the usual form of pads and bandages. This step was also successful.

We begun the first step in stitching the bladder by removing the rubber tube and using a cork in the glass one, which was removed every hour and a half or two hours to pass urine, and then replaced.

During the whole of this time the tube had been duly removed, cleansed and the bladder thoroughly irrigated with boracic acid to prevent the accumulation always so troublesome in these cases. As soon as union was complete, we begun to dilate with more energy and found this the most difficut if not the most serious. This was to stretch or dilate the new-made bladder, which by this time was very much shrunken. We found it very difficult to get a support that was substantial and stationary. After trying various plans with only partial success, we took an oblong cork, cut a hole in the end of it, so as to fit the bottle end of a rubber nipple which was tightly corked into the hole. The cork was then fashioned to fit the inside of the vulva and put proper pressure on the mouth of the urethra.

After padding with gauze an ordinary condom was stretched over the whole and tied in front and back. This end of the nipple was inserted into the vagina, and the cork placed between the labia. We tried to support this with an erdinary T-bandage, but found it would not keep uniform pressure. We then had a stout belt made, supported by whalebone to prevent wrinkling and to take the place of a T-bandage. To the back of this belt was fastened a fourinch rubber bandage. This rubber was split in front to below the vulva. By crossing these two ends in a certain manner, they gave support to both the cork and the outside vulva when fastened in front. When necessary to pass water she could detach the front part of the bandage and replace it herself. The glass tube was dispensed with,

of course, except for the purpose of washing out the bladder occasionally. Within the next three or four weeks, with this support, she was able to hold her urine from one and a half to two hours. She has worn this support for about five months intermittently, and is able to hold her urine from three to four hours without it. She usually passes water from two to four times at night, and during the day about every four hours. She now wears dry clothes day and night. But this is not all. She has undergone the most remarkable change. She is robust, well nourished, and is rapidly acquiring the development, both physical and mental, so long delayed with her. Not only are her parents delighted, but she is one of the happiest little girls in her section.

We look on this case as one above the usual interest, and if our experience will be the means of helping some one else out of a similar bondage we will feel amply repaid.

A STUDY OF THE REFRACTION OF ONE

THOUSAND EYES.

BY C. H. PEETE, M.D., MACON, GA.

The only excuse that I offer for presenting to you a subject so bare of interest to the general practitioner is that it is one affording interest of such magnitude to the ophthalmologist that it cannot be overlooked. The subject of refraction is of as much, if not of more importance, than any one thing presenting itself to the specialist in his daily labors. While other parts of our work require equally prominent places in our minds, the one under consideration requires more frequent application; and I might say, continually claims our attention. It is a condition or disease, so to speak, productive of many forms of disturbances, some of which prove very troublesome to the general practitioner, as well as the patient. It is sometimes made manifest in ways that seem to the ordinary observer to point so plainly to disease of other parts of the body, that this most important branch of surgery is entirely unthought of as even a possible cause of the symptoms. It is not my purpose, at this point, to look into the symptoms and reflexes produced by existing errors of refraction, or to make any suggestions regarding the advantages made possible by their early correction.

It is a subject so important to us as physicians, that it should be kept prominently before us, that we may be come more familiar with its dealings with our patients. In my work I do not find it necessary to correct errors of re

fraction in as large a per cent. of cases as some who have made similar reports.

Dr. H. Bert Ellis, writing on this subject, states that 87 per cent. of all his eye cases required correction of errors of refraction.

Dr. George M. Gould, in a paper on this line, states that 93 per cent. of his eye patients required correction of refraction.

While I have not noted the per cent. of cases requiring correction relative to the total number of eye cases, I unhesitatingly say that the per cent. will fall far short of that reported by these gentlemen.

The one thousand eyes, the refraction of which I wish to speak, have been selected from my books consecutively. I have chosen only cases in which a correction of both eyes was necessary, ignoring sex and age, since there are very few presbyopes recorded. In tablet form I first noted the general refraction of the one thousand eyes, 73 per cent. being astigmatic, 27 per cent. non-astigmatic, being somewhat less than 3 astigmatic to one non-astigmatic eye. The tables show that 78 per cent. were hyperopic, 18 per cent. myopic, with 40 eyes hyperopic in one meridian, and myopic in the other.

In the hyperopic cases I found 30 per cent. having simple hypermetropia, while 70 per cent. had astigmatism, simple or compound, the simple amounting to 16 per cent., the compound 54 per cent. of the hyperopic cases. Among the myopes I find 18 per cent. having simple myopia, and 82 per cent, with astigmatism, simple or compound; the simple being 47 per cent. and the compound 344 per cent, of the myopic cases. In my mixed astigmatic cases I find that out of the whole number 40, hypermetropia predominates in 22 eyes, while myopia predominates in 18. It can be seen by the above figures that in my cases of hypermetropic astigmatism the compound outnumber the simple by more than

three times the number, while in the myopic astigmatic cases the simple shows to be one and one-third times as numerous as the compound. Of the 730 astigmatic eyes shown in this report, 74.2 per cent. are hypermotropic, 20.3 per cent. myopic, while 5.5 per cent. have mixed errors. When considering the axes of the 730 eyes, I found 43 per cent. to be hypermetropic, with axes at 90 per cent.; 10 per cent. hypermetropic, with axes at 180 per cent.; 24 per cent. hypermetropic, with axes oblique, that is the axes being anything other than at 90 or 180.

I found 10 per cent. to be myopic, with axes 180; 4 per cent. myopic, with axes at 90, and 9 per cent. myopic, with axes oblique.

Of the 237 simple hypermetropic cases, only 27 required a correction of .50 D. or less, and 134 required 2.00 D. or less.

Of the 33 simple myopic cases, 2 required a correction of .50 D. or less, and 17 eyes, or 50 per cent., required 2.00 D. or less, and 8 eyes, or 24 per cent., had between 5.5 and 18.00 D.

While this is true regarding the correction of high degrees in myopia, I only found 8 eyes, or 3 1-3 per cent. of the hypermetropic cases requiring a correction of 5.50 or

more.

As I have stated, out of the one thousand eyes, I found 730 astigmatic, 40 being hypermetropic in one meridian and myopic in the other. There were 502 hypermetropic astigmatic eyes, and 148 with myopic astigmatism. Of all astigmatic eyes, hyperopic and myopic combined, 72 per cent. required correction of .75 D. or less, and 88 per cent. required 1.75 D. or less; 46 per cent. of all astigmatic eyes had axes at 90, 21 per cent. had axes at 180, and 33 per cent. had axes oblique.

Of the hypermetropic astigmatic eyes, 57 per cent. had