the disease, or prevent it in the same case if the precaution is taken to correct these influences. Some patients have a more tender skin than others, this shows why the same causes may in one case and not in another, produce blepharitis marginalis.

COURSE. In the mildest form of this disease the inflammation occurs at circumscribed points only, or there is an accumulation of scales to be found among the lashes without any redness. If we add to a tendency to inflammation of the margin of lid one or more of the aggravating causes above mentioned, you will in a short time find an entirely different picture presenting. The edge of the lid becomes hypertrophied or thickened and rounded off. Instead of a furfuraceous condition among the lashes, we find the lashes somewhat matted together, especially in the morning, Small vesicles that soon become filled with pus appear around the roots of the cilia. The exudation from these pustules dries and forms a layer or crust firmly adherent which fills up to the tips of the lases. If the crusts are removed by the forceps, quite a number of small abscesses that bleed readily and give the lid a raw appearance are seen. The long continued inflammatory process so near the hair follicles may set up a suppuration which destroys them. The cilia drop out easily, and, while they are renewed a few times, they soon become much thinned,stunted in their growth, irregular and perverted in direction.

In very chronic cases they finally cease to grow and the lid remains bald, or at most there are a few straggling lashes that may be turned in toward the cornea.

COMPLICATIONS.-The conjunctiva is always more or less involved on account of the nearness of the inflammatory process. The lid becomes very much thickened and has an irritable, red appearance. If the course of the disease is very chronic, the ducts of the meibomian glands become occluded and a retention of the secretion is the result.

EPIPHORA, or tearing, is one of the most, if not the most, frequent complications, which may be due to an eversion of the eye lid (ectropion), or an occlusion of the functum due a skinning over of this minute opening. A condition known as distichiasis, or a double row of lashes partial or complete, turning in against the eye ball, is frequently met with. If the inflammation has involved the skin of the eyelid to any considerable extent, a cicatritial contraction may cause considerable deformity by completely everting the lower eye lid.

TREATMENT.-Under this heading a great deal has been said. As we study the disease at the present time, we may set out by saying always remove that which you have found to be the cause of the inflammation. We are certainly safe in saying the most frequent cause is a refractive error, or a muscular asthenopia. This, when properly remedied by suitable glasses, is in many instances sufficient to cure the case. Should you observe that the punctum is everted, the canaliculus must be slit up, or if occluded, it must be found and opened. A case of this kind cannot recover

so long as there is epiphora. If perverted lashes are keeping up an irritation, that must be remedied. Should corneal inflammation cause an excoriated condition of the margin of the lid, the disease of the cornea must be first relieved. The same can be said of conjunctivitis. In fact all of the conditions above mentioned must be remedied or excluded before we should think of local applications.

The margin of the lid must be rid of the accumulation of scales and crusts by means of warm water ablutions, or they may be softened by the application of vaseline and then removed by gentle rubbing. Where the lashes are matted together and the crusts firmly adherent to the lid, it may become necessary to use the forceps to cleanse the lid. wise we will cause bleeding. around the roots of the eye to cauterize this raw and bleeding surface if you want to cure the case. I have never used nor seen caustic used in these cases. because far more simple remedies will suffice to cure them, when the cause of the disease is removed. Thorough cleanliness of the free margin of the lids is an important factor in the treatment of this disease. Should the nurse or parent find this difficult to do, you may clip the lashes closely to the margin of the lid. Epilation should never be practiced; it is painful and unnecessary. There are quite a number of ointments recommended in this disease, the mercurials entering into a large proportion of the formulas. The officinal nitrate of mercury ointment diluted one half with pure vaseline is a very efficient agent, but it discolors the margin of the lids. Hebra's ointment is a filthy application to the eye lids to say the least. The use of nitrate of silver, potassa fusa, sulphate of zinc and copper, in solution cannot be entrusted to the patient or nurse, since a little of it will always come in contact with the eye ball and cause bitter complaints of pain by the patient.

This must be done carefully, otherDistinct little ulcers are often seen lashes. Your text books advise you

The mildest application in the shape of an ointment is the following.

B

Aciti boracici (Morson's)

Di to zii

Vaseline parae

Zi

m. (thoroughly)-Sig.-twice daily to the free margin of the lid. This prescription can be compounded everywhere and is safe in the hands of even the most inexperienced. Should some of it enter the eye no harm is done.

The best ointment in these cases is undoubtedly the yellow oxide of mercury ointment as suggested by Dr. W. W. Seely. Hydrarg, oxidi flav (Merks impalpable) Vaseline purae

R

gr. x
Zi

my.-Sig.-to the free margin of the lids once daily, after the free margin has been thoroughly cleansed.

The old Pagenstecher formula called for lard instead of vaseline, but lard becomes rancid so easily that it is not to be employed at all in these cases.

The above formula as prepared by Ernst Wilfert, the pharmacist, is not irritating to any eye, and will relieve any case that is cured by local applications. Constitutional treatment plays an insignificant part in these cases. If the general health of the patient is such that it requires cod liver oil, tonics and stimulants aside from the disease of eye lids, these agents may be given, but never because the patient has blepharitis marginalis. Whenever this disease recurs at intervals it is most certain to be due to some

strain upon the eye. A careful correction of the refractive error under atropine and local applications of the above formula wili relieve any of the obstinate cases.

COLD-WATER TREATMENT OF FEVER.-A SIMPLIFIED METHOD. -Preyer and Flasher first advocated in 1884, and Heller in 1886, spraying the body as a safe and convenient method of reducing the body temperature. Placzek (Nirch. Arch., cxv) has recently taken up this treatment. After using a pint and a half of water of from 53° to 59° F., he uses water of a higher temperature, thus dilating the capillaries and inducing a consequent loss of considerable body heat.

Not requiring more than twenty-five minutes for the application, it may be repeated several times a day; besides this the method has the advantage of simplicity and comfort. The patient remains in bed, all coverings removed, and a rubber or wax cloth laid under him.

SOCIETY REPORTS.

E. S. MCKEE, M. D.

AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS.

The second annual session of this association met at the Burnet House, Cincinnati, September 17th, 18th and 19th, 1889, with the President, Dr. Wm. H. Taylor, in the chair.

After an address of welcome by Dr. Comegys, of Cincinnati, the following papers were read: Congenital Sinus of the Urachus : Abdominal Incision, Recovery, with Remarks, by Dr. A. Vander Veer, Albany, New York: A case of Extra-Uterine Pregnancy, Operation and Recovery, by Dr. L. S. McMurtry, Danville, Ky.: Treatment of Rupture of the Uterus, with Report of two cases, by Dr. C. A. L. Reed, Cincinnati, Ohio: Intra-Uterine Cord Amputations of the Fetal Extremities, by Dr. Joseph Price, Philadelphia: The Forceps as a means of Rotating the Head in Labor, by Dr. Edward J. Ill, Newark, N. J.: The Rectification of Face Presentations, by Dr. R. L. Banta, Buffalo, N. Y.: Umbilical Hemorrhage; its Treatment, by Dr. Llewellyn Eliot, Washington, D. C.: The Management of the Perinum during Labor, by Dr. A. P. Clarke, Cambridge, Mass.: Flap-Splitting in Perineorrhaphy, with Special Reference to Tait's Operation, by Dr. X. O. Werder, Pittsburg, Pa.: A Report of 80 cases operated upon for the cure of Dysmenorrhea and Sterility by rapid Dilatatian of the Uterus under an Anesthetic, by Dr. Franklin Townsend, Albany, N. Y.: Some Notes on the Action of the Galvanic Current in the Treatment of Uterine Disease, by Dr. Thomas Opie, Baltimore, Md.: Peri-Uterine Inflammation: its Pathology and Treatment, by Dr. L. S. McMurtry, Danville, Ky.: New Observations respecting the Functions of the Round Ligaments of the Uterus, by Dr. J. H. Kellogg, Battle Creek, Mich.: The President's Annual Address, by Dr. W. H. Taylor, Cincinnati, Ohio: Vaginal Hysterectomy, by Dr. E. E. Montgomery, Philadelphia: Supra-Vaginal Hysterectomy; ExtraPeritoneal Dry Treatment of the Pedicle, by Dr. Joseph Price, Philadelphia: Successful Removal of a Fibrous Tumor of the Right Ovary during Pregnancy, by Dr. J. H. Carstens, Detroit, Mich. :

A Case of Metremphysema, by Dr. T. E McArdle, Washington, D. C.: A Remarkable Case of Nymphomania, by Dr. W. S. Stewart, Philadelphia: Animal Suture, its place in Surgery, by Dr. H. O. Marcy, Boston, Mass.: Sutures and Ligatures; what Material shall we use, by Dr. C. Cushing, San Francisco: A Few Considerations on Peritoneal Effusions after Intra-Peritoneal Operations, by Dr. W. H. Myers, Fort Wayne, Ind.: The History of a Case of Ovariotomy, by Dr. W. P. Manton, Detroit, Mich.: Reasons for Drainage in Ovariotomy, by Dr. Hampton E. Hill, Saco, Maine.

On the afternoon of the third and last day the session was given up to the discussion of the subject, "Is Craniotomy Justifiable on the Living Child? and its Alternatives." Drainage was discussed freely, and as a general thing warmly indorsed, One gentleman, Dr. Hill, reported twenty-six ovariotomies in which he used the drainage tube twenty-four times and had twenty-five recoveries. He made twelve ovariotomies without losing a case before he ever saw the operation done. His work was highly praised by the members. Flap splitting inperineorrhaphy was severely condemned. Abdominal surgery was lauded to the skies, and should be limited to the hands of the specialist.

Socially, the association was very kindly entertained. The city of Cincinnati was thrown open to them. Doctor and Mrs. Taylor gave a reception, to which the association was invited to meet the local profession. This was a very enjoyable occasion, and the Cincinnati doctors made themselves as agreeable as possible. The local members took the association to see "Montezuma, or the Conquest of Mexico," which was very much appreciated.

The election of officers resulted as follows: President, Dr. E. E. Montgomery, Philadelphia; First Vice-President, Dr. W. H. Meyers, Ft. Wayne, Ind.; Second Vice-President, Dr. R. L. Banta, Buffalo; Secretary, Dr. W. W. Potter, Buffalo; Treasurer, Dr. X. O. Werder, Pittsburg; Executive Committee, Dr. A. Vander Veer, Albany, N. Y., Dr. C. Cushing, San Francisco, Dr. W. H. Wathen, Louisville, Ky., Dr. C. A. L. Reed, Cincinnati, Dr. H. B. Hill, Saco, Maine.

The association on meeting in Cincinnati numbered thirtyeight members, of whom twenty were present. Fifteen new members were added at the Cincinnati meeting. Place of next meeting, Philadelphia, on the third Tuesday, Wednesday and Thursday in September, 1890.