used in eyestrain to suspend the accommodative in all cases under forty years of age, and this, I think, is now the generally accepted opinion. But when the patient's time has been limited I have sometimes tried to measure and correct these errors by resorting to some mydriatic, of a modified strength, or to none at all, but neither means has proved satisfactory to myself, nor even to the patient, after a short time has passed. To make such tests and corrections properly requires usually a week, or ten days, and even two weeks is best to be sure of the results, as it is quite as important to be sure of the optician's work after the refraction prescription has finally been decided upon. My optician knows that I always see and pass upon all lenses and frame fittings that he makes by my prescriptions.

The muscles that control the movements of the eyeballs get their incentive for action, for the most part, by involition, and they act not only in pairs, but, as a rule, in double pairs, yet the quickness of their movements exceeds, probably, that of any other system of muscles in the body. Hence the inaction, or out of action, of one or more of these muscles is soon felt, especially when, as is usually the case, there is some coincident refractive error.

Every doctor has had his cases of functional nervous reflexes, each with its own particular phases. Usually such cases are periodic in their manifestations, yet sometimes they are continuous. But when he has eliminated every probable cause for such a reflex, and the patient. persistently returns, he very naturally gets tired of it and enters the case on his notebook as a "nervous crank." Finally he concludes to suggest only rest and seclusion, which is probably the first really good advice he has given his patient, presupposing that, by exclusion, there could be nothing left but eyestrain as the cause. So when rest and seclusion has given the nagged and out-of-gear eye

muscles a little time to recuperate, the nervous manifestations are in abeyance for a time, and the doctor has his cue for an eyestrain, and then when he has accurately corrected it and finds that all the nervous reflexes have disappeared, he will be almost as much delighted as the patient, but he will be even more surprised.

Finally: The importance of correcting astigmatism, particularly when out of the rule, and still more so when it is associated with any form of "heterophoria," is so much more apparent each year that I would urge all medical men to give such cases a more careful thought, and a more accurate investigation. And when the cause and effect in systemic reflexes are shown to be so intimate, there should be no excuse for not eliminating the first, when it is now well known that it can be done with the proper lenses usually, and when not, some modified surgical oper-ation can be added to the mathematical solution of the difficulty.

DISCUSSION OF PAPER BY DR. HOBBS.

Dr. Calhoun: I rise, Mr. President, to speak merely upon the point of operation in cases of eye-strain. In former years a great deal of operating was done, but very little was accomplished. This became a fad and much damage was done, and now the pendulum has swung back the other way. In many cases the nervous trouble was increased by the operation and over-correction sometimes produced, and as a result of this the frequency of the operation has decreased. But this is not the sole cause of these nervous troubles. As has been said, it is necessary to examine into every part of the body, the kidneys, stomach, etc., as they are often the cause of nervous strains and headaches. After you correct the error of refraction you should go on until you have examined every organ and corrected their defects.

Dr. Hobbs (in closing): I think the doctor failed to notice one of the important points in my paper. I tried to state plainly that everything else must be excluded before deciding that eye-strain was the causative factor of the: nervous symptoms.

THE ASSOCIATION OF CATARACT WITH UNCINARIASIS OR HOOKWORM DISEASE.

BY A. W. CALHOUN, M.D., ATLANTA.

It has been clearly demonstrated by recent investigations that hookworm disease is of frequent occurrence in certain parts of the Southern States. Dr. H. F. Harris, professor of Bacteriology in the Atlanta College of Physicians and Surgeons, has made most interesting and instructive observations upon this disease, and his writings should be in the hands of every Southern physician.

During the last few months I have operated upon several cases of cataract associated with and developing subsequent to the appearance of this disease, and I have been impressed with the belief that the hookworm was indirectly the cause of the cataract.

February 1, 1904, I was consulted by Mrs. H., forty-two years of age, from Florida. She was very pale and profoundly anemic (condition found in reputed "dirt-eaters”), with a skin of deep lemon-yellow color and the mucous membrane of the mouth and the conjunctiva almost bloodless. She gave no history of malaria, had not lost flesh and had normal temperature-indeed her health was moderately good, but there was a slight dropsical condition of the lower extremities, which she attributed to her sedentary life. Examination of the urine showed neither albumen nor sugar. Double cataract (chalky white) was fully developed with good light perception, beginning a year after the establishment of the general disease. Examination of the stools showed the eggs of the worm in large num

bers, revealing an undoubted case of uncinariasis. After a few days of vigorous treatment with calomel and thymol, I extracted the cataract from the right eye she made a good and rapid recovery and returned home a few days ago with good vision.

In June, 1903, a boy fourteen years of age was brought to me from the southern part of Florida with well-matured double cataract. He had identically the same general appearance and all the prominent symptoms of the case of the woman above described, the blindness, as in the woman, beginning after the general disease had been in existence about eight months. (Note that all the cataracts. came on after the appearance of the disease.) Specimens of the feces were examined and quantities of the hookworm eggs were found. He had no malarial history. After an active treatment with calomel followed by large doses of thymol, the cataract of one eye was needled and he made a satisfactory, uneventful recovery.

During the same summer (1903), I operated upon two other cases of cataract, associated with similar conditions -One male, forty years of age, from South Georgia, and one female, forty-three years of age, from Florida. Each presented the intense anemic yellow skin, bloodless mucous membranes (conjunctiva a bluish white), normal temperature and freedom from malaria and kidney complications. Both had slight swelling of the lower extremities. As in the others, the cataract in these cases began after the development of the general disease. general disease. In every instance where the examination of the feces was made, the eggs of the worm were found.

I can now recall to mind several other cataract cases, having all these well-marked conditions, but I did not then have any acquaintance with the parasite, and hence no examinations of the stools were made. They were supposed to be suffering from malaria and were treated as