1349PASTEURISED MILK AND INFANT FEEDING.

24 hours. On the following day there was slight eye pain,with considerable reduction of the visual acuity. The

pupils were of medium size and the reaction was normal. Iadvised her to remain in a darkened room, to have the eyes igently massaged, and to take a hot bath. I gave internallybromide of ammonium. She wore tinted glasses for somedays and is cow quite recovered.The condition produced by exposure to excessive light is

sometimes spoken of as blindness of the retina, anaesthesiaof the retina, and neurasthenic asthenopia. " Retinalelectrocution " is the term Darier uses when writing of thecerebral and retinal shocks produced by the passage ofan electric current through the upper part of the bodyand the head. This suggests to me the term " retinal-cinematocution " for the condition produced by the intenseflashes of white light. Those who have witnessed these

living-picture displays must have experienced that peculiar" tiredness " of the eyes caused by exhaustion of the retina,and how gratifying it was to close the eyelids and thusrelieve the strain. Until some improvement takes place inthe mode of exhibiting these pictures and in rendering lessintense the light the public should be warned of the dangerand advised to wear tinted glasses when looking at them,and each display should not exceed one minute.

I am, Sirs, yours faithfully,Dublin, May 5th, 19G6. EDWARD MAGENNIS, M.D. R.U.I.EDWARD MAGENNIS, M.D. R.U.I.

PASTEURISED MILK AND INFANTFEEDING.

To the Editors of THE LANCET.

SIRS,—In calling attention to a prevalent and growingevil the letter of Dr. G. A. Sutherland in THE LANCET of

May 5th, p. 1280, is a highly important and valuable one. Asfar as the evidence of my cases quoted by him is con-

cerned, he might have materially strengthened his positionby mentioning the chief feature that was the main pointof interest in each. The "extraordinary course " referred toin my paper was not the mere delay in the resolution ofa subperiosteal clot but the formation of new bone in thedetached periosteum in each of three consecutive cases

of scurvy inadvertently fed on pasteurised milk. In onecase where the change of milk instituted by the dairy com-pany was not discovered and the infant died the newlyformed periosteal bone was of remarkable extent, beingthicker in places than the femur it surrounded. In the suc-ceeding two, whilst on pasteurised milk, a thin layer of boneformed in the periosteum detached from the femur-a con-dition that was verified by skiagrams taken by Dr. G. H.Graham. On a change being made from pasteurised to freshmilk the new bone formation ceased in each and in the courseof time that already formed was slowly absorbed. Thesethree cases would seem apt illustrations of the dangers ofpasteurised milk pointed out by Dr. Sutherland in his timelyletter. I am, Sirs, yours faithfully,London, May 7th, 1906. J. A. COUTTS. IJ. A. COUTTS.

PRIMARY CARIES OF THE MASTOID PRO-CESS AS A CAUSE OF MASTOID

ABSCESS IN YOUNGCHILDREN.

To the Editors of THE LANCET.

SIRS,—I should like to supplement Mr. L. P. Gamgee’scases of caries of the mastoid (recorded in THE LANCET ofMay 5th, p. 1237) with two cases which have been recentlyunder my care. My cases have many points in commonwith his, but not all. The first was that of a child, 15months old, with a swelling behind the ear of six weeks’duration. The child never had running ear or any ofthe symptoms of pain usually associated with mastoidabscess. There was a large fluctuating swelling behind theright ear pushing it forwards. I incised this down to thebone, and after mopping away blood and pus found a sinusleading into the antrum. This I enlarged sufficiently toallow the antrum to be easily packed with gauze. I removedvery little bone and only very gently used a small curette toscrape out the antrum. It was packed daily, and in fiveweeks the cavity was completely closed. I had an oppor-tunity of examining the membrana tympani afterwards andfound that it differed in no respect from the other side,

The second case was that of a boy, aged nine years. He

began with a swelling behind the left ear, which continued toincrease in size under assiduous poulticing. I saw him aftersix weeks of this treatment and found a large fluctuatingabscess, extending over the mastoid and beneath the

temporal fascia, pushing the ear markedly forwards. Thisboy never had earache or otorrhoea and during all the time hewas under my care his temperature never ranged above 990 F.I incised as in the former case and found a sinus which fromits high and anterior situation I thought opened into theattic, not into the antrum proper. This I enlarged and packedthe cavity daily. At the end of seven weeks it was com-

pletely healed. The membrane at the present time is

perfectly normal in appearance and the boy can hear a watchdistinctly at 88 inches.

These two cases agree with Mr. Gamgee’s in the follow-ing points : (1) absence of constitutional disturbance ; (2)there never was otorrhæa ; and (3) the swelling came ongradually with an absence of pain. They differ in the

following : (1) the ear was pushed markedly forwards inboth ; and (2) there was hardly any destruction of bone.There was no caries except at the margin of the sinus itself.

I am, Sirs, yours faithfully,Leeds, May 7th, 1906. J. STBWART.J. STEWART.

APPENDICITIS AND PERFORATEDDUODENAL ULCER.

To the -Editors of THE LANCET.

SIRS,-In THE LANCET of May 5th, p. 1262, in"Annotations," under the heading of "Apptndicitis andPerforated Duodenal Ulcer," you say: "No case appearsto have been recorded of the association of inflammation ofthe appendix with duodenal ulcer." May I venture to callyour attention to the fact that in THE LANCET of Nov. 2nd,1901, p. 1194, I published notes of a case of appendixabscess that I opened and that died from a perforated ulcerof the second part of the duodenum 11 days later. I alsoin the same note gave details of two other cases of perforated duodenal ulcer associated with a septic conditionof the peritoneal cavity.

I am, Sirs, 3 ours faithfully,Leicester, May 7th, 1906. F. BOLTON CARTER.F. BOLTON CARTER.

THE EPIDEMIOLOGICAL SOCIETY.To the Editors of THE LANCET,

SIRS,—I should be much obliged if you would kindlypermit me to make a few corrections in the account pub-lished in THE LANCET of May 5th of a paper which I had thehonour of reading before the Epidemiological Society onApril 20th last on the subject of the meningococcus. In thefirst place, Elser of New York cultivated the meningococcusfrom the blood in 24 per cent. of the cases of cerebro-

spinal fever which he examined, not in 7 per cent.as stated. Colonies in broth " should read " colonieson nasgar," and "acetic" agar should read "ascitic" "

agar. Instead of saying that both the meningococcusand micrococcus catarrhalis were liable, as indeed were

all micrococci, to occur as staphylococci and streptococci,I stated that they were all apt to occur as diplococci.Lastly, the disinfection experiments quoted were made

against saliva, not against cultures of the meningococcus.I fear that I myself am in great part to blame for these

" terminological inexactitudes," because I failed to bring anabstract with me on the occasion in question.

I am, Sirs, yours faithfully,Blackheath, May 8th, 1906. M. H. GORDON.M. H. GORDON.

THE NOTIFICATION OF PULMONARY TUBERCULOSIS.-The Barnstap e (Devon) rural district council xecentlyforwarded a resolution to the Local Government Board

urging that pulmonary tuberculosis should be includedamongst the list of notifiable diseases. At the meeting ofthe council held on May 4th a letter was read from the LocalGovernment Board stating that pulmonary tuberculosis wasnot a disease to which compulsory notification could withadvantage be app id, but as many authorities had madearrangements with locil medical practitioners for thevoluntary notification of this disease the BAri2staple ruraldistrict council could follow this course without the sanctionof the Loca’ Government Board and pav a reasonable fee forsuch notification,