as much light as could be borne without pain or discomfort. The third day the cornea had attained its normal convexity, the iris presenting a healthy appearance. On the fifth day all dressings were removed. On the fourteenth day an ophthalmoscopic examination revealed a perfectly unclouded but slightly atrophic disc with somewhat diminished arterial vessels. With a three-inch glass he could with some difficulty read Snellen's No. 6 type, and readily discerned large objects at six or eight feet without the glass. Vision continued to improve slightly up to the date of his departure, April 28th. This case is of interest as showing the triumphs of the most delicate surgery under many adverse circumstances when smooth and performed under rigidly aseptic conditions. The circumstances of the case that pointed to possible failure were, the history of pain at the inception of the cataract, and continuing for some time with photophobia, notwithstanding the opaque lens; the cacæmia and illnourished condition of the patient with nasal and conjunctival chronic catarrh; the glaucomatous history of plus tension throughout; the failure to detect the position of a lighted taper at fifteen feet previous to extraction, and the hypermaturity of the lens, with partial synchysis of the vitreous body. Had there been any fault in the operation, or a flaw in the aseptic conditions, we have little doubt that our worst fears would have been realized in this case.

from want of

Living remote from a skillful specialist, the doctor was advised to take the risks of an operation, and we give the result as an encouragement to our colleagues during the anxious hours that are apt to follow even the most favorable and promising cases. The only disastrous cases that have fallen to my lot failed: one proper hygienic surroundings, and another from failure to secure a large enough opening for the delivery of the lens; and in my observation of the failures of others the following causes have been noted: Lack of perfect asepsis; some hitch in the operation interfering with absolute smoothness; failure to make the cut in a continuous plane, or miscalculation as to the size of the lens, and failure to secure an adequate opening for its delivery.

THE EYE AND THE NOSE.

BY JAMES A. CAMPBELL, M.D., ST. LOUIS, Mo.

THE influence upon other parts, of abnormal conditions of the nasal passages, whether it be from hypertrophy of the mucous tissues, enlargement of the turbinates, deflections of the septum or tumor growths, is generally admitted and is fairly well understood.

Every oculist, even of most limited experience, is aware of the intimate relationship existing between diseases of the nose and the eye. The ocular complications most generally reported under these conditions have been those of inflammatory character, and these are comparatively frequent. Persistent conjunctival inflammation, deepseated ocular congestion, sensitive painful eyes, blurred vision and ciliary spasm are the forms usually commented upon.

Within the past year or more I have been interested in tracing the direct relationship between nasal irritation and heterophoria in certain cases, and, in the light of these observations, I am convinced that this relationship of direct cause and effect is not of unfrequent occurrence. I beg leave to offer a few cases in confirmation of this fact.

Mrs. S. R., age 36, had suffered for several years with much pain. in her eyes and head, which would invariably follow the slightest. use of eyes. She had been treated for this by a well-known eastern specialist, who correctly diagnosed her case as exophoria. For six or seven months he had tried every form of treatment, except the usual partial tenotomy. Why this was not done was not explained.

When the patient came to me she was wearing neutralizing prisms 4° base in, on each eye, which, while they did not free the eyes from annoyance, rendered their use somewhat more comfortable for

a short time.

A careful series of examinations failed to discover any optical anomaly or other direct cause for the trouble, except an exophoria measuring 10° in each eye.

Examination of the nose revealed an almost total occlusion of the nasal passages from hypertrophic rhinitis and turbinated enlargement. On the right side the inferior turbinated bone wound around like a large scroll, about filling up the nose space on that side. On the left side the puffy, spongy, swollen tissues quite closed the passage.

She informed me that she had been unable to breathe through the nose with any certainty or comfort for many months, and that she had suffered much from this obstruction. She had frequent pains between the eyes and all through the head.

From the general symptoms and conditions present I felt convinced that a certain amount, if not all, of her eye trouble found its origin in the nose, and the case was conducted with this theory in mind. The enlarged turbinate on the right side was removed with the saw; the hypertrophied tissues on the left side were reduced by operative measures, principally galvano-cautery. Gradually the patient was enabled to breathe through the nose and the pains in the head ceased, and in three weeks the exophoria had decreased to 5°. The improvement in her general condition is very marked. The neutralizing lenses were taken off. Each week the exophoria grows less, and the patient affirms that her eyes and head have not felt so well for several years.

Mr. L. E. D., age 19, a book-keeper, came to me one year ago. His vision was always excellent, but for a year or more his eyes were painful on use and he had suffered very much with headaches over the eyes, extending to the back of the head.

Tests showed hyperopia requiring + 3.5 D for correction in each eye; he had also esophoria 3° in the right eye and 2° in the left. He was given 3 D for constant use and advised to give the eyes

a short rest.

Immediate improvement in reference to pain in eyes and head followed; but as soon as he went back to his books the old-time pains began again. The esophoria was still present. He was put under treatment: prismatic exercises, electric stimulation and internal remedies, which was followed by some improvement. several months he was better and worse in turn.

For

He was not aware of any nasal trouble, but a certain nasal twang in the voice induced me to examine his nose, and a considerable enlargement of the left middle turbinated bone, occluding the upper

third of the meatus, was revealed. The obstruction was removed, and immediate relief from all the eye and head symptoms followed, and continues to this day.

In a third case, another hyperope, a most obstinate and unyielding conjunctival inflammatiou was finally reduced to a condition of comparative comfort, but use of eyes was always painful and headaches were frequent, in spite of proper optical correction. Finally chance directed me to examine his nose, and there a partially occluded left nasal passage, from a spongy, swollen turbinate, was discovered. Its removal was followed by entire relief from, not only the conjunctival congestion and sensitiveness, but likewise the longendured headaches.

Quite a number of similar cases could be offered, but the above are sufficient to illustrate the fact I desire to impress, that heterophoria is frequently the result of reflex nasal irritation; and when this is the case no form of operation upon the eye muscles will do anything but harm, and relief will only be obtained when the cause is recognized and removed.

ON THE USE OF MYDRIATICS IN THE DETERMINATION AND CORRECTION OF ERRORS

OF REFRACTION.

BY E. H. LINNELL, M.D., NORWICH, CONN.

THE question as to the desirability of paralyzing the accommodation before correcting errors of refraction, is one upon which the opinions and practice of oculists differ widely. My own views and methods have become somewhat modified in this direction of late, and while I have nothing new to offer, a comparison of experience and a discussion of methods, where specialists are not agreed, is always instructive.

There can be no dissent from the statement that the test with trial lenses, with the accommodation perfectly at rest, gives us the most scientifically accurate results, and that atropin is the most thorough and reliable mydriatic to use. In hospital and dispensary practice, its routine employment is perhaps justifiable and desirable; but in private practice there are very many objections to its use, and it is frequently contraindicated by the conditions and circumstances of the patient. It is not worth while for me to enumerate the disadvantages attending its employment. They are familiar to you all from your own experience, and to a greater or less degree they attend the use of all other mydriatics, I think we are all agreed that cases constantly present themselves where we must fall back upon other tests, and in proportion as we acquire skill and experience with other tests, will we find it unnecessary to use mydriatics. Scientific accuracy is of secondary importance, and the comfort and wellbeing of our patients is the first consideration. always, and sometimes essential, to ascertain positively the full error of refraction, but sufficiently accurate data, to enable us to prescribe suitable glasses, in the large majority of cases can, I believe, be attained by other means. the inconvenience and danger attending paralysis of accommodation

It is desirable

Therefore it should be our aim to avoid