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it was totally blind, not even perceiving light, is not to be wondered at. Atropin may produce glaucoma, and to use it in an eye already glaucomatous is but to add fuel to the flame. It draws the iris up into a bundle, which it pushes into the filtration area of the eye, cutting off the already diminished exit for the lymph, increasing the internal pressure, and mechanically destroying the delicate endings of the optic nerve. So much for glaucoma, which I wish every medical practitioner would carefully study.

I find I have already occupied so much time that I can say only a few words more. I cannot perhaps use them better than to emphasize the extreme importance of a general knowledge of the symptoms and results of adenoids, as well as the brilliant results which in my experience so generally follows operation for their removal. It has been my lot to see numbers of cases of children treated for a long time by the family doctor for "catarrh," who never improved until this obstruction. had been removed. Numberless are the cases of cough and so-called croup, which are due to the same cause, and I have no hesitation in saying that earache in children is generally due to the same thing. I find a tendency to minimize the gravity of earache, and even of discharging ears. Earache is usually a symptom of congestion of the tympanum, the initial stage of an inflammation which, if not arrested, will end in rupture of the drum head. This perforation may be long of healing, and in the meantime the ear is very liable to become infected, when a prolonged suppuration may occur, with destruction of ossicles, impaired hearing, and danger to life. It is in this way that so many cases of mastoid involvement arise, and a number of cases of cerebral abscess or infection of the cerebral sinuses.

Earache is no trivial matter, and when it occurs the primary cause should be looked for and removed.

I shall conclude by relating a case which occurred the other day: A child of three years of age was brought to me because her nose was blocked by discharge. She was perfectly well otherwise. Her nose was full of semi-fluid secretion. As a matter of routine, I looked at her throat. It was normal, except a little white patch on either side of uvula, which cotton did not remove or cause to bleed. On inquiry I found that some five or six weeks previously she had had what her doctor called a stomach rash on her face, and her little sister had had the same rash. This may have been scarlet fever. Against their inclination, I prevailed upon her friends to allow Dr. Harris to make a bacteriological examination of the uvula. He informed me the next day that he had found the diphtheria germ. The case was reported to the M. O. H. The family doctor now took charge of the child. It appeared later that the friends, supported by this gentleman, still asserted that there was no diphtheria about the child, who appeared to be perfectly well, except for the nasal discharge. She continued apparently well and recovered completely; but fourteen days had not passed before her sister, two years old, was dead of malignant diphtheria. There is nothing remarkable or uncommon in this incident; but it serves to recall to our mind those cases of paralysis, and even not infrequently of sudden death, which are believed afterwards to have been diphtheritic. I have seen a girl of twenty fall back dead, apparently, because she sat up in bed when su ffering from diphtheria; and the number of cases of a similar nature which have been recorded should make us extremely careful of diphtheritic cases when diagnosed, and also to use every

means available, in order that diphtheria ambulans-if I may use the expression-may not go unrecognized.

I fear some may consider I have occupied valuable time with a very commonplace paper. Yet such at times may not be without some value.

DISCUSSION OF THE PAPER BY DR. STIRLING.

Dr. Lockhart: There is nothing of more importance to us than the headache caused by eye-strain and other troubles of that kind. I know a man in my community who suffers a great deal with a headache that can not be relieved. I believe that it is caused by fermentation of food.

Speaking of children, we often find that the physician goes along in a careless way and forgets to examine into the cause of these pains. We frequently find little children suffering with headaches and throwing their hands about, and the observing physician noticing this will find the trouble may be traced to the ear and about the throat. I am no specialist, but I believe that these troubles should be treated more carefully.

I was very much interested in this paper and the doctor seemed to apologize for presenting it, but I do not know of any paper that is of more importance to the general practitioner, coming, as it does, in the every-day work of the doctor.

WHEN TO CIRCUMCISE THE INFANT IF NOT

ON THE EIGHTH DAY.

BY SAMUEL A. VISANSKA, PH.G., M.D., ATLANTA.

It is a well-known fact, that according to the Jewish rite, all male children are circumcised on the eighth day, unless for some special reason the physician advises delay; and when the Lord said unto Abraham, “Ye shall circumcise the flesh of your foreskin, and all male children born thereafter, on the eighth day," it must have been for a very wise purpose. This law is still adhered to by the most reformed Jews, which shows that while there is a tendency to cast aside many of the older customs, the act of circumcision will never be omitted. It is not my intention to dwell longer upon this fact, but to take up the subject from the standpoint. of those not of the Jewish faith. It might be of interest to you to know that nearly all male children are born with a congenital phimosis, and unless relieved by the proper methods will cause the symptoms which we will take up later; therefore it is the duty of the physician to examine all males at birth, and instruct the nurse and mother as to the proper care of the prepuce, or if the opening is too small for the urine to pass, circumcision should be performed at once. Unless your directions are faithfully carried out, sooner or later you will have adhesions formed with a pin-point opening, the urine dribbles away or if expelled with force causes "ballooning," the bladder is distended from retention, elimination is not going on properly, which combined

with the adhesions formed gives us quite a variety of symptoms. It would be impossible for me to tell you in every instance when to circumcise the infant, because as I have just said we get such a variety of symptoms from the same cause. However, I will report a few cases, which I trust will prove of great value to you in the future. Before reporting these cases, I desire to impress upon you the fact that when a male child is brought to you for treatment, never forget to examine the prepuce, or else you will surely "slip up." You must not only be a good diagnostician, but a careful one, as we often overlook seemingly small points, which in the long run will either carry the child to the "cradle or the grave."

1. Was called to see Baby H. about 10 o'clock one morning, and as the family seemed so distressed I immediately went to the house. Had never seen the child before, as I learned afterwards they had employed another physician. The mother gave a history of the child's having been sick for several days with fever, bowels running off, and symptoms of great nerve disorder; had had several convulsions. I asked what the physician had pronounced the trouble, and was told meningitis. I then began to examine the child; it was well nourished, pulse very rapid, temperature 104, very nervous, tossing head from side to side, but without the symptoms of meningitis; chest normal, bowels slightly distended, bladder distended; then I examined the prepuce and found a pin-pointer with adhesions. As soon as I found this condition, I felt sure there was a chance for the child to recover. I immediately advised an operation and told the parents that in my opinion that was the only chance for the child to get well. They were at a loss to know what to do, but after a hasty consultation, decided to follow my advice. I immediately returned to my office for the necessary instruments, and

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