tributed to the internal rectus, the inferior rectus and the inferior oblique respectively.

The nerves of sensation are derived from the fifth chiefly from the ophthalmic division. It enters the orbit through the sphenoidal fissure just after leaving the semilunar ganglion.

Its distribution is interesting and complete.-The first filament given off is a sort of a recurrent nerve; it turns back and is distributed to the tentorium of the superior petrosal and transverse sinuses. The nerve proper splits into three branches, the frontal, lachrymal and naso ciliaris. The first division is found closely to the roof of the orbit and as it passes forward it gives off branches to the supratrochlearis to the corrugaton supercillii, the occipito frontalis muscles and the skin of the forehead. The supraorbital, another filament, passes forward through the supraorbital foramen and supplies the occipito frontalis, orbicularis pelpebrarum muscles and skin of this region with sensation. The nasal nerve gains the inner wall of the orbit and leaves it by passing through the anterior ethmoidal foramen, enters the cranial cavity, then passes into the nose, supplies the mucus membrane, and the alae and tip of this organ. A few small filaments are given off in the orbit from this nerve the long ciliary they join the short ciliary nerves from the ciliary ganglion, pierce the sclerotic around the optic nerve, pass forward between the sclera and choroid and supply the ciliary muscles and the iris. The supratrochlear leaves the orbit at the inner angle of the eye and supplies the integument of the lids, side of the nonse conjunctiva caruncula lachrymalis and lachrymal sac. The lachrymal nerve, the smallest of the ophthalmic branches, supplies the lachrymal gland and integument of the upper lid. In this connection permit me to say a few words relative to the formation of the ciliary ganglion. It is situated in the back part of the orbit. Its sensory or long root is from the nasal branch of the ophthalmic, the short or motor root is from a filament of the motor oculi. third root is from the cavernous flexus of the sympathetic. The branches of distribution are the short ciliary nerves ten or twelve in number and distributed as above indicated. It is recognized by all anatomists that there are many variations in the construction and distribution of these nerve trunks, but practically speaking the difference is unimportant. There remains for our consideration now yet that portion of the lachrymal apparatus which according to its topographical situation is found in the orbit proper, "viz." the lachrymal gland. This gland is found at the upper and outer

The

angle of the orbit, near the rim, in a distinct depression in the orbital plate of the frontal bone.

It is held in position by bands of fascia continuous from the sheaths of the ocular muscles and the ligamentum pelpebrarum. We speak of this gland in the singular while in reality there are two separate and distinct glands or an upper and a lower portion. It is an acinus gland in character and resembles in appearance the salivary glands except that it has a more pinkish color. It is oval in shape, nearly one half inch in length with its free border near the orbital margin. Should disease necessitate its removal, it can be found easily by running the finger along the upper orbital margin until we feel the suture between the frontal and maler bones which exactly represents the outer extremity of the gland; from this point an incision may extend through the fornix conjunctiva to the outer border of the levater muscle. Should this plan not be expedient, the incision may be made through the eye-brow, hiding the cicatric by making the incision among the hair of the brow. The ducts of these glands are represented by very delicate tubes from three to five or more in number; they are about one half millimeter in diameter, and empty into the conjunctival sac at the outer and upper angle a little in front of the fornix. The ducts. from the upper or larger gland pass through the smaller portion and carry off the secretion from both divisions.

The blood and nerve supply have been mentioned above.The secretion which empties into the conjunctival sac is spread over the eye-ball by the action of the lids; it acts as a protector keeps the front part of the eye moist, washes away foreign bodies and irritants.

The secretion is not constant, but flows only when called upon by a reflex nervous act. The composition of the tears is compared to a very watery mucus containing sufficient chloride of sodium to give to them a salty taste. After the secretion has served its purpose, it is gathered at the inner angle of the eye in the lacus lachrymalis from where it passes through small canals into the nose. The consideration of which and its relation to disease of the eye, we will take up at our next lecture.

(To be continued in the next number.)

EDITORIAL.

A. B. THRASHER, A.M., M.D.,

Editor.

THROAT ABUSE IN PUBLIC SINGERS AND ACTORS,

The daily press is full of items noting the voice-failure of this singer, or the throat or nose affection of that actor. The query naturally arises, why do these people so frequently break down in these organs?

The blacksmith uses his arm continuously, yet it only grows stronger; the hod-carrier uses his legs, and they become more muscular; the ordinary use of the voice seems only to strengthen it, and why should not the throats of public singers grow stronger with continued use? The answer is easy-they do not use their throats physiologically. If the throats were always free from inflammations, and the nares always healthy, then these singers and actors could go right along with their work. But the trouble is, they think they must continue the use of the voice even though the vocal organs are inflamed. Here is where the serious trouble originates. An inflamed throat needs possibly medicine, but surely rest. But when the inflamed throat belongs to a singer or actor, and is in frequent daily use, it may get plenty of medicine, but little

rest.

When the physician is consulted by a professional voice user for a hoarseness or a sore throat, the most valuable advice is to at once put the inflamed parts to rest.

How frequently the doctor yields to his greed for money and says: "Come and see me daily and let me treat your throat, and you will do nicely." Local treatment may be very necessary, but for most acute throat troubles in singers and actors, rest is the very best

treatment.

If the consulted doctor would insist on this, we would hear less frequently of voice failure among our public singers and actors. Of course, this pre-supposes a correct method in the use of the voice, for without this no throat will long stand the strain of public

use.

FALSE RETURNS.

The Cincinnati Medical Journal has, from time to time, advocated the establishment of state examining and licensing boards for the purpose of regulating the practice of medicine. It has observed, with pleasure, the development of this movement in the various states and has had particular satisfaction in noting the work of the State Board of Examiners of Virginia. The exhibit that it made of its first year's work, showing, in tabulated form, the number of applications and rejections and the schools at which the various applicants were educated, was recognized by us as placing the matter of educational results in exactly the right light; for we have long held that the various colleges of the country should stand or fall by records made before independent examing boards.

Our confidence, and we feel that that of the profession also has been shaken by the revelations concerning these same Virginia returns, which, on the occasion of their first publication, gave us such satisfaction. Three rejections were reported among the graduates of the Medico Chirurgical College of Philadelphia, making one hundred per. cent. of failures for that institution before the Board. Examination revealed the fact that but one applicant had come before the Board and that he had appeared and failed three times. This statement of facts simply gives the lie to the Virginia State Board of Medical Examiners and Licensers so far as its declarations of its own work are concerned. To-day, nobody is able to tell, from published returns, how many individuals have applied to that body for license and how many have been rejected. The confidence of the profession and the public has been shaken in medical examining and licensing boards and the cause of reform has thereby received a severe shock.

FOR the eight, possibly nine, vacancies in the staff of resident students of the Charity Hospital, there were about forty applicants. The examination of these candidates was rigid, though practical and perfectly satisfactory to the students. It consisted of a written. examination the first day, a clinical one by the house surgeons a few days afterward, and, finally, two days later, an oral examination. This plan is a great improvement over an examination of catch questions, and must always insure excellent internes for our great hospital.

BOOK REVIEWS

FROM WOOD'S MEDICAL AND SURGICAL MONOGRAPHS.

VOL. I, No. II.

On Giddiness, BY THOMAS GRAINGER STEWART, M.D., F.R.C.P.E., F.R.S.E.

These three lectures are from a series of clinical lectures on important symptoms. The subject is discussed with this author's well known felicity and thoroughness.

"The essential feature of giddiness is a feeling of uncertainty of our position in space relatively to surrounding objects." "It is constantly associated with impairment of equilibriation-disturbance of equilibriation being, so to speak, the motor aspect of the sensation of giddiness."

Equilibriation depends upon the co-ordination of many groups of muscles, which co-ordination is guided by sensory impressions, derived from different sources-sight, touch, the muscular sense, probably an articular sense, and a visceral sense, along with the great organ of special sense for equilibriation, the semi-circular canals. "Besides these peripheral structures, there are, of course, conducting fibres and nerve centers, which subserve the functions." Peripheral giddiness is usually due to contradictoriness of sensory impressions."

"Agoraphobia," he explains by the supposition that "these patients, with the nervous system morbidly sensitive, have from some peculiarity acquired the habit of guiding these equilibriations by reference to vertical lines, and that when these lines are wanting, they feel as others do when standing on the edge of a cliff."

The giddiness in Meniere's Disease, in locomotor ataxia, multiple sclensis of the brain, lesions of the cerebellum and crura cerebelli, are discussed in lecture second. In lecture third, as found in lesions of the pins, and corpora quadri genina, cerebral tumor in any part of the brain may produce occasional attacks of giddiness. In cerebral congestion and cerebral anæmia, it is a common symptom. In epilepsy, it often occurs. It may persist for long after injuries of the head.