1THm present paper is an outcome of an investigation carried out by Mr. Mackenzie Davidson and myself into the possibilities of radium as a therapeutic measure in eye disease. We have carried on the work with the limited time at our disposal for over a year, and now venture to bring forward the results obtained, in the hope that they may stimulate further inguiry and research. A good many of the present cases were mentioned in a preliminry note published in vol. xxix of the Tran8actions ofthe

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... hihalmological Society, but no statistical tables euch as are appended to this paper were made, and all the -cases are now grouped together and their special features detailed for easy inspeoction. We can endorse more fully now the opinion which we then ventured to express-namely, that radium is likely to prove of great service, both in the treatment of external diseases of the eye and in those of the eyelids. The reslts are in manyways most encouraging, and the field .of utility for radium in eye disease has widened considerably since the time that it was first shown to be a specific for rodent ulcer. Method of Application. The method of applying the radium was crude but eatisfactory. The eye wasfirst cocainized and the radium, which was contained in sealed glass tubes permitting only ,the passage of beta and gamma rays, was applied directly to the affected part. The fingers of the operator were proteted by enveloping first that part of the tube notrequired -and then the fingers in a thick, continuous wrapping of lead foil. The process is tedious,especially as care must be exernised to keep the tube in close contact with the part desired to treat which is often very small, but no more officient way could be devised. Length of Exposure and Dose. There are two points to which we should, in the first ,place, like to draw attention. First-and this is of vital importance-in no single instance have we observed the slightest ill effects from the use of radium. We have, of course, exercised caution, especially when dealing with the eye itself, and it is probable that when the actions -and dangers of radium are more fully understood there will be a much greater freedom in repeating the sittings £han we thought advisable. The second point is that no increase of inflammation or aggravation of symptoms occurred in any case, with the one exception of pain, to which I shall refer again -later on, and which, when it occurred, was usually transient and not severe. It is, of course, of the utmost importance, in dealing with a substance such as radium, that at the earliest possible moment positive rules as to the size of the dose to be employed and length of the sitting, as well as the frequency with which the sittings should be repeated, should be laid down for the guidance of the inexperienced. At the present time it is unfortunately impossible to .ve more than a few general indications, and to point out by results obtained the most likely road to a successful issue. With regard to the eye itself, we had no basis upon which to found our observations, so we thought the best plan would be to fix a time limit which would not endanger the integrity of the eye, however large a dose it ight be considered desirable to try. Mr. Mackenzie Davidson's experience with radium here proved the deciding factor, and an exposure of five minutes was fixed as being absolutely safe.*-With regard to the dose itself, it will be obvious to anybody glancing over the appended statistics that very many and varied doses were employed. We were chiefly guided as to dose by the character of the lesion to be treated, considerin that one exhibiting a tendency to spread or infiltrate surrounding tissues, or marked by ai y special virulence in its pess,cwold probably require a larger dose than a sl s rfil or non-inSfltrating lesion. Further, being anxi to. try the effects of as meny variaton thas possible, we n many Cases used a differntmdoe forthe second sitting to what was employed in the first instance. be It saoon became evident that lesions of the cornea could be treated successfully with this time imit of five minutes by the, same dose which, for afoetions of theson and lids, reqa ured an exposure three or four times as long, and also that superficialh lesions of the cornea frequently do not need any more than quite a small dose, such as 5 to 10mg., appliedonce uor twice as the case might demand. okiang Mback upon our experience, I am inclined to think, and Mr. Mackenzie D taon agrees with me, that a supply of 20 mg. is suficient to combat anyextoern affetieon of the eye in which radium is likely to be of service. Frequency of Exposures. With regard to the frequency with which the exposures were repeated, we were guided entirely by the progress or otherwise of each individual case. When dealing with a virulent and highly dangerous process, such as a hypopyon ulcer, it was obv%iously necessary to get a result with the least possible delay, and consequently the exposure was repeated as soon as was considered safe, if no improvement had been noted. Whereas, in milder cases, we were content to wait loner for signs of amelioration, being anxious to find, if possible, the minimum number of sittings necessary to effect acure. The effects of radium are continuously exhibited for a considerable space of time, extending into a matter of six weeks at least, and so some of our cases had only one sitting, and a perfect cure resulted. The margin of safety with regard to the minium interval that should elapse between the sittings must obviously depend upon the dose employed. The larger the dose, the sooner should its effects be produced, and the longer the interval between the sittings. Consequently, if a large dos was considered necessary at the first exposure, we seldom repeated it with less than a week's interv&l, except it happened to be noted that the disease continued to spread in spite of the treatment, in which case we eon sidered that a second exposure might safely be givena a rather shorter interval. RESULTS. Before briefly reviewing the results obtained, it must be clearly understood that as soon as the patient was sub. mitted to radium all other forms of treatment were as far as possible omitted. In some cases, such as corneal ulcers, it was considered advisable to continue the use of atropine and a pad and bandage, and in most cases the patient was also given boracic lotion for the purpose of keeping the eye clean. In the case of corneal ulceration it may be perhaps argued that this would to some extent discount the value of the result obtained, in that the patient might have been cured by this method of treatment alone; but, with few exceptions, the cases submitted to radium were of a kind not usually amenable to this simple treatment, and were selected on this account. Further, many of them had had previous treatment without success before radium was employed; and, lastly, a few superficial cases were undertaken to note whether radium, employed in addition to the simple routine treatment of pad, boraclc lotion, and atropine, afforded a likelihood of effecting a more speedy cure. The immediate effects of applying radium directly to the eye are practically nil, beyond an evanescent photophobia and irritability, which are probably simply a reflex disturbance induced by the method of application, and which would probably appear just as markedly if a stick of chocolate, instead of radium, were employed. A few hours after the sitting a certain proportion of the patients complained of pain, iwhich in a f-ew instances was sev-ere enough to cause a sleepless night. As a rule this symptom had passed away within twenty.four hours, but once or twice the patient has told us that the pain lasted more or less continuously for a couple of days. This, * With regard to this point, I may say that Mr. Mackenzie Davidson in dealing with rodent ulcer affecting the lid border, found that a tube of 20 or 30 mg. could be applied to the inner surface of the lid, and so lie in contact with the sclerotic for a period of half an hour without eausing any ill effect to the eye. 9