he adopted this method of treatment the disease was practically banished. His method is to instill into the eyes of the new born a drop of 2 per cent. solution of nitrate of silver. This practice gives but little trouble, and is always successful, and the only wonder is that it is not universally adopted. After the disease is established, foremost amongst therapeutic measures is the maintenance of absolute cleanliness.

As long as the lids can be opened no syringing should be done, absorbent cotton should be used every hour to cleanse the eyes from pus by gently mopping the everted lids or any fold where pus can find a lodgment. Immediately after such cleansing, a saturated solution of boracic acid (18 grs. to the ounce) should be gently dropped into the eye. This causes no irritation, acts as an astringent, and is a germicide of considerable power. After the suppurative stage is fully established, the everted lids should be penciled with a 10-grain solution of nitrate of silver once daily, in addition to the other treatment just mentioned. If the oedema of the lids prevents their being opened, a resort to the syringe is allowable. Its nozzle should be flat and perfectly smooth, and when introduced between the lids the piston should be worked very gently. Whatever the cleansing or antiseptic solution may be, the nitrate of silver will be found most valuable. To be sure the disease is self-limited, but it will run its course more quickly and safely by the use of such treatment as has been indicated. The greatest delicacy must be observed in applying the remedies, and no pressure must be made upon the eyeballs. Above all, watch the condition of the cornea, and if it becomes hazy be careful not to abrade its surface when using the elevator or syringe. If while the cornea is cloudy the swollen lids press dangerously upon it, the outer commissure should be divided with the scissors, and kept from reuniting for a few days. If ulceration of the cornea takes place, and it is marginal, pilocarpine or eserine should be promptly used; but if central, atropia is the remedy, for obvious reasons. All solutions of nitrate of silver should be washed off immediately, to prevent staining of any

abraded spot on the cornea. Contagion must be guarded against, not only for the sake of those whose duty it may be to attend the patient, but for the physician's sake also. The return stream from the eye, while using the syringe, may spurt into the doctor's eye, and cause serious mischief. I may be pardoned if I mention the name of a member of this Society (Dr. Minar) who lost his eye in this very manner-more especially since he is an instance of a noble self-sacrifice for the good of his patient. His eye had to be enucleated from this disease, caught in the discharge of a genuine charitable act. As the patient improves, the lids become thinner and thinner-the discharge lessens, and finally disappears the haziness of the cornea clears up, and soon disappears, and you have the satisfaction of knowing that your skill has been of real benefit in saving the sight of your patient.

DISCUSSION.

DR. MANTON: Mr. Chairman, as I was with Credé while he was making some of his last experiments, I desire to express my appreciation of Dr. Carrow's paper. I have already said and written a good deal on this subject, which is one in which I am interested. A couple of years ago, when I read a paper on Ophthalmia Neonatorum before one of the Detroit Societies, I was laughed at by an ophthalmologist, and asked if I would have every physician carry a bottle of 2 per cent. nitrate of silver solution and apply it to the eyes of every new born babe. I desire, sir, to reply here most emphatically Yes, for the hundreds of babies which I have seen treated in this way abroad proves that the silver solution is entirely harmless to the eyes, and the saving of one eye is worth the extra trouble of applying the solution to many eyes.

The homely saying, "The proof of the pudding is in the eating," is applicable here, for as this method of treatment is now adopted in nearly every lying-in hospital on the continent, it must be harmless as well as efficacious.

DR. CARSTENS: I do not believe that the vaginal discharge can enter the eyes during the passage of the child's head. I believe it enters after the child is born, often rubbed into the eyes by the nurse. In all suspicious cases I immediately with a small rag wipe away the discharges from and surrounding the eyes before they are opened. This is a precaution which I think often prevents serious trouble. Simple conjunctivitis caused by a bright light or soap should not be mistaken for the severe and contagious variety.

ment.

DR. WILLIAMS: In the earlier stages of the disease I generally use only the milder astringents with directions as to cleanliness, and frequently find the disease subsiding without any other treatBut later, and in the more severe forms, I evert the lids and apply the mitigated stick of nitrate of silver thoroughly over the whole inner surfaces, washing it off with a solution of common salt. Although such treatment has been severely criticised, I have never seen cause to regret its use, but nearly always a lessening of the discharge, and relief of the most urgent symptoms.

WHAT IS VAGINISMUS?

W. P. MANTON, M. D.,

Visiting Physician to the Woman's Hospital and Foundlings' Home, Detroit.

My attention has been drawn to the condition which forms the subject of this paper, by a recent interesting and valuable communication presented before the British Gynecological Society by its distinguished president, Dr. George Granville Bantock. Although this article did not attempt to answer the question under consideration, it confirmed in my mind a previously vague belief that many of the ideas held on the subject of vaginismus were far from being correct. It seems strange, however, that a condition in which, as Sims says, "the gentlest touch produces excessive suffering," should at this day be misunderstood, and the conditions presented misappreciated. At the beginning of what little I have to offer on this subject, I desire to repudiate the definition of vaginismus as found in nearly every text book devoted to the diseases of women. Vaginismus, as we understand it to-day, in the light of accumulated clinical experience, and from the teachings of the scalpel and the microscope, is not merely a "hyperæsthesia or peculiar sensibility of the site of the hymen and vaginal outlet, associated with involuntary spasmodic contraction upon irritation of the sphincters of the vagina," but a condition which may be associated with nearly every disease to which the female sexual tract is subject. Long before Sims placed this condition on the list of gynæcological nosology, it had been written of and described by Burns, Dupuytren and others. Our illustrious countryman was, however, the first to depict the condition under a specific name, and thus, though incorrectly, drew attention to it as an individual disease.

And who is there familiar with vaginismus, who cannot appreciate Sims' vivid portrayal of his first cases, as he writes of the patient's sufferings, and his own embarrassment at the utter absence of means to allay this terrible affliction?

In looking over the subject of vaginismus in the literature, I have been struck with the pertinacity with which writers have adhered to Sims' original description of the anatomy of this symptom-an excessive hyperæsthesia, etc., "associated with such involuntary spasmodic contraction of the sphincter vaginæ as to prevent coition."

What is the sphincter vaginæ ?

"It is, I think," says Thomas, "very generally accepted as a fact that the bulbo-cavernosus muscle, which passes over the clitoris and forms a figure-of-8 with the sphincter ani, is the constrictor vaginæ ;" and this is undoubtedly the same muscle described by Sims as the active agent in vaginismus. The illustrations given of this muscle picture it as a broad and apparently thick expanse of fibres, running on either side the vulvar fissure, from the border of the central perineal tendon, across the bulb of the vagina and Bartholin's gland, to the pubes and clitoris. In the text treating of vaginismus, we are told that this muscle contracts about the examining finger like a ring or wire, or prevents the entrance of the digit altogether-renders impossible the consummation of marriage, and sometimes may give rise to the condition known as penis captivus.

All this indicates and necessitates, of course, a muscle of considerable size and strength, such as that figured.

What are the real facts in the case? Some years ago while in Vienna, where material is plenty, I undertook a line of careful dissections of the female pelvis in the child, the adult, and the aged. In nearly every instance I found the bulbo-cavernosus muscle to be a thin, roundish, and pale bundle, situated at, and undoubtedly strengthening, the introitus vaginæ, which is the narrowest and most undilatable part of the canal, but totally incapable of achieving the feats accredited to it.