24. The establishment of a laboratory in 1904. 25. The campaign of education and the practical work done by the Board in the prevention and suppression of pulmonary consumption. Much might properly be said about the circular issued by the Illinois State Board of Health on "The Cause and Prevention of Consumption," which is now in its eighth edition, having been originally issued in 1904: But space does not permit more than a brief reference to this circular, which has been favorably commented upon at home and abroad, and which has been accorded the highest praise by medical journals. In 1908 the Board of Education of the state of Massachusetts wrote to the Illinois State Board of Health, asking for the price of its circular on "The Cause and Prevention of Consumption," in order that it might be distributed in the state of Massachusetts, the Board of Health of Massachusetts not publishing a circular upon this disease. 26. We might refer also to the various circulars issued by the Illinois State Board of Health. These circulars are issued in editions of sufficient numbers to meet the requirements for reasonable periods of time, and are frequently revised to keep pace with the growing knowledge on the various subjects. They are, of course, widely distributed. 27. The publication of a monthly Bulletin, through which the members of the medical profession are kept advised of the work done by the State Board of Health, and are not required to wait as in many states for the publication of an annual report, containing the information desired-which report is frequently published a year or more after the date it is supposed to cover. 28. The prompt establishment and maintenance of inspection and quarantine service in Cairo in 1905, when yellow fever threatened. Southern Illinois. 29. The prompt investigation into the prevalence of pellagra in Illinois, in 1909, and the publication directly afterward of three Bulletins on the subject, reports of which have received praise from medical journals, including the London Lancet. Dr. Egan was a member of Saint Paul's Episcopal Church, Springfield, the American Medical Association, the Illinois State Medical Society, the Sangamon County Medical Society, the American Public Health Association, First Lieutenant in the Medical Reserve Corps of the United States Army, and was also a ThirtySecond Degree Mason and a Knights Templar. In 1887, he came to Chicago, where he married Miss Lillian Beatrice Skidmore in 1889. Mrs. Egan died in January, 1910. He is survived by three sons, Ellis P., Harold H., and Sidney B., and two daughters, the Misses Marian Grace and Dorothy Alice Egan, and one sister, Mrs. H. V. Hunt of Peabody, Mass. We believe that the living will carry forward the work which the dead man loved and to which he devoted his life. Society Proceedings CLARK COUNTY The Clark County Medical Society met at the St. Charles Hotel, Casey, June 12, 1913, at 2 p. m. Members present. Marlowe, Pearce, Duncan, McCullough, S. C. Bradley, Haslitt, Weir, Hall, Johnson, Rowland and Mitchell. Visitors present: Dr. Buckmaster, Effingham; Dr. Stoltz, Dr. Rodgers and Dr. Heywood. Dr. Buckmaster, by invitation, gave a very interesting address on "Metastatic Infection," speaking first of the importance of the lymphatics in this condition, mentioning the tonsils and other lymphatics of the throat and their infections. Called attention to the great frequency of ear inflammations and defective eulosis, heart infections, etc., usually following tonsil hearing and anemia resulting; to rheumatism, tuberinfection. Then spoke of absorption from infected gallbladder, appendix and prostate gland, the metastases following typhoid, scarlet fever and other infections, causing nephritis; the frequency of colon bacillus infection of fallopian tubes, practically all joint infections being secondary from slight lung tuberculosis or other infection in other organs. Toxins may cause the joint affection, not germs. Skiagraphs were shown, illustrating same. The treatment in all metastatic infections, is of course, to remove the primary trouble: diseased tonsils, appendix, etc., or vaccines. Dr. Weir, in discussing the address, complimented the speaker and congratulated the members on the privilege of listening to such an address on such an important subject. Spoke of the great protection of the body by the leukocytes and the importance of keeping in good health. That tuberculosis usually, if not always, affects many organs and not one or two only. Dr. Hall recited a case of heart disease cured by appendicitis operation, which seems to show that removing the cause cured the metastasis. Dr. Johnson considers that we must, by modern methods, determine exactly what the infection is and not have rheumatism and malaria cover so many cases. Dr. Marlow reported a case of threatened puerperal eclampsia at eighth month of pregnancy, patient havalbumin in urine, improves on salines, etc., but soon ing headache, spots before eyes, edema, abundance of relapses. A lengthy discussion followed, in which it was suggested that possibly the normal increase in the physiologic action of the thyroid in pregnancy is lacking and the thyroid extract might do good. That to keep the skin, bowels and kidneys acting as well as possible, by laxatives, baths and diuretics with rest in bed, milk diet, but little drinks and no salt, would probably enable the woman to go to term, but if serious symptoms appear, premature delivery was recommended. Dr. Rowland reported a case of cystitis, which is very troublesome to the doctor, as well as to the woman. The discussion was interesting, bringing out the facts that cystitis, with persistently acid urine, is either tubercular or colon-bacillus infection; that in tubercular cystitis irrigation and especially irrigation with silver solutions, do no good and often make conditions worse, which seemed to be the case here; that minute chemical and microscopical examination of the urine might throw light on slow, difficult cases. Case was considered to probably be tuberculosis of bladder and possibly of the kidneys. Dr. William H. Rodger's application for membership was presented. Rules of the society suspended and he was elected to membership at once. Dr. Weir made a report of the meeting of the state medical society at Peoria, last month. A rising vote of thanks and appreciation was unanimously extended to Dr. Buckmaster for his visit to our society, his excellent address and social, friendly intercourse with us. Dr. Buckmaster, in response, spoke of team work among doctors in towns of two or more physicians, one to do laboratory work for all, another to do surgery, etc.; that the general practitioner cannot cover the whole field of medicine thoroughly and said it has become necessary that doctors go into politics not for selfish motives, but for the welfare of the public, that much money and effort is spent on hogs and stud-horses and very little to conserve the health and lives of the people of our state, which is a very important thing, as all can see when attention is directed to the subject. Society adjourned L. J. WEIR, Secretary. COOK COUNTY CHICAGO MEDICAL SOCIETY No Meeting May 21, 1913 Regular Meeting May 28, 1913 A regular meeting of the Chicago Medical Society was held May 28, 1913, with the following program: 1. "Mechanistic Theory of Disease." (By invitation.) George W. Crile, Cleveland. 2. "Lymphangioplastic Wound Under Local Anesthesia." (By invitation.) John R. McDill, Milwaukee. Regular Meeting June 4, 1913 The program of this meeting was as follows: 1. "What Chicago Is Doing for Her Deaf Children." (By invitation.) Mary McCowen, Head of the Deaf Oral Department, Chicago Normal School. 2. "Remarks on the Pathology of Deaf Mutism." Norval H. Pierce. Regular Meeting June 11, 1913 The program follows: 1. "The Digestive Symptoms of Pellagra." (By invitation.) Seale Harris, Mobile, Ala. 2. (a) "Lumbar Drainage in a Case of Hydrocephalus. Utilization of Myelocele for Drainage Tube." Lantern Slides. (b) "Congenital Absence of Anus and Rectum, with a Report of a Case and Autopsy Findings. Suggestions as to the Failure of the Usual Operations for the Condition. Hypothetical Operation." Lantern Slides. (By invitation.) H. P. Cole, Mobile, Ala. No Meeting June 18, 1913 CHICAGO OPHTHALMOLOGICAL SOCIETY Regular Meeting, Monday, April 21, 1913 A CASE OF PRIMARY SARCOMA OF THE CORNEA L. W. Dean: Three months before being seen, April 24, 1912, the patient, a woman aged 63 years, noticed a brownish flat growth on the cornea of the right eye, which had increased somewhat in thickness. There was no pain but vision failed rapidly. The tumor apparently grew from the anterior surface, was of light rust color, very vascular, 5 mm. in vertical and transverse diameters and the apex 2 mm. above the surface. It occupied the central portion of the upper half, extending a little below the median line, but having above 1 mm. of clear corneal tissue, traversed by numerous blood-vessels. The tumor was enucleated April 26, 1912. Microscopically the tumor was found by Prof. Henry Albert to be a cellular mass of tissue, not covered by epithelium, but overlapped at the edges by the epithelium of the cornea. It was well defined from the corneal tissue but there was nothing, to suggest capsule formation. The corneal epithelium was absent beneath, but Bowman's membrane was intact except in the center and the substantia propria at this point was slightly infiltrated by the tumor. The cells were large, round or oval, oat-shaped and some slightly spindle-shaped, with mitotic figures numerous, and a few cells containing finely granular yellowish pigment suggesting melanotic sarcoma. Blood-vessels were numerous and were surrounded by small lymphocytes. Collogen intercellular fibrils were shown by Van Gieson's and Mallory's stains; fibroglia fibrils were also present. Diagnosis, sarcoma,' originating entirely from the cornea, probably from the superficial layers of the substantia propria. Dr. Derrick T. Vail, Cincinnati, reported a case in which a diagnosis of melanosarcoma of the cornea had been made by the junior ophthalmologist in the Cincinnati Hospital, Dr. Wooley. Dr. Vail had diagnosed it as a soft fibroma. The anterior elastic membrane of the cornea was not invaded; it was a purely epithelial growth and seemed to spring from the usual site of a pterygium. It had extended entirely across the pupillary area and the pupil could only be seen by looking obliquely under the tumor mass, which was fungoid and dark in color and was easily stripped from the cornea. It is now nine months since the tumor was removed and the cornea is perfectly clear, with no evidence of return and no scar. Dr. J. E. Colburn reported a case in which he removed what was supposed to be pterygium from the inner canthus. In a few months it had returned and covered an area three times its original size. It was removed again and in about six months the patient had an irregular swastika-shaped tumor over fivesixths of the entire cornea. It was determined after its first removal that it was a melanosarcoma. It was removed with a white-hot electric needle or curet, going over the entire surface of the cornea and burning it quite deeply. Recovery was uneventful and prompt. It was removed ten years ago and the patient, a physician, was seen a few weeks previously, when that eye gave the best vision and there was no scar on the cornea. The method was suggested by an operation in Dr. Greenleaf's clinic in New York. Dr. C. H. Francis said the question to decide is whether the growth is malignant. From the morphologic appearance it is impossible to determine the origin of the cells. They are epithelial cells smaller in type and simpler than the epithelial cells proliferating in carcinoma. Many of them show that they are not undergoing differentiation and the question is as to their origin. Von Recklinghausen would say they are epithelial in origin, and Unna would pronounce it a nevus in the conjunctiva. He claims to have found that the outlying foci show connection with the surface epithelium, and in opposition to Von Recklinghausen's theory most of these cells are arranged vertically and not horizontally, as they would be if they rose from the lymphatics. Ribbert, on the other hand, claims they originate from the connective tissue cells. All these questions are important to determine in pigmented nevi that show proliferation. If we follow Unna, it is a carcinoma. If Ribbert's theory is right they must be classed with the sarcomata. This case shows the connective tissue cells proliferating, but they are in the same horizontal meridian as the blood-vessels and may have originated from the vessels. We know, too, that epibulbar carcinoma and sarcoma are both very vascular. Labor and Parsons believe that when a nevus cell becomes malignant it is carcinoma. On the other hand, Fuchs says without reservation that if a nevus cell becomes malignant it always develops into a sarcoma. Dr. Oliver Tydings referred to a case reported by him to the Mississippi Valley Medical Association in 1894 in a man 75 years old. He advised removal of the growth on the cornea. As he couldn't guarantee the integrity of the globe after removal, operation was refused. Three or four months afterward the patient came back with large and painful ulcer, which wasn't very vascular. It was dissected out and sent to the Columbus Laboratory, where it was reported to be a melanosarcoma, not very vascular. He did not report that as a primary sarcoma of the cornea, a neoplasm which he believes is very rare. He had hunted up the literature and at that time could find no report of a case in this country. A few cases were reported by Parsons, all foreign, some questionable. It was reported by him as a sarcoma of the anterior segment of the globe. Fifty years before the man had got a wheat beard in the eye and had had a sore eye for a long time. There was one spot which Dr. Tydings did not succeed in removing. He believed the man had suffered a perforation of the cornea and iris prolapse and later this growth had started. The cornea was clear all around. Vision three years ago, five or six years after removal, was 20/20. There had been no recurrence. Dr. L. W. Dean emphasized the fact that the tumor at its nearest point was separated 1 to 1.5 mm. from the sclerocorneal junction. It was removed a year ago. As Dr. Tydings has said, primary sarcoma of the cornea is exceedingly rare, and consequently Professor Albert was careful before making a definite report on the structure of the tumor. CONICAL CORNEA Dr. J. R. Hoffman reported a case of conical cornea complicated by ulcer right cornea in a girl aged 15 years, who had had bulging of right cornea for several years. June 14, 1910, it began to be inflamed. Examination shows large conus of right cornea protruding between lids and a large deep ulcer of the apex of cone Left cornea with Descemet's membranse presenting. moderately conical. R. V. perception. L. V. 20/200 with no improvement with lenses. Right eye atropinized and ulcer cauterized with galvanic cautery. Pressure bandage and atropin instilled. June 29, 1910, ulcer still being unhealed, used galvanic cautery again. July 14, 1910, ulcer healed, cornea markedly flatter. Ordered dionin, 5 per cent., twice daily, continued atropin, leaving off bandage. Continued dionin in increasing strength until patient was using 20 per cent. ointment at home every other day and powder in the clinic once a week. Atropin 1 per cent. until Sept. 13, 1910, when inflammatory signs and tenderness had disappeared. Vision at that date was R. 20/200, L. 20/200, no improvement with lenses. Opacity of cornea steadily decreased from at least 8 mm. in diameter to present size, till about a year ago since when it has remained stationary. At present time, R. V. 20/200, L. V. 20/200, no improvement. In a case of dislocation of the lens reported by Dr. Lloyd, his method of getting the lens into the anterior chamber was interesting. The lens had been dislocated and had gone back into the vitreous. He had the patient in the hospital on his face with the hope that the lens would come into the anterior chamber, without effect. He then had the patient make a number of forward quick bowing movements which brought the lens into the anterior chamber, from which it was extracted. Dr. Oliver Tydings, referring to conical cornea, reported the case of patient some years previously with injury to the cornea which under the slightest provocation would rupture. In that case he tried an elastic bandage, the patient at first wearing it all the time, with a small pad underneath, and for about eighteen months at night only. This condition had been existing for five years and constantly recurred. Several years after this treatment there had been no recurrence of rupture of the cornea. He certainly would resort to that treatment before adopting anything more heroic. ECTROPION OF LOWER LID Dr. Frank Brawley reported for Dr. Frank Allport a case operated on by the latter for extensive ectropion of the lower lid. The operation consisted in taking a long flap from the temporal region, leaving it attached by a pedicle, and swinging it to the lower lid which had been prepared beforehand. An incision was made just below the lid margin, the lid raised and the flap sewed into this open space left by the incision. On one side the tip of the flap sloughed and the result was not quite as perfect as on the other side. The man was suffering from a deeply injected conjunctiva from the exposure, and corneal ulcers. He is now able to close the eye, and Dr. Allport proposes to raise the lid still further, and do a blepharoplasty on the left eye where, at the outer canthus, the closure is not complete. CORNEAL MICROSCOPE Dr. H. S. Gradle exhibited a corneal microscope which had been constructed from the tubes of an ordinary ophthalmometer. The ophthalmometer is essentially a telescope or microscope with a pair of birefringent prisms. The conical tube shown contains the prism and the objective. This is pulled out and another tube without the prisms is substituted for it. The ordinary high power loupe is rather insufficient to examine the cornea and the anterior aspects of the tissues have become accustomed to the presence of the parasite and are only moderately disturbed, not sufficiently to discharge the parasite. Vaccine therapy differs from vaccination, in that it is apparently adding to the infection. Vaccination is of no value after infection is begun, but vaccine therapy is useful where the infection with a mild parasite has become subacute, where the infection is on the surface and has not become completely discharged, and where the infection recurs because of a short immunization period. Toleration may be established, in which state the host is not sufficiently stimulated to dispose of the parasite. Mixed infection usually ensues, with final recovery owing to overgrowth of one species, until finally saprophytes remain, to be finally discharged. In surface infection absorption of toxins is slow and antigens do not reach the circulation, and sufficient resistance is not stimulated until vaccines are given. Short immunity is due to low opsonic index, which may rise but falls again with recurrence. Shotgun methods should not be used, but a bacteriologic diagnosis should be made so that the system may not have to destroy unnecessary toxins. To an extent the procedure is specific, but not absolutely so. Cases should be selected by the rate of advance of the infection, the degree of reaction to the infection and the stage to which it has advanced. Applied early in slowly increasing invasions, rapid abortion of the attack may be induced. The application is indicated when the patient is not reacting against the infection. In recurring infections the short immunity period may be extended by vaccines, as in general mixed mucous membrane infections of the respiratory passages. The contra-indications to vaccine therapy are, rapid fulminating infections, confined infections, whether the patient is reacting or not, which should be drained; old chronic infections with a mechanical feature interfering with recovery; cases that have been absorbing excessive toxins; cases in which there is an underlying nutrition defect, which in itself prevents formation of immune bodies. If there is not at least a moderate reaction after injection the vaccine is not right, and if there is not early evidence of recovery some other treatment should be used. In principle, it may be said, the nearer the natural conditions of virulence are represented in a vaccine the more certainly will the normal defense be stimulated. A RÉSUMÉ OF PERSONAL EXPERIENCE WITH VACCINE Dr. William A. Mann: Based on two years' experience with private cases Dr. Mann had previously made two reports with vaccines in phlyctenular keratitis, corneal ulcers, non-specific iritis, chorioiditis and uveitis and penetrating wounds of the eyeball. His conclusions then were that a mixed vaccine of staphylococcus and streptococcus was of decided benefit, and at this time, three years later, feels still more confidence in such vaccines in the diseases mentioned. In the diseases named, due to endogenous infection, it was hardly feasible to make an autogenous vaccine, but in some the offending germ could be obtained by paracentesis. Therefore the mixed vaccines were mostly used. In phlyctenular conjunctivitis improvement was rapid and there was seldom a return. In phlyctenular keratitis healing of the ulcers was hastened, but the most decided results were obtained in the chronic type. One injection was usually sufficient, with a second to assure the cure. In one case of tubercular type improvement was not rapid nor permanent, but improvement was noted always after vaccine. Tuberculin in addition was advised. In episcleritis the inflammatory signs disappeared after on or two injections. In nonspecific iritis, if given in the early stage, pain is increased for twelve to eighteen hours, when improvement begins. Either abortion or shortening of the disease occurs. Chorioiditis was treated in only a few instances. There was improvement in all cases of uveitis except one, which did not return after the first injection. Vitreous opacities and deposits on Descemet's membrane are not much influenced. They are due to endogenous infection from a focus elsewhere in the body, as the intestines, nasal sinuses, mouth, vagina, gall-bladder, etc. According to S. Mayou staphylococcus is responsible for most cases. In cases in which tuberculosis was present improvement was not so rapid. The vaccine has been used as a prophylactic in traumatic operative cases, cataract in rheumatic patients and iritis. It does not always prevent cyclitis. The adult dose is 30 million streptococcus, and 100 million each of Staphylococcus albus and aureus. A smaller dose for women and a proportionate dose for children, given at three to five-day intervals, gradually increased. The local reaction never goes on to suppuration, though it may be severe. Fresh vaccines cause greater reaction. The preservative may cause some smarting. The treatment need not interfere with any other treatment. THE DIAGNOSTIC REACTIONS IN THE DIAGNOSIS OF GONORRHEAL DISEASES OF THE EYE Dr. Ernest E. Irons said he wished to discuss under this title the reactions which we at present have command of which will be of value in seeking a diagnosis of gonorrheal infections of the eye rather than to advocate any particular reaction. He understood from ophthalmologists that there are a large number of lesions of the eye which up to recent years have been extremely obscure in their etiology, aside from the conjunctivitis of gonorrheal origin in which there is little doubt of the diagnosis, such as certain cases of metastatic conjunctivitis or ophthalmia; cases of iritis which have been ascribed to rheumatic causes, and it seems probable that a certain proportion of these are due to bacterial infection of metastatic or embolic source. There is also a rather similar nomenclature in dealing with the joints, and some of their features are similar to those of some of the obscure cases of iritis. Some years ago many arthritides in which the etiology was not definitely made out which went on to more or less destruction of the joints were classed as arthritis deformans, and it was assumed that nothing further could be done aside from general supportive treatment, diet, etc. Now gradually that large class of arthritis is being cut down by taking out here and there cases which are believed to be of infectious origin and that there is some focal infection responsible for the invasion of the avascular structures such as the serous membranes of the joints, and many of these are gonococcic, and likewise many cases of obscure iritis have been pretty conclusively proved to be of gonococcal origin. And here the question is whether they are of toxic origin or of metastatic origin. The same question has been raised with relation to the joints, and the more the question is studied the more we are convinced that they are of metastatic origin. In a case, for instance, in which iritis and arthritis have developed within a short space of time there is no reason why we should ascribe a toxic pathology to the iritis and a |