always, but especially in such cases, exercise the greatest care in washing the child, lest any irritating matter get under the eyelids. In Germany it is customary in the gynecological wards of the hospitals, to instil a weak solution of argentum nitricum into the eyes of every child born in the institution. This sets up a mild conjunctivitis, which gets well in a few days, and cases of purulent inflammation are rare under this treatment. Such heroic practice, however, seems unnecessary in all cases; but where there is a suspicion of infection, it would be well to instil a few drops of a fifty-per-cent solution of chlorine water

Every conjunctivitis in the new-born babe should be looked upon with suspicion, and carefully watched. Indeed, it would be well for the physician to examine the eyes of the little one himself, and not trust to the statements of mother or nurse in regard to them. Aconite or belladonna may be indicated in the incipiency, where there is redness and dryness of the conjunctiva, with little or no discharge. Generally, however, the physician's attention will not be called to the complaint until it is more fully developed. Euphrasia is very useful where there is much lachrymation and profuse muco-purulent discharge. Both the discharge and the tears are excoriating, where this remedy is indicated; the lids are red and swollen, and the cheek often has an appearance as if varnished. In less severe cases, where the discharge is abundant, whitish, and bland, pulsatilla is called for. Where the disease is fully developed, and where the discharge is decidedly purulent and profuse, and the lids much swollen and oedematous, argentum nitricum is by far the best remedy; and, in the experience of the writer, the 30x has given the most satisfactory results. The most careful attention must be given to the local treatment. All discharges must be carefully wiped from the edges of the lids with small pieces of old muslin; the lids should then be everted, and every vestige of secretion removed from their inner surfaces and the conjunctival folds by a camel's hair-brush dipped in warm water, or by a gentle stream from a palpebral syringe or medicine-dropper. Recently, instead of simple warm water, a new remedy, the peroxide of hydrogen, has been used with very satisfactory results as a cleansing and disinfecting agent. It is nothing but water with an extra atom of oxygen (H, O,), and it owes its valuable properties to the instability of its composition. In the presence of pus it parts with its oxygen, which penetrates every recess and fold of the swollen mucous membranes, unites with the pus, decomposing it with effervescence, and causing it to bubble forth as a thin froth. It is unirritating, and should be kept in a dark bottle in a cool place, and used freely in a solution of one part to two of water until the lids are entirely free from secretion. When thoroughly

cleansed, an instillation of a solution of argentum nitricum, one grain to the ounce, or of dilute chlorine water, is very useful in moderating the discharge, and reducing the swelling of the conjunctiva.

The physician will be derelict in his duty if he does not carefully instruct the nurse in regard to the manner of cleansing the eye, for no one is competent to do this properly without instruction. It may seem a simple matter; but any one who has tried to inspect the cornea of a struggling child, suffering from a bad case of purulent conjunctivitis, appreciates the difficulty of the proceeding. I have found the most satisfactory way to be as follows: The child is laid upon its back in the lap of an attendant, and its head is firmly held between the knees of the physician. The lids having then been carefully dried, the tip of one forefinger is placed upon the edge of the upper lid, and the tip of the forefinger of the other hand upon the edge of the lower lid, when by gentle steady traction in a direction corresponding as nearly as possible with the curvature of the cornea, they are readily separated.

Great care must be exercised not to press on the cornea which might readily be ruptured if ulcerated; or to scratch it with the nail. Just sufficient pressure should be used to prevent eversion of the lid, which might readily occur unless the fingers were placed upon the edge of the lids. If the cornea is not at once exposed, it will come into view in a few seconds, as the eye cannot long be turned upward when the lids are thus widely separated. At least once a day the physician should himself dress the eye, and inspect the cornea to detect the first symptoms of ulceration. If it occurs, either atropine or eserine should be employed, according as the ulceration is central or peripheral, to guard against anterior synechiæ in case of perforation. If iritis supervenes, atropine should be used to dilate the pupil, and prevent adhesions between the edge of the iris and the anterior surface of the lens. It should be borne in mind, that the discharges are eminently contagious; and where only one eye is affected, the other should be carefully protected, and the nurse and all other persons should be warned to use no towels or other articles used about the patient. The pieces of muslin used in cleansing the eye should be burned. Other remedies than those previously mentioned will be called for according to the symp toms, among which may be mentioned merc., hepar., calc., apis,

and rhus.

An interesting case of rhus poisoning occurred in my practice some two years ago. The child was about three years old, and played all day in a lane in front of the house, where the poisonivy grew luxuriantly. A severe case of purulent ophthalmia.

developed in each eye. The lids were very much swollen, red and infiltrated, especially the upper ones, and there was profuse lachrymation, photophobia, and pyorrhea. After the eye symptoms began to subside, but not previously, a characteristic rhus eruption developed on the skin.

In adults, purulent conjunctivitis is also, as a usual thing, caused by contagion from the same disease, or inoculation with the discharge from some suppurating surface, gr from gonorrhoeal secretion. I knew of one case in which sight was lost in consequence of inflammation caused by pus from an ulcerated tooth.

The following case well illustrates the serious and alarming nature of the malady, and the necessity of prompt, energetic treatment. At the same time it affords encouragement for perseverance and faithful attention in apparently hopeless cases, where suitable treatment has been neglected :

Lizzie L., aged about forty, Irish domestic, contracted the disease in one eye by inoculation from a syphilitic ulcer, and in the other by contagion from the former. I saw her on the sixth day of the disease, when the condition was as follows: The lids of the left eye (the one primarily affected) were very much swollen. and oedematous, and on attempting to open them there was a profuse discharge of thick yellow pus. The conjunctiva palpebræ was swollen and succulent. The cornea looked like washleather, and was nearly surrounded by a firm chemosis of the ocular conjunctiva. The right eye was similarly affected, but the chemosis was less extensive, and the cornea was clear, with the exception of a small spot of infiltration in the lower portion about the size of a pin's head.

Notwithstanding every effort, the left eye was lost. The swollen and infiltrated ocular conjunctiva was incised to relieve the pressure upon the periphery of the cornea. Sæmisch's operation was made to prevent sloughing, if possible, and dilute chlorine water, and later a solution of argentum nitricum, one grain to the ounce, was instilled. (This case was treated before the introduction of hydrogen peroxide into ophthalmic practice.) The eye was carefully cleansed at short intervals by skilled nurses, and iced compresses were constantly applied night and day for a week. At first the discharge was diminished, and the inflammation somewhat subdued under the above treatment, and the internal exhibition of argentum nitricum and rhus; but on Aug. 4, the cornea ruptured in the lower portion, the iris protruded, the lens pressed forward, and general ophthalmitis supervened with subsequent phthisis bulbi.

The disease ran a tedious and slightly less severe course in the right eye, but, owing to the earlier commencement of treatment, the result was more satisfactory. The chemosis was most

intense and persistent, surrounding the cornea like a mound, and encroaching considerably upon its periphery. Scarification and mild astringents were at first employed, but, not being successful, they were abandoned, and the outer canthus incised to relieve the pressure of the swollen and indurated lids. Almost all semblance to a human eye was lost. The point of infiltration at the lower portion of the cornea developed into a perforating ulcer. Eserine was instilled to withdraw the iris as much as possible from it; and, as often as it began to bulge through the opening, paracentesis was practised. In spite of the above treatment, however, the whole cornea became infiltrated, another small ulcer developed near the upper margin, iritis supervened with annular post. synechia, except at the site of the lower perforation, where the iris became adherent to the cornea. The diacharge continued profuse and acrid for more than a month. As it gradually lessened in amount, and became less acrid, pulsatilla was prescribed. The chemosis, however, still continued, and the lids remained oedematous, red, and swollen. Owing to the specific nature of the disease, iod. potass. Ix was prescribed, and under its use the improvement was steady, but slow for several weeks, and the ulcer on the leg healed. Ars., apis, and nat. mur. were subsequently prescribed; but it was not until the middle of October, that all traces of inflammation finally disappeared. At that time the ulcers had both healed without staphyloma; the cornea was nearly transparent, with the exception of a small triangle above and below, whose apices met in the centre. The pupil was very small, but unobstructed; anterior and posterior synechiæ as previously mentioned; tension, normal; sight, only perception of shadows as objects were moved before the eye.

On Oct. 23, an iridectomy was made at the lower and inner portion of the cornea, slightly to the nasal side of the anterior synechia. The incision healed without re-action, and vision rose to Under the use of aurum the remaining cloudiness of the cornea cleared somewhat more, and sight improved, so that the patient was able to support herself doing housework.

In such virulent cases as the one above narrated, and especially in gonorrhoeal ophthalmia, a solution of argentum nitricum, ten to twenty grains to the ounce, applied to the inner surfaces of the lids, will often promptly diminish the discharge, and reduce the swelling and inflammation; but when the swollen lids are hard, and when the chemosis is extensive and firm, such treatment is liable to aggravate rather than relieve. Such strong solutions should be immediately neutralized with salt water, and great care must be used that they do not come in contact with the cornea; for, if there is the least abrasion, it will leave an

indelible stain. Ice compresses should be kept on the eye for several hours after such an application, and it must not be repeated until all signs of re-action have subsided. In all but the most aggravated cases, the homœopathic physician will find it unnecessary to employ such heroic treatment.

A CASE OF FRACTURE OF THE inferIOR MAXILLA. BY F. A. GARDNER, M.D.

[Read before the Massachusetts Surgical and Gynecological Society.]

On the 17th of November, 1886, a man, aged about twentyeight, came to me complaining of acute pain in the lower jaw, increased on motion. He stated that about ten days previous he had received a blow while engaged in an altercation in one of the hotels in Salem. Being under the influence of alcohol at the time of the quarrel, he could give no very definite account of how he was injured. The day following the injury he noticed that his chin was bruised and that he had some pain in the region of the mental eminence on the left side, which continued to increase in severity. Thinking that it was a simple toothache, and not attributing it to the effects of the blow, he resorted to a dentist. This was nine days after the injury.

The dentist extracted the tooth which the patient indicated as being at the seat of the pain. Relief failed to follow as anticipated, and the dentist kindly offered to extract the next tooth, which service was declined. After examining the jaw again, the dentist advised the man to consult a surgeon.

The following morning he came to my office. I found, upon requesting him to close his mouth, that the molars and bicuspids on the left side of the lower jaw met those of the upper, but that the lower incisors and right bicuspids could not be brought in contact with the corresponding teeth of the upper jaw. Owing to the strong contractions of the masseter and buccinator muscles, the left body was tipped in such a manner that the outer border of the crowns of the lower teeth rested in the depressions in the centre of those of the upper jaw. By the contractions of the digastric and genio-hyoid muscles the anterior portion of the jaw was depressed, leaving a space between the upper and lower incisors of nearly a quarter of an inch, and he was unable to approximate any of the teeth on the right side.

Upon inserting my thumbs, a side of the body in either hand, I could detect marked crepitation and mobility, with a slight amount of bleeding from the socket of the extracted tooth. Examination revealed that the alveolar plates had been fractured