the only instance of the kin(l that he had then"' met with. It has chanced to mc to notice, within the last few months, three cases nearly resembling the one given by Loring, and without any attention being directed to the SUlject otherwise than by tihe interest awakened by the first of them ; it would, therefore, seem not unlikely that such variation.s are less rare than has been supposed. 2~~~~Fig. I is a diagram of thc optic disc (icen iil the erct image) of a young Woman aged 20. An artery of about the third or fourth magnitude is seen passing from the lower-outer part of the fundus on to the (isc, where, instead of entering the substance of the nierve, it curves sharply round and disappears exactly at, or just external to, tle e(ge o* the disc. Its course is such that, minlcss it malie a second Sudden bend directly downwards, it cannot fail to ,:ass into the choroid or sclerotic. A very small vessel, only just clearly visible, appears to form a communication between the anomalous artery and another small branch which takes the usual course. As, how%,ever, 1 saw the patient only once, and the examination was mnade without atropine, this anastomosis on the disc cannot be talen as quite proved. The eye was hypermetropic, but in other respects (luite healthy. The sketch was made on the spot. Fig. 2z is from the eye of a young woman aged 25. Mr. Hlutchinson, wbvose patient she was, kindly allows me to use the case. 'rhe diagrami was taken from the erect image; but the eye was myopic to the extent of a seventh, and there was a wide crescentic staphylonia on the ycllov spot side of the disc; the choroid on this staphylomatous area was highly atrophied. A retinal vein of about the fourth size passes from the neighbourlhoud of the yellow spot inwards across the staphyloma, and, just before reaching the nerve, maklles a short sharp curve upwards ; it then disappears partly 11p)on1, J)artly external to, the boundary of the optic disc. It seems to dip directly iuto the atrophied choroid or into the sclerotic, and is slighitly enlarged at its point of disappearance. Fig. 3 shows the optic disc of a highly mnyopic boy aged 12 (from a drawing by Burgess in the inverted image). A moderately abrupt and rather narrow staphyloarntous crescent surrounds nearly three-fourtls of the circumference of the (lisc. A vein of about the third magnitude passes from the (apparent) lower-inner part of the fundus to the border of the disc; here, instead of pursuing a straight course, it curves sharply round, forming two-thirds of a small circle, passes outwards again over the crescent, and disappears at the junction between the atrophied and healthy choroidl. Just as the vessel is ab)out to (lip into the choroid, it is joined by a much smialler v'enous twig,, coming, like itself, from the yellow spot region. '[his case is very similar to the one described by Loring.Although tile majority of the vessels forming tIle circle of lIaller are situated deeply, and pass into the substance of the optic disc about at the level of the lamina cribrosa...

London : Dulau and Co. Accordingly we find a general belief in the medical profession that in diseases so relatively infrequent as retinitis pigmentosa and deaf-mutism consanguinity of the parents plays an important part. And the same is true of some other conditions where, as in the diseases just named, both sexes are liable to suffer from, and both liable to transmit, the disease. But in sex-limited conditions, such as Leber's disease and congenital colour-blindness, where only the males suffer, though the disease is carried down by (apparently) normal females, consanguinity of parents is known to be infrequent. If we start with a colour-blind male we know * Some particulars of this pedigree will be found at p. cvm.

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC's first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery.

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