more centrifugalized, and after that the foregoing process is once more repeated. From the final centrifugalate the films are prepared. The number of tubercle bacilli found in such films will be very greatly in excess of those that will be demonstrated from the same urine where this precaution of washing away the urinary salts is not followed.

F. PARKES WEBER. "Reaction with Perchloride or Iron in the Urine of Grave Cases of Hepatic Cirrhosis." Brit Med. Jour., Jan. 2, 1904.

Weber draws attention to four cases of alcoholic cirrhosis in which the urine on admission gave the perchloride reaction as seen in diabetes. In two of the cases the reaction disappeared while the patients were in hospital. As no analysis of the urine was made, the cause of the reaction was not explained, but it has been long known that this reaction may be met with pretty commonly in a great number of conditions (Windle, Liverpool Med. Chir. Jour., July, 1884).

A. E. GARROD. "On Black Urine." Practitioner, March, 1904. In an interesting review of the whole subject, Garrod points out that urine which is black, or becomes black, may be excreted in jaundice, hæmaturia, hæmoglobinuria, hæmatoporphyrinuria, melanotic sarcoma, alkaptonuria, ochronosis, when much indican is present, in phthisis, in certain rare cases of undetermined nature, and after taking certain drugs and articles of diet. Black urine is undoubtedly rare, although when a large amount of bile or blood pigment is present the urine may look almost black. In many of these cases the urine is not black, but rather brown or blackish. True black urine is met with in melanuria, which occurs only in connection with melanotic sarcoma, a rare condition. Characteristic melanotic urine is not black when passed, but becomes black on exposure to the air, or on the addition of nitric acid or ferric chloride. Alkaptonuria is a rare congenital condition in which also the urine has the normal colour when fresh, but darkens on standing, and the change follows more rapidly when an alkali is added. Such urine deeply stains linen, and

is therefore readily noticed in infancy. The urine reduces Fehling's solution with the aid of heat, hence alkaptonurics are liable to be mistaken for diabetes, but it does not give Nylander's (bismuth) test for sugar or rotate polarised light. To recognise it with certainty homogentisic acid must be extracted from the urine. Ochronosis is a name given by Virchow in 1866 to blackening of the cartilages met with post mortem in the case of an old man who died of aortic aneurysm. Several other cases have been recorded, but it is extremely rare. It is believed to be due to a pigment which is neither melanin nor alkapton, for in certain cases it has given reactions suggesting both of these pigments. Blackening of urine after articles of diet and drugs is of especial interest to the inedical profession. One of the commonest causes is carbolic acid, and its compounds and allies such as salol, salicylates, naphthalin, creosote, and thallin. Rhubarb and senna in large doses cause alkaine urine to turn a dark purple red colour. Some dark coloured vegetable pigments such as those of bilberries and black cherries are said to be excreted in the urine. Hydroquinone is known to be formed from arbutin contained in the leaves of the uva ursi, and may cause conspicuous darkening of the urine of patients who are taking that drug. A similar result may follow the administration of resorcin.

W. OSLER. "Ochronosis." The Lancet, Jan. 2, 1904.

Osler, after a brief abstract of the history of this condition since it was first described by Virchow in 1866, records the case of a man, aged 57, who consulted him for diabetes and rapid action of the heart. His urine darkened on standing, the sclerotics showed small V-shaped areas of deep pigmentation near the cornea, and there was also slight pigmentation of the nose, while the inner surface of the ears was of a deep blue colour. The pigmentation had extended considerably during the past six years. The staining of the eye-balls affected the sclerotic coat and not the conjunctiva, and did not extend to the covered parts of the eye-ball. One of this patient's sons has alkaptonuria.

The other case is the brother of the first patient, his age being 49. He has been repeatedly rejected for life insurance on account of his urine reducing Fehling's solution. He also showed pigmented sclerotics and ears. This patient died of pneumonia after a short illness, but no post mortem examination was obtained. In both cases there was alkaptonuria, but although Osler thinks the pigmentation of the ears was due to blackening of the cartilages, in the absence of any post mortem examination this cannot be considered to be proved.

RIEGLER. "A Delicate and Simple Test for Sugar." Deutsche. med. Woch., Nov. 15, 1903.

Riegler recommends the following test: Place 1 c.c. of urine in a test tube, and add as much oxalic acid phenylhydrazin to cover a knife point, and 10 c.c. of water; this mixture is boiled over a small flame, continually agitating until completely dissolved. Ten c.c. of a 10 per cent. solution of potassium hydrate is then added, the test tube closed with a cork and thoroughly shaken. If sugar is present the mixture at once, or in one minute, turns a reddish-violet colour. Sugar in a solution of .05 per cent. may be demonstrated. The presence of albumen does not interfere with this reaction.

BONDI. “A Simple Method for Carrying Out the Diazo Reaction. Centralbl. f. inn. Med., 1904, No. 10.

Bondi describes a method applicable when only a few drops of urine are available. The re-agents are used in the customary concentration, but the test is made on filter paper instead of in test tubes. A drop of the suspected urine is allowed to fall on a double piece of filter paper, and with a glass rod a drop of ammonia is deposited on the same spot. The rod is wiped off and is moistened with a little of the sodium nitrite solution. It is held horizontally, and a drop of sulfanilic acid solution is allowed to run down the rod till it mixes with the sodium nitrite at the end. The moist spot on the paper is then circumscribed with the wet end of the rod, and a red coloration appears when the reaction is positive. Urines which do not give the diazo reaction produce only a faint yellowish colour.

THE EYE SYMPTOMS OF TRAUMATIC

HYSTERIA.

By J. JAMESON EVANS, M.D., F.R.C.S., Honorary Surgeon to the Birmingham and Midland Eye Hospital;

Ophthalmic Surgeon to the Workhouse, &c.

IN view of the difficulty which is often met with in deciding between functional and organic disease on the one hand, and functional disease and malingering on the other, it is well to make use of all signs and symptoms which might help the investigator to decide as to the true nature of the case in hand. The eye symptoms are perhaps the most definite in that ill-defined group of symptoms which we call hysteria.

The more general recognition of these symptoms will, I hope, tend to lessen the conflict of medical evidence in some of those obscure nervous cases, following accidents and injuries, which find their way to the law courts. The two cases recorded below are fairly typical of the class, and the case of the man shows that the male sex is by no means free from a complaint which used to be considered a monopoly of young girls.

Case 1-Rose J., aet 23, a factory hand, had a blow on the right eye in January, 1900, and came to the Eye Hospital as an “accident." The damage appears to have been insignificant, and she was given some boracic acid lotion and cocain drops and discharged. In the ordinary course such a case should have been well in a couple of days. As she did not get any better, she returned on the 14th February, 1900. At this time there was injection of the right palpebral conjunctiva, and also of the lower half of the bulbar conjunctiva on that side. There was marked photophobia and lachrymation, and the right eye was generally kept closed.

The pupil reflexes were normal in each eye. The media were normal, the optic discs were slightly blurred at the edges, but there was no definite papillitis or any other lesion of the

fundus oculi in either eye. The fields of vision both for white and colours were much contracted, but more so in the right eye than in the left eye. (Unfortunately these fields have been lost, but more recent records are available.)

The same local treatment was adopted, and she was given a mixture of potass. bromide and iron.

March 28th-The conjunctival injection was more pronounced, and there was a distinct zone of ciliary injection. The blepharospasm was increased, and photophobia and lachrymation were marked.

Guttæ atropin. c Cocain.

Mist. Potass. Brom. c Ferro.
Galvanic current applied daily.
Smoked glasses.

April 10th-She was much better.

R.V. c +50 D.
6
- 12

Cocain drops were substituted for atropine and cocain. Galvanism was continued.

Ꭱ Mist. Pot. Brom. c Tinct. Valerian Ammon.

May 12th. She had had severe headaches. The injection of the globe was slight, but the blepharospasm was pronounced.

R.V.= c + I. L.V.= c + I.

36

R Guttæ atropin. c cocain.

Mist. Pot. Brom. c Valerian.

Right upper lid painted with Nitrate of Silver.

May 23rd. A roseolar rash covered the right side of her face and neck, and on the slightest exertion her face (especially on the right side) became bathed in perspiration. There was some catarrh of the respiratory passages.

May 25th-Congestion of the eye less. Complained of "globus" and aphonia. Rash had disappeared.

May 28th. She had a recurrence of the roseolar rash and sweating. Numbness and tingling of right arm.

June 11-Right ankle and hip joints fixed and painful. No swelling or redness.

R Gutt, cocain, c Liq. Suprarenal.

Mist. Pot. Iodid. c Sod : Salicylat.

Galvanism.