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soluble salts of quinine. As it is incompatible with acid itsshould not be prescribed with acid solutions of quinine,which are rendered most palatable by syrup of lemon.

Castor oil is made acceptable to the palate by the additionof amyl acetate 0 1 per cent., and saccharine 0 - 3 per cent.,dissolved in alcohol, 5 per cent., and the taste of cod-liveroil is rendered less unpleasant by flavouring 100 grammes ofthe oil with acetic ether 2 grammes, saccharine 0 ’ 4 gramme,and five drops of oil of peppermint. An alternative method

of masking the odour and taste of cod-liver oil consists in

adding two drops of eucalyptus oil to 150 grammes of the

oil. Linseed mucilage is used as a vehicle for cough mixturesand mucilage of starch is a useful suspending agent for thesalts of bismuth, which are hopelessly incompatible withboth acacia and tragacanth. Glycerine of bismuth carbonate,containing 50 per cent. of the salt in a very fine state of sub-division, is particularly active from a therapeutic point ofview. The taste is much improved if prescribed with com- I

pound infusion of orange, which also suspends the bismuthsalt without rendering the particles coherent. Menthol water

containing 0 1 per cent. of menthol may be used as analternative to peppermint water and is useful as a vehicle foralkaline and antiseptic solutions for the nose and throat. TheGerman Pharmacopoeia contains a preparation known under thename liquor ammonise anisatus, corresponding with aromaticspirit of ammonia but flavoured with 3-2 per cent. of anethol.Several combined sweetening and flavouring agents are

capable of a wide application, particularly simple elixirflavoured with tincture of orange and sweetened with sugaror saccharine. An elixir flavoured with orange and liquoriceis superior to liquid extract of liquorice in disguising thetaste of cascara, ammonium chloride and the alkaline

iodides. For flavouring children’s mixtures elixirs are

objectionable, as they usually contain about 20 to 25 percent. of alcohol, in which case a syrup flavoured with

peppermint, wintergreen, anise, or dill will usually be foundacceptable, especially if the mixture be attractively coloured.Practically all syrups can be prepared with glycerine insteadof sugar and further sweetened if necessary with saccharine.A convenient solution of saccharine for dispensing consists ofsaccharine, 5 per cent. ; sodium bicarbonate, 3t per cent. ;alcohol, 12 per cent. ; and water sufficient to make 100.Five drops of this solution may be used for sweetening eachounce of a mixture. From reading Mr. Grier’s interestingpaper it would seem that by choosing a suitable combinationof colouring, sweetening, and flavouring agents, any bitter,acrid, or otherwise nauseous drugs may now be renderedattractive to the eye and palatable to the taste of the mostfastidious patient.

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RUPTURE OF THE LIGAMENTUM PATELLÆ.

THOUGH rupture of the tendon of the quadriceps muscle isa common accident what is practically its continuation, theligamentum patellae, is so much stronger that its rupture hasseldom been recorded. In the Boston Medical and SurgicalJoulfnal of June 18th Dr. C. F. Painter has reported twocases of this accident. It is noteworthy that in both theruptures resulted from direct violence to the tendon itselfthough a violent contraction of the quadriceps may havebeen a contributory cause. The patients fell heavily uponthe flexed knee and the rupture took place close to theattachment to the patella. The disability is greater than thatfrom fracture of the patella. The two cardinal symptomsare loss of ability to extend the leg and a gap in the liga-mentum patellae. But swelling and tenderness may obscurethe gap and the severity of the injury may for a time bethought sufficient to explain the inability to extend theknee. In the first case a man, aged 63 years, while comingout of an uncarpeted room slipped and fell heavily with his

right knee flexed to a right angle. He was unable to get up,partly in consequence of the pain and partly in consequenceof inability to use the leg. Effusion rapidly appeared in thejoint and he was carried home and put to bed and ice-bagswere placed round the knee for several days. There were muchpain and tenderness about the front of the joint. The swellinggradually subsided but no power was regained in the leg. A

gap was palpable below the lower border of the patella andcontraction of the quadriceps did not tighten the ligamentumpatellse. A vertical incision was made from the middle of thepatella down to the tubercle of the tibia. This immediatelyopened the knee-joint ; the fat pad usually found in this

situation had disappeared. There was much clotted blood in

the joint, which was washed out with sterile saline solution.The ligamentum patellag had shrunk down to about half aninch. Mattress silk sutures were passed through the end ofthe ligament and by these it was drawn close up to the

patella. Four holes were bored in the cartilaginous marginof the patella through which the sutures were passed. Theincision was closed and the limb was put up in the extendedposition in plaster-of-Paris. Union took place by first

intention and the function of the limb was completelyregained. In the second case, a man, aged 32 years, fell

from a car heavily on the ground. Fracture of the patellawas diagnosed and he was kept in the house for six weeks.After that he began to walk about but he slipped and someswelling of the knee followed. 17 days later he was admittedinto hospital. There was moderate swelling of the patellabut if it had been fractured the union was osseous. There was

marked swelling, particularly over the lower part of the patellaand upper part of the tibia. Below the patella a gap was felt.A skiagram showed no evidence of fracture of the patella.The patient could not extend the leg. A similar operationwas performed and the use of the limb was regained ; thepatient could extend it to within five degrees of normal.Dr. Painter also reports a case of incised wound of the

ligamentum patellse. A man, aged 23 years, cut the upperpart of his leg with a hatchet. The wound bled freely andwas sewn up by a practitioner. The patient remained in bedfour or five days and then began to walk about but had toreturn to bed. After that he frequently "sprained" theknee, which became swollen. When seen by Dr. Painter

four months after the accident the knee was swollen, appa-rently from effusion. An oblique scar crossed two-thirds ofthe width of the ligamentum patellae. Voluntary extensionof the knee was possible only for a few degrees. A similar

operation showed that the ligament was completely divided.It was sutured to the patella and nearly normal extension ofthe knee was regained.

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THE COAL SMOKE ABATEMENT SOCIETY.

THE nintn annuat report ana. oalauce-sneet 01 tms societyfor the year 1907 has been issued recently and a copy of it

should be in the hands of everyone who wishes to see Londonfree from smoke and a clear sky over head. During theyear under notice (1907) 1262 cases of smoke pollutionobserved by the society’s inspector were dealt with

by the committee and in nearly all cases were reportedto the local authorities concerned. In 82 of the remain-

ing cases representations were made directly to theoffenders at their special request and in the majority ofinstances this resulted in the suppression of the nuisances.A very satisfactory feature of the report is the evidenceof the amicable relations existing between the societyand the London County Council and the majority of themetropolitan borough councils. The society has taken partin many of the conferences which were held in England andabroad which included the subject of smoke abatement intheir discussions, and an evening was given to the subject at

826

the Royal Sanitary Institute. Careful scrutiny of any pro-posed legislation which the society has thought likely to beinimical to the interest of the public has been made andaction taken where possible. The committee reportsthat it is making an effort to induce the electric power,gas, and smokeless fuel companies to combine in

establishing a permanent exhibition of apparatus, methods,and fuel -for the. abatement of smoke from dwellinghouses as distinguished from industrial premises. The

report points oat that the investigations of the

society show that the abatement of smoke nuisances bythe use of mechanical appliances is generally attendedwith the economical working of industrial concerns. SirW. B. Richmond is the president of the society and thevice-presidents include H. R. H. Princess Louise Duchess ofArgyll, the Duke of Fife, Sir William Huggins, and SirThomas Barlow, while the council is composed of repre-sentative men in science and art and the professionsgenerally. Dr. H. A. Des Yoeux is the honorary treasurerand the offices of the society are at 25, Victoria-street,London, S.W. Subscriptions, which may be of any amountfrom 5s. per annum, are urgently needed for the continuanceof a work which has already done not a little to improvethe atmospheric conditions of our great metropolis.

CHRONIC FAMILY ACHOLURIC JAUNDICE.

AN interesting case was shown before the pascuatnc section.of the Gesellschaft fiir Innere Medizin und IÜnderheitlkl1udein Vienna on May 21st by Dr. Rudolf Pollak, and publishedin the Wiener Meilizinische Ilrocheschraft of June 27th. The

patient was a girl, aged eight years, who, according to thehistory given by her mother, had been for several yearsalmost always yellow in colour. Occasionally the yellowcolour of the skin and sclerotics would disappear for a fewdays but would very quickly return. The mother of the

patient had also showed the same symptoms in herself forseveral years and the maternal grandmother of the child hadsuffered from jaundice for years before her death. The child

had two healthy sisters who had never shown any signs ofjaundice. On examination of the patient herself the skin, thesclerotics, and the mucous membranes were found to be dis-tinctly icteric. There was also considerable enlargement ofthe spleen, which extended downwards three fingers’ breadthbelow the costal margin and was of firm consistency.The urine, though repeatedly examined, did not show

any trace of bile pigment, although urobilin and uro-

bilinogen were abundantly present. The stools were of

normal appearance and were never acholic. The bloodexamination revealed a considerable degree of anasmia—

3,200,000 red blood corpuscles per cubic millimetre with

poikilocytosis and polychromatophilia. There was a

moderate leucopenia (4600 leucocytes per cubic millimetre).The clinical picture of this case was practically identicalwith certain other cases observed some time previously by Dr.Pollak ; one of these was a girl, aged 12 years, who showedan intense jaundice from birth onwards and a very greatlyenlarged spleen, the condition of urine, faeces, and bloodbeing similar to that in the case just described. He also

described two other cases occurring in two sisters, one agedeight years and the other eight months. The mother of these

children had been icteric from birth but had no splenicenlargement, and her mother and grandmother were

also afflicted with lifelong jaundice-a history, there-

fore of the condition extending to four generations.Dr. Pollak gave an instructive ’J’éS11/Tné of previous obser-

vations on cases of this kind to which, among many others,the following names have been applied: simple achol-uric jaundice, chronic infectious splenomegalic jaundice,family or congenital jaundice with splenic enlargement,

and chronic acholuric jaundice with splenomegaly. In

many patients the course of the condition is practicallydevoid of symptoms ; in many cases it appears to be com-

patible with long life, and the only case which Dr. Pollakcould find in which a necropsy had been performed was onerecorded by Minkowski, the patient having died from aminfluenzal pneumonia. In some patients attacks occur at

intervals lasting several days and associated with malaise,nervous distress, and often with diarrhcea and slight febriledisturbance. Bettmann observed in one case attacks of

hasmoglobinuria which were induced by exposure to cold.Various theories have been propounded to account for this.peculiar condition. Pick suggested that there was a con-genital communication between the lymph channels and thebile passages. Minkowski supposed that there was an

anomaly in the metabolism of blood pigment, possibly as.the result of some primary defect in the spleen. Senatoralso believed that the condition was of primary splenieorigin. Dr. Pollak regards this view as untenable, since

cases of similar nature are on record without any enlarge--ment of the spleen, including three cases recorded by Pick,one of the cases of Benjamin and Sluka, and one of hisown. The majority of French observers regard the condi--tion as a chronic infection of the bile-passages, but the fatalcase to which reference has been made showed no inflam-

matory conditions in the bile-passages. Widal and Ravaut

postulate a degenerated condition of the liver, but againstthis the cases investigated by Dr. Pollak showed a normalhepatic function. Benjamin and Sluka attributed the originof the condition to derangement of the haemopoietic system,chiefly on the ground of the anasmia associated with it. Dr.

Pollak has investigated the haemolytic action of the serumin these cases but has obtained negative results, and he has.also examined the resistance of the red corpuscles to salinesolutions and has not found it lessened, in opposition to theresults of Chauffard. Examples of this disease have beenrecorded in this country by Sir Thomas Barlow and Dr. H.Batty Shaw, who referred to cases of like nature observedby Dr. Claude Wilson and Dr. James Finlayson. Theyregarded their cases as allied to Hanot’s cirrhosis, and it isof interest in this connexion to notice that Gilbert andLereboullet maintain that all stages may be recognisedbetween simple family cholasmia, splenomegalic jaundice,and biliary cirrhosis. These observers also maintain that

Napoleon I.. was an example of family jaundice. The condi-tion is one of considerable obscurity and further pathologicalobservations are necessary before its exact nature can be

regarded as- established. --

INSPECTION OF CHILDREN’S EYES IN BRUSSELS.

Dr. Paul De Ridder, in a report on the inspection ofthe eyes of Brussels school children, published in La PresseX6dicale Belge of August 16th, remarks on the increasingfrequency of myopia as the age advances. Thus, of childrenfrom 6 to 8 years- of age, there were only 5’ 5 per centmyopic; from 10 to 12 years of age there were 10

per cent. ; and from 13 to 14 years no less than 18

per cent. were myopic. Hypermetropia and astigmatism,on the other hand, did not appear to depend on

the child’s age or amount of study, about 21 per cent.

coming under the former and 9 per cent. under the lattercategory whether the junior or senior classes were examined.Dr. De Ridder seems to have made it his business to

explain to the children about to leave school the conditionof their eyes and to point out to those who were myopic thekind of work that tends to increase myopia. He presents adiagram showing that the numbers of myopes amongst the

1 THE LANCET, May 31st, 1902, p. 1536.