Surgical Treatment of High Myopia.-H. V Wurdeman (Jour. of the Amer. Med. Assoc.,, December 9. 1899). Myopia of high degree is extremely rare. Thus of 5000 eyes examined only 29 (.58 per cent) have myopia over 10 D. The surgical treatment of high myopia consists in the removal of the lens by discission, and according to the author the indications are as follows: 1. Surgical treatment should be limited to those cases over 12 D, who suffer great inconvenience from their correcting lenses. The ideal cases for operation are those of 17 to 18 D. 2. The operation is mainly indicated in young adults. 3. Cases having active disease and changes in the ocular structures, such as progressive myopia, choroiditis, fluidity of the vitreous, or detachment of the retina, are not applicable. 4. The dangers of operative interference are more than counterbalanced by the results to be achieved, which are mainly increase of visual acuity and of the visual field, and more extended use of the eyes, which accompany diminishment of the refraction.

Extirpation of the Lachrymal Sac and Gland.-C. R. Holmes (Archives of Ophthalmology, No. 1, 1899). The indications for the removal of the tear sac and gland are: I. In cases where it becomes necessary to operate upon the globe, as for cataract or glaucoma, especially so, should there not be sufficient time to carry out other methods of treatment. 2. In patient who cannot devote the time, or who may be unable to endure the treatment by probing. 3. In all cases where conservative treatment has

failed to cure within a reasonable time. Although advocating the extirpation of the lachrymal sac and gland in suitable cases, I am a firm believer in conservative surgery, so long as milder means will accomplish the desired object, to wit, that before slitting the canaliculi and probing, thus lacerating or bruising a delicate and inflamed membrane, we should first thoroughly carry out antiphlogistic treatment in connection with careful attention to the nose and accessory cavities, which may embrace surgical measures, massage as advocated by Königshöfer, and cleansing of the sac by gentle syringing with mild astringents. And if, after this it becomes necessary to probe, let us proceed gently, so as not to make a false passage.

Description of a New Method for the Implantation of Glass Balls into the Orbital Cavity.-Charles A. Oliver (Phila. Med. Jour., May 27, 1899). The procedure which in its latest details has given me the best results with the least amount of reaction (in fact frequently less than with ordinary enucleation), is practically as follows: The conjunctiva around the entire corneal limbus is freed from the globe and dissected sufficiently far back so as to expose the tendons of the four recti muscles. The tendinous extremities of the muscles are made ready for separation from the globe. A half-curved needle with its point directed toward the corneal border, and holding a long piece of catgut thread, is carried directly through the belly of the internal or the external rectus muscle, and brought out of the tendon of the muscle just behind the remaining attachment to the globe. The muscle thus secured is cut loose from the globe just as in ordinary tenotomy. The catgut thread is drawn through as far as practicable, and a sufficient length of the strand of gut is left untouched in order to allow a loop broad enough for free manipulation between it and the eyeball. The needle is carried over to the opposite side of the cornea, and, with its point directed away from the cornea, is made to transfix the tendinous belly of the other lateral muscle, which is secured and freed from its connection with the eyeball. The vertically-placed muscles are dealt with in a similar manner. The four recti muscles are thus freed from their tendinous attachments to the globe, and each pair of muscles is secured in a loose sling that can be tied the moment that this becomes necessary. Working in between the broad loops of catgut attached to the ends of the muscles that are held apart by an assistant, the eyeball is enucleated with as much of the optic nerve as may be desired, without any difficulty. The cavity previously occupied by the globe is thoroughly cleansed and a water-tight glass ball of about three-fourths of the size of the normal globe is dropped into place. The ends of the lateral rectus muscles which are held by the lower and the first placed catgut thread are neatly trimmed and sutured together. The same is done with the two ends of the vertical rectus muscles. The circular opening made by the cut edges of the overlying conjunctiva is lengthened into a lozenge by a couple of horizontal snips, and is carefully brought into linear apposition by a series of silk threads. The operative field is covered by a gauze protective-bandage upon which iced compresses are placed. If the operation be done under strict asepsis, without any undue violence, and the parts be kept thoroughly freed from blood-clots and loose or hanging tissue, and if iced compresses be employed for the first

twenty-four or forty-eight hours after the procedure, there will be absolutely no reaction, and the surfaces will be ready for the insertion of an artificial eye in a very brief time-in fact, earlier than after an ordinary enucleation, while the cosmetic results will be as fully as good as those that are gotten by Mules' method.

MENTAL AND NERVOUS DISEASES.

BY FRANK PARSONS NORBURY, M. D.

Physician to Oak Lawn Sanitarium; Neurologist to Our Savior's Hospital; Physician to Passavant
Memorial Hospital; Lecturer Psycho-Physics, Illinois College.

AND EGBERT W. FELL, B. S..

JACKSONVILLE, ILL.

Postanesthetic Paralysis.-(Editorial in The Gaz., Dec. 15, 1899,)— Paralysis following anesthesia is attributed to the patient, to the agent employed. Mally, in the Revue de Chirurgie, Nov. 7, 1899, classifies such palsies as follows: (1) Those of central origin being due to hemorrhage. These are extremely rare. Patients have sclerosed blood vessels and apoplexy is liable to follow from the slightest cause. (2) Hysterical paralysis is also extremely rare and is attributable to the moral shock. (3) Peripheral palsies are the most frequent and important. They usually occur in the upper extremities and are due to pressure on branches of the brachial plexus caused by faulty position. The deltoid and supra and imfra-spinous are most frequently involved. Prognosis is good and recovery is the rule. (4) Reflex palsies are extremely rare and are characterized by exaggeration of reflexes and atrophy. Their occurrence is accidental. None of these are therefore due to the anesthetic, and the peripheral only is avoidable. Treatment consists of electricity, passive motion and massage.

Neurasthenia, Its Symptoms and Treatment.-(Gray, Med. News Dec. 16, 1899)-Neurasthenia is a depression of the functions of the nervous system. Either spinal or cerebal symptoms may predominate. The symptoms are those of impairment rather than perversion of function. The cause may be any depressing circumstance, or mental or physical overwork, worry, disease, masturbation, use of alcohol, morphine, etc. The occasional appearance of albumin sugar or casts in the urine may be due to neurasthenia. Uric acid is unimportant. The differential diagnosis from melancholia, hysteria, general paresis, bromism, etc., can be made by careful study of the symptoms. The prognosis is usually excellent. The treatment consists of removal of cause, rest, tonics and electricity. Prolonged confinement in bed is seldom necessary, ten or twelve out of twenty-four being usually sufficient. If anemia exists iron and quinine should be given, sometimes with strychnine. A pill of strych. sulph. gr., ferri. sulph. gr. ii, quin. sulph. gr. ii, after meals is recommended. Large amounts of beef should be given. If the patient is not anemic arsenic and strychnine are

useful. In lithemic cases lithiated water should be given, glycero-phosphate of lime 15 to 30 grains daily has recently been advocated in France. Errors of digestion should be attended to. Hypnotics are not required. The mental diversion should be such as not to fatigue the patient. The author thinks electricity of great value if rightly used, and gives the method employed by himself. Massage is often of value.

The Differential Diagnosis Between Chronic Joint Diseases and Tranmatic Neuroses.-(Sayre, Med. Rec., Dec. 20, 1899)—Mistakes in diagnosis are caused by failure to get the complete history,too superficial examination, and a lack of attention to minor symptoms. They can be avoided by noticing the following points: (1) Symptoms of nerve inflammation follow soon after the injury, while those of joint disease do not. (2) Atrophy follows nerve injury sooner than joint disease. (3) In neuroses the temperature general and local, is subnormal in inflammation of a joint, elevated. (4) In joint diseases involuntary spasm is always present. A limited amount of motion is usually possible. (5) Pain in joint inflammation is limited to definite and limited areas, in neuroses it often is not. Attention is called to the value of the presence of a neurotic disposition in making the diagnosis. The author gives reports of three cases of neuroses which had been diagnosed as joint disease.

Calomel as a Diuretic in Cardiac Affections.- (Bourgeon, Rev, de Therapeut, August 15, 1899.)-The diuresis increases with the dose and stops on the withdrawal of the drug. The quantity of urine excreted varies from a pint to three quarts daily, depending on the individual, the nature of the trouble, and the degree of edema. Three to six grains should be given in one or two doses every two, three or five days, according to circumstances. The exact results of this treatment cannot be foreseen, and it should not be used until the usual remedies have failed. If albumin appears the calomel should be stopped.-From abstract in Med. News.

Heart Disease from an Obstetrical Point of View.-Wright (Canadian Practitioner and Review, December, 1899) summarizes his paper as follows: (1) A woman having a heart lesion, which is compensated, should not be prevented from marrying. (2) Abortion should not be induced, unless very serious symptoms are present. (3) Premature labor should seldom or never be induced. (4) Mitral lesion is the most serious heart lesion during pregnancy and labor; aortic stenosis next, aortic incompetency next; mitral insufficiency is the least serious. (5) Treatment during pregnancy consists in the administration of the following, according to indications: Strychnine, digitalis (or strophanthus), cathartics, nitrite of amyl, nitroglycerine. Diet should be regulated. (6) During labor keep up the action of digitalis. especially during the first stage. Give strychnine and stimulants, if required, and chloroform. As soon as the first stage is completed deliver with the forceps. Watch the patient during the third stage and for some days after.

DR. RALCY HUSTED BELL and his journal, The Raven, are now located in St. Louis We are not surprised, Dr. Bell is a man who is progressive, and what is more natural than that he should come to the city which is ready to welcome any and all who are energetic. The Raven is not distinctly a medical journal, it is devoted to the philosophy of living as it appears to the editor, and he, being a medical man, emphasizes the medical aspect of things generally, and brings his journal within the elastic bounds of medical journalism. THE FORTNIGHTLY bids Dr. Bell and his journal a most cordial welcome.

CONGRESS ON "TUBERCULOSIS AND ITS MODERN TREATMENT.— From advance sheets of the Medico-Legal Journal it is learned that the Medico-Legal Society will devote an extraordinary session to "Studies on Tuberculosis, Its Management and Modern Treatment,"on the third Wednesday of February, 1900, at a regular meeting in this city, to open an investigation and discussion of the whole subject, and to invite the leading American scientists and specialists to contribute papers, and unite in the discussion of this subject, and the most advanced and modern treatment of tuberculosis. The following questions have been decided upon to be submitted for this discussion: Ist. Special hospitals and sanitariums, their construction and operation. 2d. What are the most successful methods of treatment? 3d. Individualization of certain forms of tuberculosis, its importance and necessity. 4th. Is change of climate a necessity for successful treatment? 5th. Should the use of anti toxines in tuberculosis be condemned from a purely scientific point of view? It is purposed to announce, in the programme, the name of one or more experts, who will submit a paper upon each of these questions. As a large number of the specialists are willing to take part at the opening meeting, after the dinner at the opening session at 7 p. m., on the third Wednesday, it is proposed to continue the Congress. the next day, so as to make the discussion full and complete. It is proposed not to limit the titles of papers to those stated questions, in case an author desires to submit his views upon any other germane subject that he prefers. The great interest in this subject, on both sides of the Atlantic, which also has been given great prominence in the Paris Congress of 1900, will make the movement of great interest, not only for the profession, but also the general public. Members and others who are willing to take part are requested to immediately write to either member of the committee, upon which of these questions they will submit their views prior to the first of February next, if possible, so that the same may be printed and submitted to the others who are to take part, in advance of the meeting, as is the custom in foreign countries. The following committee has been named by the Medico-Legal Society, to act as a Coumittee of Arrangements for this Congress, with full power, and the profession is desired to co-operate by contributing papers and to taking part in the discussion, and to advise either member of the committee as early as possible. Thomas Bassett Keyes, M. D., 98 State St., Chicago, Ill.; J. Mount Bleyer, M. D., 460 Madison Ave., N. Y.; Clark Bell, Esq., 39 Broadway, N. Y.

Malassimilation.

B Syr. hypophosphite (McArthur's)..... Sig.-Dessertspoonful at meals and bedtime.

I bottle