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work of fiction, we need only refer to Mr. SomersetMaugham’s grim story " Mackintosh," where such acondition is admirably described. Mackintosh wasanxious to kill a man, by name Walker, or shall werather say, that such a man should be killed. Anenemy of Walker, a Polynesian native, came to seeMackintosh for some medicine, and saw a revolverlying on the table. Mackintosh saw that he saw it,and went out of the room ; " it was this other personthat possessed him that drove him out of the room,but it was himself that took a handful of muddledpapers and threw them on the revolver in order tohide it from view." When he came back he did notdare to look to see whether the revolver was there,but that night Walker was shot and next morning therevolver was back on the table with four emptychambers. To many people lonely places, the desertor mountain, seem particularly favourable environ-ments for the attacks of the unconscious mind or evil Ispiritual influences, whichever they may be called.To others, as Dean Inge says in his second series of" Outspoken Essays," 1 snow-peaks and glaciers open" avenues of communication with the magnalia Deiwhich are less easy to maintain amid the dark andgrimy surroundings " of a London home. Physicalconditions are, however, not to be put on one sidealtogether, and it may be that the abnormallyreceptive condition of the mind might, in the visionsof the devil which came, say, to St. Dunstan andLuther, have been dissipated by a dose of calomel.But for all that demoniacal possession or obsession isnot a matter which either physician of soul or of bodycan afford to put on one side as superstition.

PROTECTIVE GLASSES FOR METAL-WORKERS.

THE fact needs wider recognition that the greatmajority of accidents which happen to the eyes happento metal-workers working with eyes unprotected,and that they could easily have been prevented bythe simple expedient of wearing goggles. Dr. vanKirk, of Pittsburgh, reports that in a steel millemploying about 8000 men the vision of one or

both eyes has been saved in from 20 to 25 cases ayear by the use of goggles, and that this alone savesthe company about$50,000 or$60,000 a year incompensation. a As was to be expected, it took sometime to obtain the cooperation of the men, but nowthey realise the value of goggles as a protection, andthe penalty of discharge for failure to wear them whenso ordered is rarely necessary. There is no moreimpressive proof of their efficacy than the demonstra-tion of a pair of goggles cracked by a splinter whichotherwise would have inevitably injured, and possiblydestroyed, the eye of the wearer. The injuries thatoccur from this cause may be divided into two classes :First, those in which the foreign body actually pene-trates into the globe and lies either in the anteriorchamber, the lens, or the vitreous. These are allserious, and the great majority of cases where theforeign bodies penetrate into the vitreous, even if theparticle itself is successfully removed, end with thetotal loss of sight in the affected eye. In the secondclass of cases, which includes the vast majority, pene-tration of the globe does not occur and the splinter lieseither in the conjunctival sac or in the cornea. Inthese cases it is a good rule to make that unless thesplinter can be removed by the use of a soft pledget ofcotton-wool-i.e., in all cases in which it is embeddedin the cornea-the case should be from the earliestpossible moment under the care of a specialist. Thegreat danger of these cases lies in the frequencywith which, owing to lack of efficient treatment, aspreading corneal ulcer arises after the apparentlysuccessful extraction of the foreign body. In the steelmill already referred to the number of corneal ulcersdeveloping after these injuries was reduced after theintroduction of the system of prompt treatment by a

1 Longmans, Green and Co. 1922.2 Journal of the American Medical Association, Sept. 16th,

1922.

specialist to about one-quarter of what it had been,and in each of seven cases in which an ulcer did developthe occurrence could be traced either to a lack ofpromptitude in seeking treatment or a failure to carryit out when given. The most frequent source ofinfection is a diseased lacrymal sac, but in any casethe eye should be protected and kept under observa-tion until the injured epithelium of the cornea hasre-formed, as shown by its no longer staining withfluorescein. In the majority of cases it will not benecessary to occlude the eye for more than 24 hours,whereas if an ulcer is allowed to form the treatmentmay last for weeks and the vision may be permanentlyimpaired or even, in bad cases, lost.

RURAL ENDEMIC TYPHOID FEVER.

EPIDLMIOLOGICAI. workers familiar with Dr. RalphJohnstone’s report to the Local Government Board,in which he traced a series of typhoid cases in a hamletto a chronic carrier, will be interested in a valuablestudy of the same subject by Dr. Norment, of theUnited States Public Health Service, which appearedin the Public Health Reports (Washington) forSept. 1st, 1922. These relate to two counties in theState of Maryland which were made the subject ofintensive study. Spot maps giving the incidence oftyphoid cases in four consecutive years showed somestriking features in the distribution of the cases. Incertain areas decided clumping of cases was noted.and this was found to be due, in several instances, tothe occurrence of cases year after year, indicatingchronic endemic conditions rather than transientepidemic conditions. Careful case histories were

obtained, including contact histories, for 63 cases ofrural typhoid in nine months of 1920 ; 57 of thesecases appeared to have originated locally, and of thisnumber 32 gave a history of contact with specificallylocated sources-viz., either demonstrated carriers orunrecognised clinical cases. The general importanceof investigations of the kind indicated above isinsufficiently recognised. More careful case historiesand field study would probably demonstrate manyof these specific connexions with previous cases. Theadvantage of such inquiries and of the action takenon the findings is that it can secure a readier andquicker and, furthermore, a more complete result inreduction of disease than can be hoped from themere pursuit of remedial measures against localinsanitation.

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THE VALUE OF ALBEE’S OPERATION FOR

TUBERCULOUS SPINE.

WITH the exception of those complicated by nstulse,phthisis, or paralysis, all cases of tuberculous spineadmitted to the clinic of Dr. H. Gorres at Heidelbergare treated by Albee’s operation. In reporting on120 cases subjected to this operation, he states! thatimmobilisation in bed for three to four months after theoperation was the rule, and although in the early days aplaster jacket was worn for a further 18 months, recentexperience has shown that it is safe for the patient toget up without support, and to return to work withoutany jacket. Of the first 60 cases, 3 died in the firstyear after operation, and 8 could not be traced. Of theremaining 49, 42 were well and working, and of these29 were operated on more than three years previouslyand therefore could be regarded as permanentcures. From the re-examination of all the cases, itwas demonstrated that the implanted bone producedneither limitation of growth nor diminution in themovements. It is true that the bridged-over portionwas completely stiff, but the general movementsof the spine were scarcely affected. Childrengrew apparently normally in height. The kyphosisremained, but cases operated on before kyphosis hadappeared showed no bending of the spine, suggestingthat kyphosis may be prevented by the operation.

1 Deut. med. Woch., June 30th, 1922.