given were recorded, and the dates on which treatment was given were marked. The second clinic day 20 new patients whose names had been sent to the principal came for treatment and also the 20 old ones. The third clinic day, 20 more new ones came and 40 old ones, and so on until all the cases were coming to the clinic.

At one time there were more than 200 cases coming for treatment at each clinic. Each patient was given a card with his or her name, age, sex, and date of first treatment, as well as the number of his or her page in the record book, marked thereon. The card was brought to the clinic every time, the page referred to, and the date marked. At the end of each clinic the book was looked over, the names of those absent were taken, and if these were absent the next clinic day, the principal of the school was notified and the patient required to come for treatment. The acute cases were not permitted to go to school. Three nurses were instructed in the diagnosis and treatment of trachoma, and they helped to apply the treatment at the clinic and were also sent to the suburban schools to treat the patients who could not, on account of the distance, come to the hospital.

The treatment given depended on the character of the case.. Those presenting well marked masses of granulations were treated by copper sulphate applied as follows: The eye was anesthetized by instilling 3 or 4 drops of a 2 per cent solution of cocaine. The lid was everted by holding the eyelashes between the thumb and index finger of the left hand while the middle finger pressed a match stick behind the tarsal cartilage on the external surface of the lid and exposed the retrotarsal fold. The sharp edge of a lance-shaped crystal of copper sulphate, held in the right hand, was then used to curette away the granulations, at the same time exerting its caustic action.

In some cases the trachomatous membrane was incised with the crystal in numerous places and curetted away. A boric-acid wash was freely used and the patient sent home and told to apply ice to the eye continuously for four hours. In all, about 100 cases were treated in this manner. Some of these cases were treated in this way two and some three times at intervals of two weeks. Between operations a 50 per cent solution of glycerite of boroglycerin was applied to the lids twice a week.

Those cases in which the granulations were comparatively few and more or less discrete were treated only by the application twice a week of a 50 per cent glycerite of boroglycerin or of a 20 per cent solution of copper sulphate in glycerin. These solutions smart the eyes for a few minutes after application, but the patients soon become accustomed to this, and even the youngest children will take the treatment without causing any trouble.

The acute cases were first treated by the instillation of atropine to relieve the photophobia and by instillations of a 20 per cent solution of argyrol until the acute symptoms subsided. Then the copper sulphate crystal was used as described above.

All the patients received an eye lotion to be used freely at home four times a day. It consisted of boric acid, 2 parts; sodium biborate, 1 part; water, 80 parts. They were all instructed to use individual towels and washbasins, and warned against rubbing the eyes with their hands.

The time consumed in treating these cases was very short. As the patients stood in line, each one was given a piece of clean cotton, and after the medication was applied the patient was put to one side to wipe the eyes with the cotton, and the next case was treated. One person can easily treat 100 cases an hour. The patients who were to be treated with the crystal of copper sulphate were separated and treated when the others were all through.

The minimum number of people required to operate a clinic of 100 in an hour is three, only one of whom need be a physician. One is detailed to keep the books, writing the name, age, sex, history, description, and treatment of each new case, and keep a record of the retreatments. One gives out the cotton and keeps the line moving, and one applies the treatment.

RESULTS OF THE TREATMENT.

From September, 1912, when treatment was begun, to February, 1913, there were discharged from the clinic as cured 30 cases. These cases no longer had granules, discharge, or lymphoid hypertrophy in the eyes. They all belonged to the group of mild cases. All the other cases showed marked improvement, and a great many were almost cured, having only a few very small granulations left. Indeed the lids looked in a great majority of cases so different from what they did before treatment that if they had been reexamined by the author as new cases many of them would have been diagnosed as "doubtful cases." Especially gratifying were the results obtained in the acute cases. While they are all far from cured, and have marked cicatrices in the lids, yet the corneal complications have all subsided, the visions are normal, and the patients feel so comfortable that it is difficult to make them believe that they must continue treatment.

CONCLUSIONS.

1. Trachoma is prevalent among the school children of Cebu, about 13 per cent having the disease.

2. The trachoma is mostly of a benign character.

3. To examine for trachoma it is necessary to expose the retrotarsal fold.

4. The diagnosis of early cases is of the utmost importance. 5. Trachoma is curable if treatment is regular and systematic. 6. Trachoma in the schools can be controlled by suitable measures, easily carried out.

7. The procedures adopted for its control in Cebu are applicable to towns of similar size in the United States.

PREVALENCE OF DISEASE.

No health department, State or local, can effectively prevent or control disease without knowledge of when, where, and under what conditions cases are occurring.

TYPHOID FEVER.

Missouri-St. Louis.

Surg. Carrington, of the Public Health Service, reported that during the month of August, 1913, 172 cases of typhoid fever had been notified in St. Louis, Mo., and that during the first five days of September 72 cases had been notified, making a total of 244 cases reported since August 1, 1913.

The State Board of Health of Texas reported that during the month of July, 1913, 1 case of cerebrospinal meningitis had been notified in Coleman County, and 1 case at Ballinger, Runnels County, Tex.

Cases and Deaths Reported by Cities for Week Ended Aug. 23, 1913.

Cases and Deaths Reported by Cities for Week Ended Aug. 23, 1913.

Number of new cases

reported

during month.

2

1

1

2

1

1 27

Cases and Deaths Reported by Cities for Week Ended Aug. 23, 1913.

During the week ended August 23, 1913, pellagra was reported by cities as follows: New Orleans, La., 1 death; Providence, R. I., 14 cases; San Francisco, Cal., 1 death.