slowly interrupted galvanic currents are of no service in determining muscular contractions. Heretofore, most physicians have held that electrical treatment, when advanced Wallerian degeneration, shown by the reaction of degeneration, has occurred, would be useless; but I believe that so long as the static electricity will produce any muscular contraction whatever, so long is the case hopeful, to say the least, and it is reasonable to look for very considerable restoration under its use; especially when combined with electrization with the continuous galvanic current, as detailed in the case just reported and presented to you. The claim that because certain multipolar or ganglionic cells in the anterior horns of the gray matter of the spinal cord are destroyed in the disease known as polio-myelitis anterior acuta, or acute spinal paralysis, the muscular fibers with which they were connected must of necessity degenerate and become utterly useless, is, I believe, false. I conceive that we have been provided by nature with infinitely more air-cells than we have use for in the normal state of the respiratory organs, that as the depurative function of the kidneys may be performed by but one, that as nature has supplied us with duplicate organs in many instances, that as we have a circulatory system which is so complete that even though the main vessel of supply to a part be rendered perfectly useless, still the nutrition of the part may be maintained as a rule, so are we, by analogy, justified in believing that though certain cells may be destroyed in the anterior horns of the gray matter of the cord in acute spinal paralysis, there are other cells which are connected with the fibers that are paralyzed (and, it may be, undergoing degeneration because of polio-myelitis) that have the potential of the cells undergoing degeneration and about to die so far as their function is concerned, and that by the passage of the continuous descending current at short intervals frequently repeated, after all evidence of acute inflammation in the cord has ceased to be present, and the frequent repetition of muscular contractions by whatever will produce them, whether it be Faradic current, interrupted galvanic current, static electricity or what notthat we may develop the potential of some cells in the cord and cause them to so develop as to perform the functions of the cells destroyed by the polio-myelitis. As certain influences exerted on the sensory centers produce impressions on the motor centers which eventuate in the movement of a muscle-nolens volens-so may muscular movements, induced electrically or otherwise, gradually impress the motor center with which it is connected, and by so impressing, agitating, irritating if you will this motor center, develop a sympathy, a responsiveness, a coincidence of development of function which will ultimately end in the establishment of a new, full-powered, motor, multipolar, ganglionic cell-of a new path for the conduction of motor impulses, and a coincident renewal of the trophic influences by the development of a previously, so to speak, superfluous and non-functioning ganglionic cell. It is claimed that boldoin, the glucoside of boldo leaves far exceeds in its hypnotic and narcotic effects opium, chloral and other similar agents. THE ELECTRO-CAUTERY IN THE TREATMENT OF GRANU LATED LIDS. BY FLAVEL B. TIFFANY, M. D., KANSAS CITY, MO. [ Professor of Ophthalmology, Otology and Histology in the University of Kansas City.] There is scarcely a practitioner throughout the land who is not more or less frequently called upon to treat "granulated sore eyes;" so common is trachoma in the United States-and yet how few succeed in effecting a permanent cure in these cases! That more frequent cures are not effected is perhaps due a largely to the patient as to faulty or inefficient treatment. The disease is so chronic and so obstinate that the patient becomes discouraged and discontinues the treatment ere a cure is half effected. The disease of granulated lids is perhaps the most common affection of the eyes that the general practitioner is called upon to treat. For this reason mainly am I prompted to write a few lines upon the subject, calling attention to the thermo-cautery as a therapeutical agent in this most persistent disease. During the past year it was my good fortune to visit nearly all the principal eye-clinics of Europe, in several of which I saw the thermo-cautery used in corneal affections with excellent results. It occurred to me that it might also become a powerful instrument in the cure of trachoma. On my return I immediately tested its virtues in this vexing disease with the results hereinafter spoken of. There are two forms of granulation of the lids, acute and chronic. In the acute, there is a turgescence of the conjunctiva, and hyperemia of the papilla; while in the chronic form, in which the thermo-cautery is more indicated, there is, besides these, a neoplastic growth and hyperemia of the lymphatics. In the normal conjunctiva the lymphatics are imbedded in the reticular portion, and are not visible to the naked eye. The new growths are vesicular, ranging in size from a pin's point to a tapioca grain. They are semi-transparent and are mostly found in the cul-de-sac, or retro-tarsal fold. Occasionally they are distributed over the entire palpebral surface, extending even upon the ocular conjunctiva, more especially upon the carunculæ. They frequently by degeneration cause a fibroid metamorphosis of the retro-tarsal fold, often producing the obliteration of the cul-de-sac, thus bringing the palpebral conjunctiva directly in contact with that of the globe. This frequently results in entropion, and even ptosis. From the constant friction of the granular lids upon the delicate cornea, the latter loses its brilliancy, and frequently pannus follows in the disastrous train. However, I do not now propose to write upon the etiology, pathology or complications of trachoma, but merely wish to call attention to the newer mode of treatment-the thermo-cautery. My friend, Professor Hansen Grüt, of Copenhagen, was the first to write of the good results of the use of the thermo-cautery in corneal affections, but while with him I do not remember seeing it applied to trachoma, nor did I hear him speak of it as an agent in the cure of this disease; although he was ever enthusiastic over it as an agent in affections of the cornea. In the first place, WHAT ARE the advantages of the thermo-cautery over the more common treatment for granulations, such as nitrate of silver, sulphate of copper, chloride and sulphate of zinc, etc.? These latter have their curative effect as stimulants, thereby causing sloughing of the granules. This is a very slow and tedious process, somewhat dangerous to the formation of corneal complications, besides being quite painful. The nitrate of silver, if used too strong, may destroy the connective healthy tissue of the conjunctiva, as well as discolor it, giving it a very unsightly appearance. My friend Dr. Galezowski, of Paris, is in the habit of dissecting the entire conjunctiva of the palpebral fold, together with the granules, but this does not get rid of the disease without further treatment of perhaps several months; and in less skillful hands might cause entropion, lag-ophthalmitis, etc. The electro-cautery is confined exclusively to the individual granules, which it destroys at once without affecting neighboring tissues. It not only destroys the granules by cremation, but through contraction the granule is not re-formed. The cautery then destroys both the granule and the power to re-formthat is, it destroys the granule and the germ, or the specific trachoma bacillus that Prof. Sattler claims to be the cause of the disease. Herein would appear to be the secret of its effectiveness over the method of removing the palpebral conjunctiva, and in the latter case the germ or bacillus is still left to work if any laxity of vigilance gives it the opportunity. MODE OF EMPLOYING THE CAUTERY. An eight per cent. solution of cocaine should be sprayed over the everted lids three or four times during a period of fifteen minutes; when the conjunctiva becomes thoroughly anæsthetized the cautery should be applied to each individual granule, cremating it level with the conjunctival surface. In this way I have seen the most severe form of granulations disappear like the melting of hailstones before the sun, causing the roughest lids, with heavy crops of granules, to become smooth in a few days. For the dense growth of granules I use a thin, flat blade, one centimeter in length by three millimeters in width, bent at an angle of about forty-five (45°) degrees. The flat surface is thoroughly applied to the granules, burning them level with the surface of the conjunctiva, Where the granules are more sparsely scattered I employ a pointed electrode, applying it to each individual granule. If all the granules are not absolutely destroyed, the cauterization may be repeated within ten or fifteen days. The Paquelin cautery with small points. may be used instead of the electro-cautery, with equal efficacy. The after treatment consists of a light compress and bandage, wrung out of a solution of bichloride of mercury, 1 to 2000; the compress should be changed twice a day and continued for several days, after which mild astringents may be sprayed upon the everted lids two or three times per week. With this treatment I believe that trachoma may be cured in a much shorter time than by any other known mode, and with far less pain and discomfort to the patient. 1044 Main Street, August 10, 1888. AN INSTRUCTIVE STUDY FOR THE ALEXANDRIA QUARANTINE BOARD, AND A CAUSE OF CONGRATULATION ON THE PART OF THE EGYPTIAN SAN ITARY DEPARTMENT. BY DR. J. A. S. GRANT-BEY, CAIRO, EGYPT. [ Written for the Arabic Medical Journal, Al-Shifa.]* As a comfortable delusion seems to be spreading with regard to the sanitary condition of India, and of Calcutta in particular, it may be well to direct attention to the actual state of affairs. It is impossible to speak of the filthy condition of the broad fringe of hamlets by which Calcutta is surrounded without using forms of expression that must seem exaggerated when judged by an ordinary standard. But the fact is, there is no possibility of exaggerating either the horrors of the hamlet-world or the manifold dangers by which, owing to the lethargy of the local government, the city of Calcutta is surrounded. "Far from being improved they are growing rapidly worse, and the only effect of the trivial action into which the municipality has been goaded is to create a false feeling of security in certain quarters. That there will be a terrible awakening one of these days is the conviction of every one who has the slightest acquaintance with the subject and who brings to it an unprejudiced mind. For some years past Calcutta has been fortunate in escaping one of those visitations which strike terror into the mind and reässert the devastating power of epidemic disease. But a peep at the hamlets will amply prove the folly of believing that the present immunity is likely to be more than short-lived, for nothing has been done in the way of prevention worth one moment's consideration." It has just come to our knowledge that during the first week in December, 1887, a gentleman of Calcutta visited one of the hamlets in the suburbs of the city, and his description of its unsanitary condition was considered worthy of a place in the March number of the "Journal of the Health Society for Calcutta and its Suburbs." We have thought that by publishing a resumé of what was reported our eyes might be sufficiently opened to the risk we run by being next door neighbors, and that we might be on our guard against the importation of transmissible diseases. He reports: "I went to the hamlet called Kurryah, and it is conveying a very feeble idea of what I saw to say that the condition of the place is simply frightful. Here we have a group of closely built huts crowded with people. The land on the south side, not twenty yards distant, is used for curing skins. It is needless to sickening, and that the air is thoroughly saturated with it. cluding a number of foul places, drains into what seems to be a blind ditch, which is accurately described as a bubbling scum-covered, seething mass of say that the stench is The whole area, in This journal, Al-Shifa, having published something regarding the sanitary condition of Egypt and the want of action on the part of the proper goverament authorities, was very promptly suppressed by the government.-ED. INDEX. utter corruption. A few huts separate the ditch from two tanks, one of which is covered with a green scum and is used for bathing, washing clothes, utensils, etc. This tank is separated from a second one to the east of it by a 'bund' or earth dyke about five feet thick-not thick enough, however, to prevent percolation. The water in these two adjoining tanks is at the same level, and percolation evidently takes place freely. The water in the second tank is free from vegetable scum, but it is not clear water and it abounds with low forms of life. On my visit to this delightful (!) spot I had a companion with me, and the object of our search was to find out the sanitary conditions in the midst of which a recent and fatal case of cholera had had its origin. The whole of the people of the neighborhood use the second of these tanks for a drinking water supply. Further we ascertained that from thirty to forty cases of cholera occur in the vicinity every year. We had the tank water microscopically examined, and it was found to be teeming with life. Perhaps its worst feature was that the forms of low organization which are to be found in fairly pure water were conspicuously absent. Under these circumstances the mystery is not that there is illness about the place, but that any one can live there in ordinary health even for a few weeks. Now I wish to lay stress upon the fact that there is not a word of this statement introduced for sensational effect-the picture is very far from being over-colored. The hamlet here described is a real, everyday aggregation of huts, neither better nor worse than hundreds of others; it is a thoroughly typical hamlet in all its wretched features-an ever-active center for the propagation of the most dangerous forms of disease that threaten the health of a vast European and native community. "When, I would ask, will the municipality realize that its paramount du ty is the removal of such plague-spots? When will it begin to grapple in earnest with the evil that exists at our doors and threatens the public health at every moment? The fact I am most anxious to emphasize is, that in spite of all that has been said, and even of the stern remonstrances of the supreme gov. ernment, the municipality has practically done nothing even to investigate the unsanitary condition of the city, and to remove the reproach that is attracting to Calcutta the attention of the leading European authorities in sanitary matters." We say the above is an instructive lesson for the Quarantine Board at Alexandria, because the narrator is an eye-witness and his report is not simply a telegraphic dispatch. We shall give in our next article an account of a cholerastricken village in the suburbs of Calcutta in December last, and of how the authorities cloak the truth so that it is not known in its naked form to the outside world. The Egyptian Sanitary Department may well congratulate itself that there is at least one country in a worse sanitary condition than Egypt; but this is no reason why it should "rest and be thankful." There is yet much to be done to improve the Demographic Statistics of Egypt. In Cairo just now we are having a mortality of 80 per 1000, and it is on the increase; who knows what it may be in villages where stinking, pestilential ponds serve for the water supply to man and beast at low Nile? We feel sure that the mortality of the inhabitants during the summer months would diminish by one-half at least if the people were furnished with potable water; and we cannot conceive of |