cheap crude in several numbers of THE LANCET, commencing with the of which he himself and his guests, three in number, espirits issue of Oct. 22nd, 1898, p. 1080. on the Within 24 hours he
president
mittee
are
partook freely suffered from
"
,
following day.
and attacks of vomiting, headache and THE RELATION OF CHOLELITHIASIS TO and vertigo, sweating partial paralysis, and stiffness of the PANCREATITIS. which lasted for three legs days. About 24 hours after the THE New York Medical Journal of May 16th contains an11 debauch his vision began to fail and he could only dimly important paper by Dr. Joseph Wiener, jun., on the relationaperceive large objects outside the central part of the field of of cholelithiasis to pancreatitis. Anatomical facts lead vision. In the centre of the visual field there was total to the conclusion that a close relation must exist between absence of sight (central scotoma) in both eyes. The pupils affections of the common bile-duct and of the pancreas. A reacted to light and accommodation and ophthalmoscopic .stone which obstructs the common bile-duct near the papilla examination showed that the fundus in both eyes was of Vater must obstruct the duct of Wirsung. If the pan- redder than normal and considerably mottled. The sense creatic secretion cannot enter the intestine microbes may, r of colour perception was entirely lost. The characteristic make their way from the duodenum and multiply and set upÞ lesions ] of the eye produced by the drinking of methyl or pancreatitis. Moreover, the obstructed secretion may bewood alcohol and of drugs containing methyl alcohol have forced backward into the parenchyma of the gland produc- been described by Professor G. E. de Schweinitz and an ing injurious effects. Opie has collected 32 cases in whichaccount of the same was published in an annotation i THE LANCET of June 7th, 1902 (p 1615). Dr. Sherer pancreatic lesions and fat necrosis were associated within cholelithiasis. In one case a calculus had found its way intoadds that the second man who took part in the drinkirg the pancreatic duct and caused suppuration. In 26 out of the debauch was less severely affected. He suffered from 32 cases there was fat necrosis. In 1889 Thayer reported rnausea, dizziness, vomiting, and headache. His eyesight the case of a man, aged 60 years, who in the last 16 monthsbecame dim and this dimness lasted for a few days and I of life had repeated attacks of pain in the left hypo- tthen began to improve until in three weeks’ time vision chondrium and epigastrium followed by jaundice. Hewas quite normal. The third man drank more deeply than became collapsed and died. At the necropsy the thickened his h companions, with the result that he had several attacks of gall-bladder was found to contain over 100 calculi. The vvomiting and became very prostrate ; he grew delirious and common bile-duct was dilated to the size of the little finger comatose, C, in which condition he died within a period of .and in the duodenum was a stone of the size of a hazel nut. 48 4 hours. The fourth man became totally blind in two or The pancreas was large and reddish-brown and there was three tl days and his sight has never been restored since then. necrosis of the surrounding fat. In 1896 Kennan reported The T fifth case referred to by Dr. Sherer was that of a woman the case of a woman, aged 36 years, who was suddenly seized w who swallowed a "small medicine-glassful" of methylated with vomiting and pain in the upper abdomen which were spirits in order to obtain relief from pain attending mensf followed by collapse. Death occurred in 48 hours. At the st struation. Her condition became worse and she suffered fr, necropsy a stone of the size of a pea was found projecting from dizziness, vomiting, and severe headache soon after from the papilla and other tones were found in the gall- ta taking the spirits. At the end of 24 hours her sight bladder and common duct. The pancreas was enlarged, in- be began to fail and on the third day she could only dimly Dr. and surrounded local peritonitis. tensely congested, by recognise large objects in the margin of the field of Wiener relates the following case. A woman, aged 41 years, vision. vii Central vision was absolutely lost. The pupils the mother of three children, was suddenly seized with violent re, reacted to light and to accommodation. Dr. Sherer states th a search through medical literature revealed 25 cases pain in the upper abdomen on Jan. 28th. On Jan. 30th the that pain had increased and become colicky. The whole abdomen of toxic amblyopia due to wood alcohol. In all of these was tender and the right rectus muscle was somewhat rigid. as in the five cases reported by himself, the los ca: cases, Appendicitis was diagnosed. In the evening, when Dr. of central or macular vision was complete in character and Wiener first saw the patient, the face was pale and anxious ; generally permanent in duration. The pathological process the pulse was 120, somewhat irregular, soft, and com- is .a retrobulbar neuritis of the optic nerve, affecting chiefly thE axial bundle of nerve fibres arising from the macula pressible ; and the temperature was 102.5°. The epi- the lutea. The perception of red is lost first and then gastrium and right hypochondrium were tender and the right lut rectus muscle was somewhat rigid at the level of the the dimness of sight progresses until central vision is nausea