on, 130 Nuclear stain, hematoxylon as a, 84 Occlusion vulvar dressing, 522 Ocular affections associated with lithemia, 263 Oculists and opticians, 108 Ophthalmology, growth of, as a special branch Ophthalmology, home study of, 283, 290, 413 Ophthalmometer, the; a few practical direc- Ophthalmoscopes, defective, 197 Orbital tumor, 368 Organo-therapy, 409 Orthopedic instrument makers, can phycicians Osteo-lipo-chondroma, resection of humerus in a case of, 287 Otitis media, 382, 392 Otorrhea, double purulent, 79 Our new dress, 49 Our new volume, 7 Oxaluria and albuminuria, a case of, 294 Oxygen in drug narcosis, 198 ether anesthesia, 510 Packard, John H., 152 Paralyses of Potts' disease, 353 Paralysis, following non-diphtheric angina, 106 Pilocarpin, io, 16 lymphocytotic action of, 241 Pityriasis maculata et circinata, 484 rubra, a case of, 446 Pleurisy, 180 Primæ Viæ, cleanse the, 310 of pelvic inflammations, 216 Prostatic hypertrophy, castration in, 342, 455 Pruritis, phenazone in, 297 Pruritus ani, constitutional treatment directed etiology and symptomatology of, 396 Pruritus vulvæ, 126 methyl-blue in, 297 Psoriasis, 60, 110, 481 presenting circinate lesions, 171 Puerperal sepsis, treatment of, 29 septicemia, hysterectomy for, 131, 459 Pulmonary affections, simplified resistance valve for pneumatic treatment of, 204 Punton, Dr. John, 321 Pupil, 413 Purdy, Chas. W., 20 Purgation, free, in gynecologic diagnosis, 205 Purpura, 35, 156 Putnam, Dr., 377 Rachford, Dr., 378 RANDALL, B. ALEX., II, 173, 394, 483. Ransohoff, Joseph, 341 Raynaud's Disease, 125 disease in general paralysis, 377 coroner's, causes of death in, 372 on medicine, 251, 518, 520 on nervous and mental diseases, 377 on surgery, 270, 341, 420, 478, 491 Repressed vice, 88 Resistance valve simplified, 204 Respiration in the newborn, 252 Responsibility of newspapers for their adver- tising columns, 47 Resuscitation of children born asphyxiated, 398 Retinitis, albuminuric, 94 Reeves, James E., 158, 160, 169, 206, 331 acute, 348, 371 appendicitis associated with, 252 Rhinitis, atrophic, 481 sclerotic, 487 Ribs, syphilitic periostitis of the, 472 Rickets, 18, 432 RIESMAN, D., 363 Ringworm of the scalp, 232 RISLEY, S. D., 1, 175, 263, 411. See Clinics. ROBERTS, JOHN B., 237, 246, 271, 333, 443, 466. ROBINSON, W. D., 101 ROSENBERGER, Randle C., 460 RUGH, J. TORRANCE. See Clinics. Septicemia, puerperal, 29, 131, 459 Sextuplets, case of, 490 Sexual insanity and suicide, 57 Shall medical charities always be abused? 460 Shoemaker, John V., 502 Skiascopic eye, a, 29 for epithelioma of eyelid, 175 Skull, remarks on fractures of, 303, 311 Society proceedings, 238, 246, 260, 281, 301, 311, Society, The Tri-State Medical, 472 Spelling, 67 Sphero-cylinders, transposition of, 156 Spinal cord, diagnosis of lesions of, 490 diseases, iron bed-frame, in treatment of, 83 Spleens, multiple, 252 Splints, wood pulp, 14 Staphisagria, 35 Starr, Dr., 421, 490 State Boards of Examination, 250 STEINBACH, L. W., 341 See Clinics. Sterilization by heat, 342 STEVENS, E. W., 56 Stewart, R. W., 359 Stimson, Lewis A., 482 STOUT, GEO. C., 171, 446. See Clinics. Strontium salicylate, 338 Strychnin in opium poisoning, 497, 501 in tobacco and alcohol amblyopia, 202 Subinvolution and metritis, 481 Sugar in urine, test for, 13, 160, 222 Supra-vaginal hysterectomy, 135 Surgery, reports on, 270, 341, 491 SWAN, JOHN M., 270, 306, 341, 420, 478, 491, 526 Syphilis of the eye, 31, 423 Syphilitic periostitis of the ribs, 472 Sore-throat, common membranous, 28 TALLEY, FRANK W., 60, 120, 242, 248, 332, 373, 481, 487 Tape worm, 298 TAYLOR, J. MADISON, 25, 46, 68, 149, 156, 382, 501 Taylor, Robert W., 482 TAYLOR, WM. J., 14, 83 Temperature and climate, 527 irrigations, 258 Van Harlingen, Arthur, 462 Van Noorden, Carl, 298 VANSANT, E. LA RUE, 293. See Clinics. Varicella, complicated with gangrene of the scrotum, 116 Varicella in adults, 298 Vassali, Dr., 490 VAUGHAN, V. C., 8 VEASY, C. A., 94, 253. See Clinics. Veins, varicose, 466 Vulva, tuberculous ulcer of, 180 Vulvar dressing, occlusion, 522 Waldstein, Louis, 241 Warren, J. Collins, 398 Water analysts, conference of, 251 WATSON, ARTHUR W., 188. See Clinics. Weidman, W. Murray, 470 Welch, William H., 421 WELLS, WM. H., 94, 336, See Clinics. Wharton, Henry, 238, 301, 491 What the code is, 378 White, J. William, 342 Who will cure the doctors? 119 Whooping cough, 375, 382, 501 Willard, De Forest, 491 WILSON, H. AUGUSTUS, 268 175 MAY 28 1897 The Philadelphia Polyclinic. VOL. IV. No. 1. CHRONIC IRITIS; SECONDARY BY S. D. RISLEY, M. D., PROFESSOR OF OPHTHALMOLOGY; ATTENDING SURGEON WILLS EYE HOSPITAL; LECTURER IN OPHTHALMOLOGY UNIVERSITY OF PENNSYLVANIA. We have under treatment at the clinic a large group of patients illustrating the various phases of iritis. These you have been permitted to study daily in the outdoor service. To-day I have selected from the wards a patient suffering from the sequelae of this disease. The patient, a colored man, æt. 30, contracted syphilis two years ago and suffered a severe attack of plastic iritis as one of the secondary manifestations. This was neglected too long, and, as a result, a total annular synechia was formed in both eyes. In the right the pupil is occluded also by a mass of lymph. In the left the pupil area is closed to light by the gray anterior capsule. Vision is reduced to counting fingers with difficulty-that is, to say with uncertainty, at one foot with each eye. When he applied for relief two weeks ago, he stated that his vision was not so bad until recently, although he thinks that there has been a more or less steady failure since his recovery from his acute attack. He had, at first, been able to return to his work and was free from pain, but had occasional attacks of redness and discomfort. Recently, these recurrences have been more frequent and are attended with a dull post-ocular pain, which, for the past month has been constant, and radiates to the temples, vertex and occiput. The vision has grown rapidly 1 A clinical lecture delivered at the Polyclinic Hospital, Philadelphia. JANUARY 5th, 1895. worse during this time, so that he has been compelled to relinquish his employment as a coachman. When first seen the pupils were small, and apparently at the apex of a funnel-like depression, due to the pressing forward of the iris by the accumulated secretion behind it. The iris was wanting in its usual lustre and was quite in contact with the cornea, blocking entirely the angle of the anterior chamber. The right cornea was steamy, the left transparent. The tension of both balls was greatly increased, but higher in the right. The sensibility of the cornea was much impaired in the left and a shred of lint could be drawn across the right without causing any annoyance. The field of vision, as determined with a candle-flame, was but little, if any, disturbed in the left, but on the right side the nasal field was wanting. We have here an excellent illustration of a very frequent sequel to a neglected iritis of the plastic type, and one which would have been prevented by suitable treatment at the outset of his acute attack. His unfortunate condition shows the great importance of securing a wide dilatation of the pupil in the early stage of the disease. The question now to be answerd is: Does any form of treatment promise relief? The opinion given must be based upon several considerations. In the first place, it should be borne in mind that the iris is but a part of the uveal tract of the eye, and we can therefore hardly expect that the deeper parts of this important membrane have escaped participation and injury from so violent an attack of inflammation of one of its parts as this man has obviously had. Since the uvea is the principal nourishing coat of the eye, it |