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third day after birth, which shows the duration of the in-

cubation period. The text-book statement that the incuba-tion period varies from a few hours to two or three daysprobably is due to inclusion of cases of ante-partuminfection. The gonococcus appears to gain entrance to

the conjunctival sac through membranes that have been

ruptured some time before birth. Of 28 caes in

which the time of rupture is mentioned the interval

before birth was not less than 24 hours ill 12 casesBut in 16 cases the interval between rupture of themembranes and the discovery of the ophthalmi was lessthan 24 hours. To explain these cases slight lateraltears of the membranes or infection through uninjuredmembranes must be assumed. A local factor is indi

cated in seven of the cases by the fact that one eyealone was affected at birth. In most of the cases the

labours were normal. In 15 of the cases the gonococcuswas found, in two the pneumococcus, and in one the

bacillus coli. Many of the cases were at birth in the earlystage of ophthalmia, but in two cases the disease had

apparently run its course, leaving a damaged or shrunken

eyeball. Perhaps in gonorrhoeal metritis or endometritis

gonococci pass through the chorion during early pregnancywhen its vascular connexion with the uterus is marked.The hypothesis remains that the foetal circulation may beinfected in consequence of general gonococcic infection ofthe mother. Mr. Stephenson and Dr. Ford suggest that

many congenital affections, such as staphyloma, corneal

opacities, microphthalmos, lacrymal abscess, and vulvo-

vaginitis, may be due to intra-uterine infection.

THE CARE OF THE SPONGE.

ONE of the most agreeable and convenient adjuncts con-cerned in preserving personal cleanliness is the sponge.Considering the extraordinary capacity of the spongefor holding water and the frequency of its use it

ii obvious that enormous quantities of water must in

the course of time pass through its innumerable cells.

For example, if a sponge which absorbs, say, a pintof water is alternately soaked and squeezed out a

dozen times during a bath the amount of water thathas entered into, and passed out of, the sponge at

a single sitting, so to speak, would be 12 pint!=, so that

during a year at this rate no less than 500 gallons of

water would have traversed its cells. This estimate isnot an exaggerated one and probably the sponges of mostcleanly disposed persons are made to deal with a largerquantity than this. However that may be, it is obvious thatthe sponge must arrest the impurities of a water just as doesa good filter and sooner or later slimy matter accumulates,the quantity and quality of which depend upon the characterof the water-supply. The use of soap would, as a rule,increase the slime owing to the formation of insoluble curdsof lime soap. The number of organisms and the amount ofimpurity in the water may be quite insignificant in relativelysmall volumes of the water, but when the accumulationcaught in a sponge represents some hundreds of gallons ofwater the sponge may obviously teem with potentialities forevil. The bacteriology of water slime is of the greatest interestsince it is this slime found on all the sand filter-beds whichremoves dangerous entities and thus protects a communityfrom water-borne disease. The unclean sponge contains asimilar slime which must prove a very prolific breeding-ground for micro-organisms. A consideration of such facts

emphasises the desirability of keeping the domestic spongeabsolutely clean and all doubt as to the presence ofseeds of disease should be removed by thoroughly disin-fecting the sponge at regular intervals. There is no better

disinfectant for the purpose than sunlight and the sponges,after having been washed thoroughly in strong washing soda

solution and rinsed in a weak solution of hydrochloric acidand finally in pure water, should be squeezed and hung up todry in the sun’s rays. This process also renovates the sporgein a most satisfactory manner. Amongst artificial dis-infectants a weak solution of formaldehyde, or sulphurousacid, would appear to be suitable.

THE TREATMENT OF INOPERABLE SARCOMAWITH THE MIXED TOXINS OF ERYSIPELAS

AND THE BACILLUS PRODIGIOSUS.

Dr. W. B. Coley has contributed to the American Juurnalof the Medcial Sciences for March an important paper in

which he gives the late results of the treatment of inopEr-able sarcoma with the mixed toxins of erysipelas and of thebacillus prodigiosus. It may be remembered that in 1891he first described the treatment of inoperable sarcorra

with repeated injections of the streptococcus of erysipelas.This treatment was suggested by a case of very malignantround celled sarcoma of the neck, which recurred four

times after operation. It finally so involved the deeptissues that operation was impossible. Soon after the last

operation an attack of erysipelas occurred, which was

followed by a relapse. The tumour disappeared and thepatient was well seven years later. In a case of inoperablerecurrent spindle-celled sarcoma of the tonsil and cervicalglands Dr. Coley injected beneath the skin of the neck

covering the tumour a culture of the streptococcus of

erysipelas. A typical attack of erysipelas followed, the

tumour broke down, and the outlying nodules disappeared.The patient recovered health but a hard fibrous mass

remained in the tonsil which had lost its malignantcharacter. He remained well for eight years and then

succumbed to recurrence. Ten other cases (four cases

of carcinoma and six of sarcoma) were treated in

the same way but in six (including all the cases of

carcinoma) repeated injections failed to produce erysipelas.In most of these slight improvement took place whilerepeated injections of the cultures were being given. In the

four positive cases one patient remained well for eight yearsand then died from recurrence and another remained wellfor three and a half years and then died from metastases.The occurrence of two fatal cases caused Dr. Coley toabandon injections of the streptococcus of erysipelas forthose of its toxins. To intensify their action he added thetoxins of the bacillus prodigiosus. The value of his presentpaper lies in the fact that he is able to give his final results.He reports 36 cases in which the tumour disappeared underthe treatment. These were as follows: round-celled sar-

coma, 13 ; spindle-celled sarcoma, 16 ; mixed-celled sarcoma,two ; epithelioma, one ; chondro sarcoma, one ; and three inwhich no microscopic examination was made. In ten of thesecases the patients were well more than ten years later atthe time of the report. In 26 cases the patients were wellat periods varying from three to 13 years after treatment.In five cases fatal recurrence took place after the patient hadremained well for periods varying from six months to threeand a quarter years. These results would be remarkablein cases of primary operable sarcoma. But here the

patients were beyond hope from operation. In carcinomaDr. Coley finds that the toxins have a marked inhibitoryaction but that this is rarely curative. He has col-lected 60 cases of malignant disease treated by othersurgeons with complete or partial success ; 27 of the

patients were alive and well at periods varying from threeto 12 years after the treatment. These results certainly areremarkable but we think that it is a pity that Dr. Coleyneglects to state what proportion the successful cases formof the total cases treated. However, he appears to justifyhis claim that this treatment should be a routine after all

primary operations for sarcoma and carcinoma. As to the