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A Keeley Cure.

THE siren of the flowing bowl,
With rose-red lips and magic fell,
Long years ago about the soul

Of young Augustus cast her spell.
She lured him on from bad to worse,
Till he was in a grievous plight,
And friends, to rid him of the curse,
Sent him a year ago to Dwight.
And there bi-chloride's golden lash
Was laid about him day and night-
Ah, well, he doesn't need the cash

He crowded in the slot at Dwight.
He'll ne'er regret he let it slide,

He'll never want his boodle backIn a fit of "snakes" last week he died, A raving dipsomaniac.

-Tommy Dod.—Medical Age.

MEDICAL PROVERBS, gleaned by the philosopher of the Medical Age.

GERMAN PROVERBS.

A physician is an angel when employed, but a devil when you must pay him.

Dear physic always does good.

A disobedient patient makes an unfeeling physician.

SPANISH PROVERBS.

What cures Sancho makes Martha sick.

The earth hides as it takes

The physician's mistakes.

He that sits with his back to a draught, sits with his face to a coffin.

Of the malady a man fears he dies.

He that would be healthy must wear his winter clothes in summer.

ENGLISH PROVERBS

Diseases are a tax upon our pleasures.

A good surgeon must have an eagle's eye, a lion s heart and a lady's hand.

Tender surgeons make foul wounds.

MISCELLANEous.

A physician is a man who pours drugs, of which he knows little, into a body of which he knows les French.

Do not doubt; you are no doctor.-Anen. Most physicians, as they grow greater in skill, grow less in religion,—Massinger.

Faith Cure.

This

Iv surgical ward L. of the San Francisco city hos pital is a female of uncertain age, who hails from Boston. Her broken leg was rapidly healing. female is a firm believer in the faith cure and ascribed the knitting of the fractured bone, not to the skill of the surgeons, but to her Christian faith. As she is a very voluble exponent, in four days' time she had converted several of the inmates of the ward to her belief in faith, One Sunday she told her converts to get up and, after kneeling in prayer, those who had crutches should threw them aside, those whose limbs were in splints shou'd tear them off, and then they should all march to the outer gate, order it thrown open and repair to their respective places of abode. This was at nine o'clock and while the nurse was getting a prescription filled. Cries of anguish from the direction of ward L. reached

(CONTINUED OVER NEXT LEAF)

and properly attending to them and keeping them always in a normal condition. A knowledge of the diseased conditions, the foundation of which is laid in the neglect of regularity and temperance in eating, drinking, sleeping, working, studying and exercising; in the neglect to give proper attention to the functions of the bowels, kidneys, skin, and even of the lungs, by the practice of regular deep breathing; in a disregard of any abnormality of the menstrual functions; or in a neglect of the proper care of the nose, mouth and teeth.

Thorough and special instruction should be given to young girls in regard to the long train of evils, chronic diseases and life long misery caused by undue exposure to cold, or wet, or by becoming chilled or having wet feet, during the menstrual period; that a "cold" taken during that time is not likely to affect the nose and throat, where it could easily be cured, but that it is more likely to affect the already physiologically congested ovaries, tubes and uterus, where a cure is not likely to be ever effected. It will not do to trust to the mother's feeble authority in this matter. Nothing but

a clear knowledge of the serious and often embarrassing consequences of indiscretion. will serve to caution most young girls to prudence.

A knowledge of contagious diseases, the means of their contagion and the necessity and difficulty of efficient isclation, quarantine and disinfection should be imparted to all. When this subject is properly understood by the people, a well-meaning but ignorant Auntie, going from a diphtheria or scarletina infected family to another family of healthy children would be regarded much as a venomous serpent would coming in their midst. Then a person would not feel justified in going right out f: om a contagious sick-room into the crowded cars or public gatherings to spread the disease broadcast. Then the people might finally become convinced of the importance of raising children to maturity without allowing them to run the gauntlet of whooping cough, measles, scarlet fever, chicken pox, small-pox, diphtheria, which annually slay many and leave the mark of chronic impairment upon many more. Then might we hope that contagious diseases would

be finally stamped out and disappear entirely from civilized society.

A thorough knowledge should be imparted of the physical evils of even slight indulgence in stimulants, tobacco and narcotics.

A fair and impartial statement should be given of the worthlessness of patent medicines, the dangers of some of them, and the base swindle of them all.

In the physical training department the pupils should be instructed and trained in the best methods of avoiding accidents of various kinds and how to treat injuries that arise from those that unavoidably occur. In this depart ment should be given instruction in regard to fire-arms and explosives; how to prevent fires and to escape from burning buildings; railroad, steamboat and driving accidents; alighting from and boarding vehicles in motion; to prevent and treat accidents from drowning, suffocation, &c.

This may be taken as a mere skeleton outline of a practical course of instruction in this most important branch of educational training. There are many who have had large experience and given much thought to the subject, who could easily take it up and complete it. The state should at least take as much interest in teaching its youth how to become and remain healthy as in giving them the training which will help them to become wealthy.

Let us, then, have in our public school system, thorough, systematic instruction and training in the all-important subject of the preservation of life and health.

Bichloride of Gold for Cobra Bite.

WE learn from the Indian Medical Record that Dr. Calmettes, of Saigan, Cochin China, has demonstrated that the subcutaneous injec tion of bichloride of gold, made before apoplectic symptoms have occurred, is a certain antidote to the venom of the cobra di capello. This suggests its utility in poisoning by other venomous reptiles and inse ts.

DOCTOR, if you are satisfied that THE MEDICAL WORLD can h lp you in your practice and enhance the interests of the profession we should like you to join our large family of readers and contributors. We will give you the advantage of a trial trip the remainder of 1892, including the June (Cholera Infantum) number, for only fifty cents.

Original Communications.

Short articles on the treatment of diseases, and experience with new remedies, are solicited from the profession for this department; also difficult cases for diagnosis and

treatment.

Articles accepted must be contributed to this journal only. The editors are not responsible for views expressed by contributors.

Copy must be received on or before the twelfth of the month for publication in the next month. Unused Manuscript cannot be returned.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than anything else.-RUSKIN.

Cataract.-Question and Reply.

EDITOR MEDICAL WORLD:-Dr. Brown, of Milwaukee, Wis., gives us a very interesting dissertation on the differential diagnosis between glaucoma and cataract. ] would be pleased to have an article from him on catar act. I recently examined two very interesting cases in the same family. One aged fourteen years, the other seven years. Both had cataract from birth, and both cases were pronounced incurable by prominent oculists. The lenses. are pearly white, but vision is not entirely destroyed in either case—that is, they can discover a lighted lamp in the room. Now, if they are not curable I would like to know why. The optic nerve seems to be perfectly healthy, or why should they discern light? Why wait for a cataract to ripen? and what is the philosophy of a cataract ripening?

Dr. Brown's article appears in March WORLD, page 92.

Linwood, Kan. J. D. WARFORD, M. D.

EDITOR MEDICAL WORLD:-Complying with the request of Dr. Warford, Linwood, Kansas, for an article on cataract, I will confine myself to the points mentioned by him, the general subject being too broad for one sitting.

1. Why should an oculist refuse an opera tion on a congenital cataract as useless, when there is a perception of light on the part of the patient?

He may do so for one or more of the following reasons:

(a) In his judgment, the perception of light may not be sufficient to warrant an operation. To discern light is not always enough to justify operative measures. The whole field must be taken into consideration. A patient should not only see light immediately in front of the eye, but also when the illumination comes from positions to the right, left, above, below,

-he should quickly and at some distance (20-40 feet) be able to locate the direction whence the brightness comes.

Again, comparing the density of the cataract with the power of light perception, the difference between the two may be so striking as to indicate serious internal difficulty to the thoughtful surgeon. Still again, the pupil may be very inactive, and not readily respond to the stimulus of light, thus demonstrating a weak perceptive power. All these conditions -marked limitations of the field, feeble projecting ability, a great disproportion between the opacity of the lens and the perception of light, a sluggish or inactive pupil-all these point to some serious internal lesion, disease of the retina and optic nerve, atrophy of the choroid, turbid vitreous, etc. Under these circumstances, the prognosis may be so doubtful as to warrant the experienced oculist in refusing an operation.

(b) The tension of the eye-ball (its softness to touch) may be so far below normal as to justify the diagnosis of detached retina, a condition precluding a successful operation.

(c) A surgeon may not be willing to risk his reputation by operating on a case which, in his opinion, is likely to result disastrously to his patient and himself. We have often heard that liberal minded oculist, Dr. Carrow, of the University of Mich., say to his students, "A surgeon has no right to refuse an operation when everything is to be gained and nothing lost." If the condition of things is carefully explained beforehand, and well understood by patient and friends, an operation under these circumstances would redound rather to the credit than the disadvantage of the conscientous surgeon.

2. What is the philosophy (pathology) of a ripening cataract?

The crystalline lens is made up of long fibers, or rather very elongated cells arranged in a peculiar manner. The central fibers are known as the "nucleus "--the external cells, as the "cortex." I speak now of senile cataract, to which reference is apparently made. As age advances the lens gradually hardens. This is a normal condition. This hardening begins in the nucleus. Between the nucleus of a normal senile len; and a senile cataractous lens, there is little difference in transparency. Sometimes, however, the nucleus of a senile lens hardens in an irregular manner, that is, differently from the usual and natural way. This irregularity in hardening is supposed to make such an alteration in the external fibers of cortex as to cause them to become swollen, granular, disintegrated and divided by fissures, the result of which is a loss of

transparency, and, in time, a dense opacity-a cataract. Between the cells are found particles of coagulated matter, which also help to destroy the clearness of the lens.

3. Why should we wait for a cataract to ripen?

In mature cataract, the lens is sclerosed, and consequently somewhat shrunken. This shrinking causes the lens to be more or less loose in its capsule, and detaches from it every part of the cortex. Being now smaller than normal, and completely separated from its enveloping capsule, it is easily removed, leaving no lens substance behind to awake inflammation and destroy the effect of the operation. On the other hand, if the cataract be removed before it is ripe, some particles of the cortex which adheres to the capsule remain behind, and, being transparent, are not observed at the time of the operation. Sooner or later these fibers become opaque; appear in the pupillary space, ruiming vision, causing unpleasant inflammatory reaction, and oftentimes destroying the eye itself.

Dr. E. E. Hagler, University of Michigan, recently reported to me such a case. A patient had been operated upon for cataract by an eye. surgeon. Shortly after the operation the pupil was found filled with opaque matter. A second operation was performed at the University clinic, and the mass removed proved to be a collection of lens fibers, which had escaped removal at the hands of the first operator. Fair vision, however, resulted. On the other hand, Dr. Flemming Carrow informs me in a private communication, that during the past winter he has removed in his clinic several cataracts, where he could perceive a distinct red reflex through the lens, and that the results were good, and the operations not difficult. It may be that the experience of such bold though careful and conscientious operators, may in time modify the classic opinion as to the necessity of perfect ripeness before operating on a case of cataract. The revived practice of syringing out the capsule and anterior chamber with a mild antiseptic solution after operation, and the desirable results claimed from it, may also aid in bringing about some modification of the present practice, a change very agreeable to those patients, who, after blindness occurs, are obliged to wait a long and tedious time for their cataracts to mature.

Finally, the following simple tests for determining the ripeness of a cataractous lens may be found useful by the general practitioner :

1. The edge of the iris rests upon the crystalline lense throughout its entire margin. There is nothing between the two, ex ept the very thin lens capsule. Bearing this in mind, throw an oblique focal light of medium strength

upon the eye, in a dark room. If the external or cortical part of the lens be opaque or ripe, no shadow will be thrown by the edge of the iris, because it rests upon an opaque surface, the hardened lens. If the outer part of the lens be still transparent, the edge of the iris will throw a shadow upon the hard centre of the lens, which shadow will correspond in width with the thickness of the cortical lens substance, which still remains transparent. With a little patience, this test will be satisfactory.

2. Dilate the pupil, and expose the whole lens. Examine carefully. If the striæ or lines of hardening upon the surface of the lens are fine and opaque looking, the cataract is mature. If the lines are broad and glittering, of various shades, some like mother of pearl, the lens is likely not mature. In a few weeks the difference in hue and appearance between the stria will be seen to be less, and finally to disappear. The cataract is now ripe.

3. Dilate the pupil. With an ophthalmos copic mirror, throw a good reflected light upon the lens. A mature cataract should not permit the slightest red reflex from the fundus.

4. A test for favorable prognosis: In a dark room throw a faint light, reflected from a hand mirror, upon the eye at a distance of from two to four feet. In a promising case, the patient should distinctly recognize the illumination and also the directions whence it comes. slowness of perception in these particulars is suspicious, and points to a more or less unfavorable result. I trust that these tests may be useful to some one.

Any

Often do I see patients who have come from a great distance to have a cataract removed long before it is ready for an operation. Such could be saved much expense and trouble, did their family physician, use a little more care in making his diagnosis. All of the above "reasons" and "tests" can easily be under stood by any intelligent practitioner, and if they shall be helpful to any such of my brethren, the trouble of writing them out will be amply compensated for.

BELNO ADDISON BROWN, M. D. 201 Grand Avenue, Milwaukee, Wis.

Monstrosities and Maternal Impressions. EDITOR MEDICAL WORLD:-On the 22nd day of April, '92, I was summoned to attend Mrs. W., in this city, who was then in severe labor. When I reached her bedside I found, upon examination, slight dilatation and the head presenting, though the tense waterbag prevented accuracy of diagnosis. Wishing to allow every advantage of dilatation, I did not interfere for some time with the amniotic membranes.