347THE PROGNOSIS OF GUNSHOT WOUNDS OF THE ABDOMEN.

cause from July, 1914, to April, 1915. Previouslysuch cases had been quite insignificant in number.Dr. Mendelson, who is a strong supporter of the

prohibition policy, is of opinion that methylatedspirit-drinking is practically confined to personswho were already of confirmed alcoholic habits, butthis view appears to be disputed by other medicalauthorities. Thus, in the Russian Supplement ofthe Times of July 28th, 1915, extracts are given froman article contributed to the RU8Sky Wratch by Dr.Novosolsky, in which the writer affirms that theuse of methylated spirit and other substitutes isspreading amongst all classes of the population whoformerly drank vodka, and this opinion appears to bein some measure confirmed by the observation thatthe alcoholics treated at the Obukhov Hospitalfor methyl alcohol and varnish drinking includepersons of all ages and professions. The RussianGovernment is fully alive to the danger of this newdrug habit, and is endeavouring to combat the evilby bringing the sale of denatured spirit under strictercontrol and also by adopting more effectual methodsof rendering such spirit unfit for use as a beverage,but no evidence is as yet available to show to whatextent these measures have proved successful.

THE PROGNOSIS OF GUNSHOT WOUNDSOF THE ABDOMEN.

LAST year at the Swiss Surgical Congress Pro-fessor Sauerbruch narrated his surgical war

experiences in Germany, and as the text of thislecture has now come into our hands we mayexpand with advantage the summary alreadygiven of his remarks on the treatment of gunshotwounds of the abdomen. Sauerbruch is convincedof the necessity of immediate operative interferencein all gunshot wounds of the abdomen in whichthe peritoneum is involved, and believes that whenthis necessity is generally recognised the arrange-ments for carrying out the operations will readilybe improvised at the front. He regards theexternal circumstances-the operation-room andthe appurtenances of a theatre-as in generalvastly overrated, holding that correct diagnosis,followed by immediate and technically correctoperating, is the only factor which seriously counts.He refuses to speak, as is often done, of hopelessoperations, in view of the consistently good resultsof early operation. It cannot be too much

emphasised, he adds, that men who recover afterabdominal injury retain an undiminished capacityfor living and for working and do not swell theranks of the war cripples. Sauerbruch thereforeregards the operative treatment of gunshotabdominal wounds as precisely the most encouragingfield of action for the military surgeon.

IDIOPATHIC DISLOCATION OF THE EYEBALL.

Dr. David M. Greig, of Dundee, records in theEdinburgh Medical Journal (Vol. XVIII., No.2) acase of idiopathic dislocation of the left eyeball ina female child aged 11 months. The child was aneglected and badly nourished child weighing only7 lb. There was no proptosis except when thechild had screaming fits. Both eyes were thenproptosed, the left more than the right, and onthese not infrequent occasions the left eye oftenbecame dislocated forwards between the lids. Itcould not be retracted voluntarily, but was easilyreplaced by gentle pressure. Dr. Greig has been

1 THE LANCET, 1916, i., 634.

unable to find any record in the literature ofspontaneous dislocation of this nature, but wedoubt if it is quite so rare as the absence of

published cases would seem to indicate. In cases

of extreme proptosis accompanying exophthalmicgoitre dislocation forwards between the lids occursvery readily, and the same is true in some cases ofoxycephaly, in which the orbits are very shallow.We have seen cases of this type of dislocation asso-ciated with very slight traumatism, where, indeed,the injury has been so trivial that one is inclinedto attribute the displacement to the effects ofsudden fright. In our experience these cases havealways occurred in children; there has been practi-cally no injury to the eye, which has been replacedin the orbit with the greatest ease.

I

ANOTHER SPIROCHÆTAL DISEASE.

EARLY in 1916 a febrile disorder was describedby Werner and Haenseler as occurring on theGerman Eastern front, and named by them five-dayfever or febris quintana, and by later observersfebris wolhynica. In the summer of 1916 a numberof similar cases occurring on the Western frontwere known as Meuse fever. A paper by Dr. W.Thorner in the Münch. med. Wochenschr, forDec. 12th last gives a concise account of the diseasewith two charts-which we reproduce-showing

the characteristic course of the temperature. Put

briefly, the characteristic symptoms are: Suddenelevation of temperature without rigor, and defer-vescence without sweating ; acute pain in the legsoften requiring morphia, but without definiteevidence of periostitis; an enlarged spleen sensi-tive to pressure; heart, lungs, digestion, andurine normal ; polynuclear leucocytosis up to20,000. The symptoms described need not bereproduced in greater detail, as they correspondexactly to the description of trench fever on ourown front given by Dr. A. F. Hurst in THE LANCETof Oct. 14th last. The resemblance between thetemperature charts given by the different authorsis very striking. The German observers havedevoted much attention to discovering the ex-

citing cause of the fever. Werner thought hesaw on one occasion a spirocheete rather longerthan the diameter of a red cell. Korbsch sawdancing cells and a suggestion of moving filamentsamongst them. Topfer observed short rods. Pro-fessor Riemer, who summarises these observationsin the Miinch. med. Wochenschr. for Jan. 16th, hasnow found spirochætes very scanty in direct films,but fairly abundant after anaerobic culture for aweek in blood serum. He gives micro-photographsshowing an organism scarcely longer than thediameter of a red blood cell, with four turns,exceedingly mobile and difficult to see unstained,but readily taking up any anilin dye and de-

colourising with Gram. Some of the spirochaeteswere longer, with a middle piece between the turnsas though two spirals were intertwined. Attemptsto infect guinea-pigs with the organism were un-successful, and Professor Riemer is too cautious to