He shows, from two cases, that this condition may be relieved by the adaptation of means for restoring the want of proper balance in these muscles.

Another paper presenting food for thought is by Dr. Theobald, on the Pathogenesis of Pterygium. No theory has ever been offered that sufficiently explains the mode of origin of this disease. We know that it consists of a thickening of the conjunctiva, and the formation of blood-vessels which gradually encroach upon the cornea, ultimately reaching its center, where it stops. Its seat, in nearly every case, is over the insertion of the internal rectus muscle, rarely does it grow from the outer side, or from above or below. In all cases there is a constant relationship between the location of the pterygium and one of the recti muscles. The theory of Arlt that pterygium has its origin in a small marginal ulceration of the cornea, to which the conjunctiva becomes adherent, and then gradually extends by ulceration and adhesion, has been almost unanimously accepted. This, however, does not explain the almost constant location of pterygium over the internal rectus. Theobald well claims, in view of the intimate connection between the vascular system of the recti muscles and that of the conjunctiva, near the corneal border, that these muscles by influencing the blood-supply of the overlying conjunctiva do, in fact, play a most important role in determining the formation of pterygium. If this be true, it is easy to see why, since the internal rectus lies in closer relationship with the conjunctiva than any of the other straight muscles, and is, moreover, the largest and most active of these, pterygium finds location so frequently over the point of insertion of this muscle.

The Transactions contain many other interesting papers, notably one on the Examination of the Eyes of the Adult Imbecile, by Dr. Oliver, and on the Increase of Blindness in the United States, by Dr. Howe. Sufficient has however been given to show the amount and value of the work done by this Society of practical and progressive ophthalmic surgeons.

J. M. RAY.

The Surgical Diseases of the GenitoUrinary Organs, including Syphilis. By E. L. Keyes, A. M., M. D. A revised edition of Van Buren and Keyes' Text-book upon the same subjects. 8vo, pp. xv and 704; cloth; price, $5. New York: D. Appleton & Co. 1888.

Ophthalmic Surgery. By Robert Brudenell Carter, F. R. C. S., Ophthalmic Surgeon to St. George's Hospital, and William Adams Frost, F. R. C. S., Assistant Ophthalmic Surgeon to St. George's Hospital. A chromo lithographic plate and ninety-one. engravings. 12mo, pp. 554; cloth, $2.25. Philadelphia: Lea Brothers & Co. 1888.

Newspapers in 1888. From the edition. of Geo. P. Rowell & Co.'s "American Newspaper Directory," published April 2d (its twentieth year), it appears that the newspapers and periodicals of all kinds issued in the United States and Canada, now number 16,310, showing a gain of 890 during the last twelve months, and of 7,136 in ten years.

The publishers of the Directory assert that the impression that when the proprietor of a newspaper undertakes to state what has been his exact circulation he does not generally tell the truth is an erroneous one: and they conspicuously offer a reward of $100 for every instance in their book for this year where it can be shown that the detailed report received from a publisher

was untrue.

men.

Correspondence.

NEW YORK LETTER.

The Long Island College Hospital, of Brooklyn, held its twenty-ninth annual commencement exercises on Friday evening, March 9th, at the Academy of Music. Diplo. mas were awarded to thirty-eight gentleThe Hippocratic oath was adminis tered by Prof. Skene, Dean of the Faculty; and while this added eclat and variety to the exercises, the writer fails to see any advantages to be gained by it. The man, for instance, who would perform any of the dishonorable actions mentioned in the "oath" would not hesitate to take it without the least intention of keeping its promises. The address-pregnant with good thoughts and advice of the evening was de

livered by the Rev. Dr. Talmage. How he did laud doctors in general and the graduating class in particular! As a word-painter Talmage stands without a peer. To hear him, whether from the pulpit or rostrum, makes one love the English language. I quote from memory a few excerpts from his beautiful address: "Open your eyes wide and start for heights of success that have never yet been scaled. Young man, you can do it. I have looked you in the eye and noticed your cerebral development, and I am sure you can do it." "My theory is, for every wound there is a leaf, and for every poison an antidote, and for every disease a specific, and I charge you that you experiment, explore, invent, and discover until you have. cured some of the ailments that have hitherto been considered incurable." "Charge apon cancer, and consumption, and leprosy, and hydrophobia." "There is need that some of you with some new compound go forth in the strength of Him who cleansed the ten lepers, and turn the fatal spots upon the cheek, first into the white lily of convalescence, and then into the red rose of full health." "It is time the foaming disorder, hydrophobia, be made to quit the earth, and it be demonstrated that the genius of man is superior to the bite of a dog or the scratch of a cat." "You, doctor, are our first and last earthly friend; you stand at the gates of life when we enter this world, and you stand at the gates of death when we go out of it." "No other calling in the world, one excepted, has received so great honor as yours." "The physicians of this country do more missionary work without charge than all the other professions put together." "It has been estimated that vaccination in fifty years has saved more lives than all the battles of a century have destroyed." man who wrote the book entitled 'Every Man his own Doctor' ought to write another book entitled 'Every Man his own Undertaker."

"The

The forty-seventh commencement of the University of New York took place last Tuesday evening, in the large and beautiful auditorium of the Metropolitan Opera House.

The graduates numbered one hundred and sixty-three, and were from all parts of the world. As name after name was read by the secretary of the faculty, groups of friends in the galleries testified their interest and approval by volleys of hand-claps. One graduate from Alabama, with a bright and shining pate, aged at least sixty, brought down the whole house when he stepped upon the stage to receive his diploma. The Seventh Regiment Band furnished the music. Cappa wields the baton as gracefully as

ever.

Bellevue graduated over one hundred, but had no commencement exercises, a custom that has been practiced for several years. The College of Physicians and Surgeons has a seven months' course, and about the first of May will graduate near one hundred and thirty students. This College is rapidly gaining in popularity; its buildings and apparatus are all new, it is lighted by electricity and is splendidly equipped throughout. Its dissecting-room is a model, and is said to be the finest in the world.

The attendance at the different colleges in this city has, during the past year, been unusually large. The matriculates at Bellevue numbered nearly five hundred; at the University nearly six hundred, and at the College of Physicians and Surgeons over eight hundred. The last institution mentioned will, in the future, require a rigid preliminary examination of all applicants for admission, and this, no doubt, will have the effect of cutting down the attendance considerably. It is a step in the right direction, however.

Dr. William A. Hammond but recently married his second wife, who is young, beautiful and rich, and a dear friend of his daughter. He will, next October, move to Washington, D. C. Nearly twenty-five years ago he was dismissed from the United States Army and came to this city. In 1878 the decision of the court-martial was set aside, and he now returns to the capital, as he predicted, rich, respected, and with his full rank as Surgeon-General. In addition to an elegant mansion, not far from the residence

of Mrs. General Logan, the doctor is building a private hospital at a cost of $100,000, for the accommodation of patients suffering from nervous diseases. The hospital will accommodate thirty patients. His son, Dr. G. A. Hammond, a talented and ambitious young man, will be his father's successor in New York.

CHARLES W. MURPHY, M.D.

No. 25 MADISON AVE., March 12, 1888.

Abstracts and Selections.

A NEW COMBINATION OF COCAINE.-Under date of January 7, 1888, Dr. Andrew H. Smith writes: "Observing the strong acid property of saccharine, it occurred to me that it could be made to take the place of an acid in combination with the alkaloid cocaine, and thus avoid the extremely bitter and disagreeable taste of the muriate, the salt usually employed. With the aid of Mr. B. Frank, Hays, the well-known pharmacist of this city, a salt was obtained which is freely soluble in water, and has an agreeable, sweet, fruity taste, a valuable property when the drug is to be employed in the throat, especially in the case of children. The molecular number of saccharine (a better name would be saccharinic acid) is 183, that of cocaine 303; combined in these proportions a neutral salt is formed having about eighty per cent of the alkaloidal strength of the muriate, a five-per-cent solution of the first being equal to a four-per-cent solution of the second. Experiments are being made with combinations with other alkaloids."

If the child is at school, she should at once be removed; and even the milder kinds of intellectual work should be strictly prohibited. But these measures, though good enough in themselves, are rarely sufficient to overcome the evil already accomplished. To arrive at satisfactory results, we must afford complete rest to the exhausted and irritated ganglia. In other words, we must induce sleep, and by prolonging the state of unconsciousness to suit the morbid exigencies, enable those reparative processes to transpire in the ganglia which are essential to the complete functional restoration of the cell. The great factor in the successful treatment of this class of cases, then, is restperfect, undisturbed tranquillity of the thinking apparatus-not the limited amount of rest suited to the healthy brain, but a quantity greater in proportion to the degree of morbid deterioration. By prolonged sleep it is possible for the ganglia to hoard up an amount of energy

proportionate to the duration and profundity of the sleep itself, or, in other words, in the ratio of the reduction of the daily output of brain energy. Thus by slow degrees the proper correlation between integration and disintegration may be re-established. It is useless, however, to hope for any permanent results at once, for, when the perverted nutritive conditions have once become established, nothing short of prolonged rest can by any possibility result in the re-establishment of the normal nutritive processes of the cell economy.

Where the function of sleep is affected, as it is in many cases, it is impossible to increase at once the amount of rest to a sufficient extent to meet the demands of the morbid cerebral condition. Nevertheless, by gradually increasing the duration of the sleeping period, it eventually becomes possible to afford the patient an amount of rest sufficient to neutralize by slow degrees the condition of irritation and exhaustion. The bromides should be given during the day in cumulative doses, in order to allay the condition of irritability, and to cause a progressive decline in the mental manifestations as the hour for complete repose approaches. There should be no hesitation in employing sedatives, but always with the understanding that their use is only a measure of temporary expediency.

The most difficult class of cases to manage is that in which there is present some stomachic weakness precluding the possibility of any considerable medication, and necessitating a more or less protracted discontinuance of treatment from time to time.

Where such digestive difficulties exist, no attempts at profuse medication should be made, at least not until the tolerance of the stomach has been largely increased by appropriate means. With the present resources at our command, this problem is much easier of solution than it would have been even ten years ago.

The method by which the above principles of treatment may be carried out are: (1) Cerebral rest; (2) increased general and cerebral nutrition; (3) elimination of psychical irritation, and removal of peripheral irritation, particularly that engendered by light and sound.

The subject is secluded in a darkened room from ten to fifteen hours at a time, according to the amount of sleep which it is desired shall be had during the twenty four hours. The amount of sleep is progressively increased by habit, moderate medication, and hydro-therapy, and no attempt is made to produce a sudden state of stupor by the reckless use of sedatives. When the patient awakes, as is usually the case, two or even three times during the hours set apart for rest, nourishment is administered, but always in a fluid and easily-digested form. Where

difficulty is experienced in again falling asleep, resort is had in the beginning to limited medication. The few hours of wakefulness are devoted exclusively to some form of amusement, reading, writing, and even the mildest forms of mental concentration being absolutely prohibit ed. It is hardly necessary to say that the problem of cerebral rest is essentially different from and presents many more difficulties than spinal rest, as described in the earlier edition of Weir Mitchell's book. To give repose to the motor cells of the cord is comparatively an easy problem, and one which only exacts a permanent fixation of the motor apparatus for its solution, the consciousness or unconsciousness of the individual being only a matter of secondary importance. Rest, however, for those cells the function of which is the evolution of mind, can only be obtained by a prolonged period of absolute unconsciousness; and this, as a matter of course, will often tax the patience and resources of the physician to the utmost. Perseverance and the utilization of the principle of habit will usually, however, render essential assistance.

In conjunction with this system of rest, the Turkish and vapor baths may frequently be employed with advantage.

Having at length by these measures reduced the condition of cerebral erethism, alteratives may be given. At one time the sulphate of zinc was given very largely in chorea; but of late years the preparations of arsenic, which seem to exert almost a specific influence, have driven it more and more into the background.

In giving arsenic it is usually well to carry its administration up to the usual point of toleration. At the present moment Dr. Corning stated that he had a boy of fifteen under treatment, who is taking eight drops of Fowler's solution three times a day, without apparent detriment. The case is one of three years' standing, and the patient, a precocious, neurotic, and undersized boy, has been in the hands of various physicians.

He at once put him upon a course of thorough rest, prescribed forty grains of the bromide of sodium a day, removed him from school, and prohibited animal food, substituting for the latter a farinaceous diet with milk. This farinaceous diet was, however, only continued for a short time, till the cerebral erethism had disappeared.

Six weeks have now elapsed since he first began treatment. The irregular movements, which were located in the left side of the face, extending to the shoulder and hand of the same side, have now ceased altogether, and only when excited or startled do they reappear. This case will, in all probability, make a complete recovery; but Dr. Corning will not allow him

to return to school, or to indulge in violent exercise of any kind, for fear of a relapse. At present his appetite is good, and he is taking large quantities of nitrogenous food.

In this, as in many other cases, he employed simultaneously galvanization and refrigeration of the head in the beginning of treatment.

As this is a useful mode of allaying the irritability under which these patients labor, he described it. A stout band of india-rubber webbing is first secured around the head, so as to interrupt the circulation in the scalp. An electrode of sponge, provided with a hollow chamber of tin, is then connected with the positive pole of a galvanic battery, and placed upon the head. The chamber is then filled with ice-water (not ice); and the negative pole having been placed on the neck, the current is made, and treatment continued for half an hour. Sometimes he still further enhances the efficacy of the procedure by the application of compression to the carotids (by means of any mechanical compressor). Quite striking effects are sometimes observed immediately after the cold begins to make itself felt, which of course occurs rapidly on account of the suspension of the circulation in the scalp, by which the transmission of the cold to the cortex is greatly facilitated. Thus, some months since, he had a little girl under treatment for choreic spasms of the face. These, though not excessive, were obstinate in character, and did not yield readily to arsenic; and yet, when the above application had been made for about ten minutes, the spasms invariably entirely disappeared, and remained absent as long as the treatment was continued, and sometimes for an hour afterward.

When the combined sedative action which the galvanic current and the ice exert upon the cortex is borne in mind, such prompt effects are, perhaps, not to be wondered at. To the child and his parents such results appear little short of marvelous, and the spirit of hopefulness thereby engendered constitutes a helpful factor in a protracted course of treatment.

Finally, it is well, at least in the early part of treatment, to confine the patient to a strict farinaceous diet, which, in chorea, as in epilepsy, will form a helpful adjunct to the treat

ment.

These, in brief, are a few of the salient features of that mode of treating the affection which he has found most efficacious in practice. Therapeutic Gazette.

THE ACCOMPANYING EFFECTS OF ANTIPYRIN.-The Deutsche Medicinal Zeitung for November 24, 1887, is almost entirely made up of articles relating to antipyrin. American,

Austrian, German, French, Hungarian, and Italian practitioners and experimenters are quoted at length. Naturally their opinions differ on various points, yet all agree that in antipyrin we have an antipyretic of great value, and one which is singularly free from unpleasant accompanying symptoms. Among the few authorities who have observed unpleasant symptoms to follow its use Dr. Daniel Bernouilli, of Basle, is conspicuous. His experiences with the drug are far from favorable. The case he cites is a most singular one. The patient was suffering from a subacute attack of rheumarthritis, and antipyrin was prescribed. It was, however, observed that a quick rise of temperature immediately followed after every dose of the drug. At first the remedy was well endured, but later, small and single doses called forth this singular and paradoxical action: Immediately after the administration of the drug pain was produced in the chest and bowels, followed by a quick and considerable rise of temperature, accompanied by chills, a full, rapid pulse, vomiting, turgescence of the face, injection of the conjunctivæ, and also by an eruption which at one moment would be very apparent and in a little while after scarcely noticeable. This action was certainly due to an idiosyncrasy of the patient toward antipyrin.-Ibid.

THE USE OF CALOMEL IN THE PREVENTION OF PITTING IN SMALLPOX.-In order to prevent the forming of pustules or the disfiguring marks on the face in smallpox many methods have been recommended, but none can boast of sure and successful results.

tinc

Among the remedies which have gained great reputation may be mentioned the application of indifferent fats, collodium, ture of iodine, a solution of carbolic acid or of corrosive sublimate, also cutting of the pustules and cauterizing them by nitrate of silver, and, finally, various forms of masks on the face, or continual cold compresses. Although the latter would seem to give the best results, it can not always be employed, either because not every body can support cold compresses, or because this application is troublesome to make, as it requires constant attention.

Having frequently had such cases under his care during a recent epidemic of smallpox at Warsaw, Dr. Joseph Drzewiecki, in a letter to the New York Medical Record, January 21, 1888, states that he has convinced himself that calomel, applied as a powder on the face, does not prevent the development of vesicles from the papules; but when vesicles or pustules were developed it caused them almost immediately to dry up, and in this manner prevent the for

mation of marks. How and why calomel acts in these cases the author does not pretend to explain. However, we may suppose that possibly several agents have a share in producing this result. Perhaps the calomel acts partly as calomel, partly as sublimate, or partly, perhaps, as metallic mercury, since calomel, becomes decomposed into these two latter substances under the action of light; and the mercurials then act either by immediately destroying the micro organisms or by preventing their development

In his cases he employed calomel alone, in the form of powder, dusting it over the face, or mixing it with starch in the proportion of twenty to thirty per cent. The author supposes that, instead of calomel, the oxide of mercury might also be employed with success. As regards the strewing of calomel into the eyes, sometimes adopted with a therapeutic aim, we need not fear that it will do them any injury.-1bid.

THE TREATMENT OF CARBUNCLE BY CARBOLIZED SPRAY. A lecture on the above subject by Professor Verneuil, of Paris, is translated for a recent number of the Medical and Surgical Reporter, in which the distinguished surgeon takes very conservative ground in the matter of the surgical treatment of furuncle and carbuncles. Beginning with the treatment of long free incisions, he gradually restricted operation to grave and well-marked cases, and of late treats all carbuncles, small or large, diabetic or not, painful or painless, by simple carbolic spray (two per cent), applied by steam atomizer for an hour at a time, three or four to a day. He has found this proceeding to remove pain and offensive odor, as well as to reduce swelling even in diabetic subjects, and to be freer from resulting septic infection of the general economy than the more common use of the knife. It is not claimed that this treatment will prevent accidents which may occur when the carbuncle has given rise to an extensive sphacelus in extremely cachectic patients. But in the majority of cases, if taken early, he believes that we have in the spray an abortive treatment for carbuncle.