main white.

Dr. Kedzie will examine the subject further, and report at a future meeting.

A communication was received from the local board of health in the township of Minden, Sanilac County, stating their action for preventing the spread of glanders by killing and burying a horse affected with that disease, and that an action for damages had been commenced by the owner of the horse against the individual members of the Board.

An interesting communication was read from Wm. F. Jenison, of Eagle, Clinton County, showing the advantage to farmers of securing good water and thorough drainage.

A communication was also received from A. Kehl, of Pulaski, Jackson County, asking a multitude of questions relative to drainage where low land lies in adjoining townships. Both of these communications were referred to Dr. Lyster.

Adjourned on Tuesday evening until April 9.

An Improved Ophthalmoscope.

BY D. E. DUDLEY, M. D.

NOTWITHSTANDING the ingenious designs-practical and commodious forms-which characterize many of the more modern opthalmoscopes, particularly those so nicely devised and arranged both by Dr. Loring and Dr. Knapp, of this city, I take pleasure in presenting to the profession a modified one, which, while it obviates some objections, will, I am persuaded, be found to embody all the advantages possessed by those so justly celebrated of the above-named authors.

While respecting the optical and general features of the Loring and Knapp instruments, the essential of what I may call my modification consists in arranging two equal discs containing the dioptric trains-positive and negative-in a form which, in my opinion, is more compact and convenient for manipulation.

This result I have obtained by collocating both discs upon an eccentric pivot, allowing thereby an overshot or projecting margin of each-the one to the right, the other to the left-from the lateral borders of the infe

rior third of the instrument. Upon this they are rotated and managed with all the ease and facility which distinguish those of the single disc.

Of the advantages accruing from this arrangement I need scarcely speak. The discerning ophthalmologist will at once perceive them. By it he can adopt the form and construction of any mirror his fancy or experience may lead him to prefer. The lenses of the dioptric media, while retaining that medium aperture compatible with efficiency, may, through their plus and minus combinations, amount to a series more than sufficient for every exigency, and the instrument still kept in due bounds with regard to size; in fact, considering the number of combinations, it is the smallest of ophthalmoscopes.

The focal index can, of course, be arranged either by the metrical or English enumeration, and made to read positives upon one side and negatives on the reverse, or both placed upon the back of the instrument, according to fancy.

This ophthalmoscope I have had made by Miller Brothers, opticians, who, in executing my design, have exhibited much skill and elaborateness of workmanship.

NEW YORK, November 20, 1877.

Removal of the Thyroid Gland.

WE learn from the Buffalo Medical and Surgical Journal that Dr. Julius F. Miner, of Buffalo, on the 25th of last October, removed the thyroid gland, in consequence of goitre, in the case of a German, aged forty-three. The swelling began when the patient was about nineteen. Previous to the removal, every sort of medicine had been employed by various physicians which was supposed to have beneficial effect upon glandular enlargements.

During the last three years the patient suffered inconvenience. For over a year past he would wake at night with a feeling of suffocation. It became so distressing that, as he expressed it, "he often wished to die at once and be done with it, rather than live to die every night."

The patient having been brought under the influence of ether, an incision three inches in length was made diagonally across the tumor, which was then seized with strong tenaculum forceps and raised from its bed. As soon as this was done the patient, who had before struggled for breath, began to breathe easier. The tumor was now enucleated, the vessels being tied as approached, some of them before division. After the first incision the knife was discarded, the dissection of the attachments being accomplished by the handle of a scalpel. There was considerable hemorrhage, which was controlled by ligature without the use of the cautery. The arterial supply was from the usual branches, but they were only to be known from their situation, and not from their size or importance. No artery was found of the size of the superior thyroid, as supplying the gland in health. The firmest attachment was at the base, being the entrance of the inferior arteries, which were ligated and divided. The wound was closed with superficial sutures and water dressings applied. He rallied immediately from the operation, had no trouble with it afterward, and he suffered so little that the necessity of keeping his head still could not be impressed upon him. In due course of time the ligatures came away and the wound healed; in two weeks he was at work, feeling better and able to do more than he had for three years. There was an entire absence of any bad symptoms.

The tumor removed consisted of a hard mass having the appearances of cartilage, in which were found small calcarious deposits, with two or three cysts in the center of the body. It was irregularly quadrilateral in form, the corners being rounded; the anterior surface was convex, while the posterior was slightly concave, having half an inch to the right of the center of a perpendicular groove, half an inch deep and three-quarters of an inch wide, marked tranversely by the rings of the trachea. Its weight was 3vj, 3iv, gr xv. It was nine (9) inches in circumference, three and three-quarters (34) inches in breadth, four (4) inches in length, and two and one half (24) inches in thickness.

The union

of the two lobes could not be made out, for the neck had so enlarged as to entirely fill up the interval between them. From its position, size, appearance and

the relation of other structures to it, there can be no doubt but that there was in this case an enlargement and solidification of the thyroid gland of slow growth. The pressure upon the trachea was so great that it flattened it, and misled one physician who made a laryngoscopical examination, and induced him to state that the impediment to respiration was due not to the pressure from the enlarged gland, but to a small tumor which was growing upon the interior of the trachea, but that he had no instruments by which it could be removed.

The points of greatest interest are the facility with which the gland was removed, and the comparatively slight hemorrhage which was so easily controlled. This was owing to the greatly lessened vascular supply, due, no doubt, to the nature of the degeneration; and the case is confirmatory of the statement made in the article previously quoted, "that a diseased gland may in some cases be more safely extirpated than a healthy one."

SIGNS BY WHICH PHTHISIS IS RECOGNIZED IN ITS EARLIEST STAGES WITHOUT THE AID OF PHYSICAL EXAMINATION OF THE CHEST.

(The Medical Record, September 1, 1877.)

1. Retraction of the skin over the cheeks.

2. Cerulean hue of the sclerotic, due to anæmia of the conjunctiva.

In bronchitis and emphysema there is conjunctival anemia, and also in the later stages of phthisis.

3. Atrophy of the lips, of the ears, and a thin pinched appearance of the nose. Wherever the skin closely covers cartilages, as in the ears and nose, a showing through, as it were, of the cartilaginous frame-work is one of the earliest signs of loss of flesh.

4. Pallor of the cheeks and face as compared with each other and with the malar surfaces.

5. Dilatation of the nostril upon the affected side. This is the case in all pulmonary affections, but especially in the earliest stages of phthisis.

6. The respiration is invariabiy accelerated, and the disturbance affects expiration as well as inspiration. In certain nervous disturbances the respiration is accelerated, but it is the inspiration only which is at fault.

7. Sinking of the clavicle more upon the affected side than upon the opposite, and giving the appearance of having a very long neck.

8. Great hyperæmia of the pillar of the fauces, present long before the pulmonary disease manifests itself, and continuing until pus is expectorated. When purulent expectoration is established, descomposed pus irritates the throat, and then the other parts usually become hyperæmic.

9. Intense congestion of the throat, early hoarseness, and vomiting are unfavorable symptoms, and indicate enlargement of the bronchial glands. This vomiting is caused by pressure upon the pneumogastric by the enlarged glands. A large proportion of phthisis cases will tell of having had sore throat for a number of years previous to the development of any chest symptoms.

MICROSCOPY.

Numeration of Blood Corpuscles.

DR. W. R. GOWERS, in the Lancet of December 1, says that the richness or poverty of the blood in corpuscles can only be ascertained by directly counting the number of corpuscles in a given volume of blood. It is only by this means that variations in their number-an important element in all conditions of anemia-can be with accuracy ascertained or stated, and it is thus that the relative numbers of the red and white corpuscles can be best determined. The method has been largely employed in France and Germany, but is almost unknown in clinical work in England.

The principle of the proceeding consists in making a definite dilution of a measured quantity of the blood, and counting the number of the corpuscles contained in a certain volume of that dilution. Several modifications of the process have been made. An inconvenience, however, has been that the instruments can be employed only with one microscope, and with an eyepiece made specially for the work.

In order to remedy the inconveniences, Dr. Gowers constructed an instrument which can be used with any