which gave me so much trouble. Dr. Jenks has criticised me somewhat, and I am glad of it, as it gives me an opportunity to say that I do not deem it essential that we should find an enlarged ovary or a distended tube; it is sufficient to know that a woman has suffered for a long time froin some form of uterine or pelvic trouble; that she has had good treatment from a thoroughly competent attendant, and that she has patiently and earnestly carried out his instructions, and that she has not been benefited. I have stated that I do not believe it possible for a woman to suffer from menstrual troubles for a term of years without the uterine organs undergoing a degeneration which is somewhat peculiar to them. I wish to make that statement again, for I believe that the appendages and ovaries are often diseased when it is impossible to detect any change in their condition, at least until after they are removed. Any woman who is a burden to herself and to her friends, and this condition is brought about by menstrual troubles, is entitled to our consideration, and I think that we fail to do our duty if we do not give them the benefit of the experience which has been so fully placed before us. Dr. Ranney has, from his personal acquaintance with Dr. Battey, placed a high estimate upon his method of operation. Dr. Carstens and Dr. Manton do not believe any more firmly in the necessity for an accurate diagnosis than I do, but I am sure that a diagnosis can not be made in all cases that will be satisfactory. I am especially sure that the appendages should be removed in many cases where menstrual difficulties have existed for a long time, even though the cause of the trouble is not apparent. OPHTHALMIA NEONATORUM. FLEMMING CARROW, M. D. (Corresponding Member Detroit Medical and Library Association; Corresponding Fellow The object of this paper is not so much to give a lengthy recital of the special pathological conditions found in this disease, as to call the attention of the Society to a trouble which I dare say is more fatal to the eyes of infants, when unrecognized or improperly managed, than any other eye affection. Furthermore, it is a sad thing to contemplate, after the loss of an eye from this disease, that it might have been saved by a timely recognition of the true condition in the beginning. The fact that infants are often attacked within three or four days after birth by a very simple and mild form of catarrhal eye disease, leads physicians to think lightly of conjunctival inflammation in these young patients. Ophthalmia neonatorum often finds physicians off their guard, who take a slight swelling of the lids with a little discharge for the simpler form, and nurses have not yet learned to call the attention of the busy doctor to an inflamed eye, the like of which is so familiar in the lying-in room. A few drops of a decoction of tea, or a poultice of the tea leaf, satisfies the mother, until the increasing swelling and discharge leads her to believe something serious has happened, and now the physician's attention is called to the case, only for him to find a sloughing cornea and the child hopelessly blind. This picture is not overdrawn by any means, as the record book of any ophthalmologist will prove. It seems, therefore, to be of sufficient importance to engage our attention when we consider the hopeless condition of children who, having a long life before them, are subjected to total blindness; more especially is this so when we know that a timely knowledge of the case will enable us to preserve the sight in almost every instance. As this subject has been brought to my notice several times during the year just past, it very properly serves as an excuse for reminding the Society never to fail to examine closely the eyes of an infant which become inflamed two or three days after birth. The most frequent cause of this disease is a specific irritating vaginal discharge being brought in contact with the eye of the child during parturition. He would, therefore, naturally look for the disease in those children born after protracted labors, as in such cases the head is in contact with the vaginal walls a long time. Credé found that in 50 per cent. the expulsion of the head was protracted. Others have had a similar experience. The disease, however, is also communicated through the agency of the fingers of the nurse during the first washing of the child. Some of the vaginal discharge will adhere to the body of the infant, and is carried by the nurse's fingers into the eye in her endeavors to cleanse the corners of the lids-thus bringing into direct contact with the sensitive mucous surfaces of the eye this specific germ-laden discharge. It has been claimed that sudden exposure of the infant's eyes to a bright and dazzling light will set up this disease. It is true that an inflammation is begun in this way, and that through neglect or want of cleanliness this inflammatory action becomes characterized by a purulent discharge; but if we analyze this discharge we will find that it is of a croupous variety, frequently assuming a stringy appearance. The lids are hard and stiff, and their mucous lining of a pale yellow tint; the discharge will adhere to the conjunctiva, and when removed will expose a reddish velvety surface. This is caused by a stasis in the blood vessels, but the fibrinous flakes of discharge do not penetrate deeply into the tissue of the conjunctiva, as is the case in diphtheritic conjunctivitis. So we see there is a very noticeable difference between a conjunctivitis set up by the irritation of bright light, and that caused by a specific vaginal discharge introduced into the eye during birth. Two or three days, then, after birth, we notice a red line running horizontally across the upper lid, and this is usually the first indication we have of specific infection. Open the lids and you will observe more or less infection of the conjunctiva and a slight yellowish secretion. A few hours hence and you have the symptoms of a most intense inflammation. The lids swell, the upper lid hanging down over the under, and looking as though water had been injected under the skin. The pus is now more abundant and thinner, and of a greenish-yellow color. You can not get a view of the cornea without using an elevator, and any pressure now upon the eyeball is most dangerous, as you may rupture the thinned cornea. While the discharge keeps up, the cornea is in constant jeopardy from long-continued maceration in the abundant pus, more especially as we know the cornea of so young a child possesses very little power of resistance. The epithelial covering of the cornea becomes implicated, is shed in some spot, and in a few hours its tissues are broken down, and a central fistula formed, which, despite our best efforts, continues to furnish a channel by which the discharge of a suppurative choroiditis finds exit, until complete atrophy of the globe takes place. If the eye is not lost in this way, the cornea sloughs, and its place is taken by a dense white cicatrix, completely shutting out the light. Of numerous cases of this disease which I have had referred to me, all began in the same way, ran the same course, with a few insignificant variations, and ended in the same disastrous manner when not recognized sufficiently early for treatment to be of avail. How necessary it is, therefore, for the general practitioner to be very suspicious of any inflammatory eye affection occurring in young infants. These cases always begin within eighty hours after birth, and there is no disease which yields more readily to gentle and appropriate treatment, and it is equally true that there is no disease more fatal to sight if not recognized early and combated. To prove the truth of both these statements, allow me to relate a case referred to me by Dr. Washington, of Roscommon, within the last few weeks. The doctor delivered his patient of a child, and did not have occasion to visit her again for a week. In the meantime, the child's right eye becoming inflamed, the nurse applied the usual useless and unclean remedies-breast-milk, tea poultices, and the rest of the household pharmacopoeia. The eye not improving, and the left becoming affected from allowing the discharge from the right to get into it, the doctor was summoned. He at once saw the nature of the case, and began the most active treatment of the left eye, having first, however, to pronounce no help for the right. His treatment easily saved one eye, and would have saved both had he been notified sufficiently early. After the left eye recovered he sent the child to me to ascertain if anything could be done for the right. I found a central corneal fistula, the eye reduced in size, hopelessly blind, and undergoing suppurative choroiditis. This is the least distressing case, save one referred to me by Dr. Newkirk, of Bay City, during the year. Of course you will understand I am not speaking now of those cases where the doctor's attention was called to the condition of the eye as soon as the disease began, but rather of those unfortunates whose nurses thought they understood the trouble. The history of one case of this kind will serve as the history of any number, the only difference being the form of corneal complication, which acts secondarily in producing blindness. Let me repeat, therefore, that my object is to call the attention of members to the disease, and to point out what experience has proved to be the appropriate treatment, and one which can be adopted with the almost certain assurance that it will lead to recovery. First, as to prophylaxis. Credé has tried thorough cleaning of the vagina of the mother just previous to the birth of the child, and although it has diminished the number of cases the disease did not disappear. He then began to disinfect the eyes of the infant immediately after birth, and whereas in his clinic at Leipsic 10 per cent. of the children born had eye trouble, after |