Ophthalmology and Otology. Conducted by Melville Black, M. D., Denver, Colo. INJURIES FROM BURSTING OF LOCOMOTIVE WATER AND OIL GAUGES. C. D. Conkey, M. D., Superior, Wis. (The Ophthalmic Record, May, 1905), quite justly remarks that this subject has not received the attention that it warrants, and the present movement, when there is so much activity in improving the tests for color blindness and the vision of railroad men, seems an opportune time to present it. The oil and water gauges on both locomotives and stationary engines are constantly breaking, and, unless protected by some kind of wire mesh, flying particles of glass are very likely to penetrate the eyes of the engineer or fireman and cause irreparable damage. Dr. Conkey reports several cases thus injured, the vision being permanently damaged or lost. I could add several more, as could almost any oculist of experience. I am informed that most of the manufacturers of locomotives are protecting their oil and water gauges with wire mesh, but that this is not true of stationary engines. Further, that owing to the difficulty of keeping the glass clean while covered with wire mesh, the engineer removes the mesh. Workmen who are constantly exposed to danger, especially in railroading, are prone to disregard little dangers, such as the bursting of water glasses. There is scarcely an engineer of experience who has not seen many gauges break, but since he was fortunate enough to escape injury, he does not regard it of importance except to his engine. A more careful engineer may be subjected unwillingly to danger from the bursting of these glasses because of some former engineer having removed the wire protectors, and the company thus becomes responsible in case of his injury. Manufacturers should be required by the railroads as well as by purchasers of stationary engines to cover the oil and water gauges with wire protectors, and it then should be the duty of the employer to see that the employee does not remove them. A penalty for a breach of this rule could be imposed, which would soon put a stop to the insubordination. ON PERITOMY FOR DIFFUSE CORNEITIS Simon Snell, F. R. C. S. Edin, Sheffield, Eng. (Ophthalmology, April, 1905), discusses this subject. Much has been written in this country upon it, especially by Coover and Fox, but Snell is either unaware of their published reports or sees fit to ignore them. This is altogether too common with our foreign confreres. Snell describes his operation as fol curved scissors. tomy. Snell has performed this operation largely for diffuse keratitis. We take this term to mean the diffuse opacity of the cornea associated so frequently with scleritis. He also performs the operation for recurring ulcers of the cornea, for the superficial ulceration of the cornea which occurs in middleaged or elderly people, and which tends to spread ultimately over a large part of the corneal surface, in cases of detachment of the corneal epithelium, and for relapsing iritis. lows: "Cocain and adrenalin are in- mended rather than a partial peristilled. A speculum is used to separate the lids, and the patient is directed. to look downward. A fold of conjunctiva just beyond the cornea at the upper part is seized with forceps and is then snipped with From this point the severed all round the tance of from 2 to 3 mm. The portion left adhering to the cornea is next dissected up and removed with scissors. The division of the conjunctiva around the cornea is facilitated by using a pair of scissors having one blade somewhat longer than the other and ending in a bulbed extremity, which readily runs underneath the conjunctiva. "Recovery from the operation is usually rapid, especially in young subjects. For a few days a rim of bare sclerotic is visible, but after the lapse of a very short time there is little and later often no indication of any operation having been performed. In no instance have I seen any ill effects from it." The complete operation is recom Personally, I have for years held the operation of peritomy in considerable esteem. At first I performed the operation in cases of pannus associated with trachoma, and later begun performing it in cases of keratitis associated with scleritis. In both these conditions it has served me well. For certain ulcerative conditions of the cornea I can understand how it might be serviceable, and am disposed to try it, although as yet I have never done so. tinct diseases. The swelling of the lymphic glands, elevation of temperature, gradually increasing cachexia, and normal, or only slightly abnormal, morphology of the blood, they have in common, but, in a certain number of cases, the etiology and pathologic anatomy seem to justify a differentiation or classification as distinct diseases. Kundrat distinguishes between true new growths, pseudoleukemia, and lymphosarcoma, the latter being distinguished from new growths by less marked tendency to metastasis, the rare involvement of the organs usually the first to suffer from the development of new growths, and the almost exclusive development of lymphosarcoma in the mucous membrane of the small intestine, its spread by way of the lymph channels and only rarely by the blood channels, and the rare occurrence of retrograde metamorphosis. According to Benda, in pseudoleukemia the swollen glands occasionally break their capsules, while in lymphosarcoma an extension to contiguous structures is the rule rather than the exception, and the disease extends from gland to gland, but there is no swelling of distant glands as in pseudoleukemia, and the liver and spleen are rarely involved. In pseudoleukemia the pathologic process is a simple hyperplasia, while in lymphosarcoma there is atypic tissue formation and lymphoid cells are present. A second group of cases which, since publication of the papers of Pel and Ebstein, have attracted the attention of many clinicians, is characterized by the usual symptoms of pseudoleukemia, but, in addition, also, by regularly recurring periods of febrile elevation of temperature with normal temperature during the interval. Occasionally during these fever periods there is either enlargement or diminution in the size of the glands and spleen., Askanazy has reported cases that ran the usual course of pseudoleukemia, but at autopsy showed a modified gland tuberculosis. Similar cases have been reported by Paltauf, Sternberg, Falk enheim, and Yamasaki. On the other hand, tuberculosis is held to be secondary or accidental by Fischer, Reed, Dietrich, Warnecki, and Hutchinson. Hans R., aged 8, of healthy family, has had whooping-cough, measles, broncho-pneumonia, and diphtheria. Since Jan. 1, 1904, he has emaciated, has seemed unwell, but has had no other evidence of disease. February 3, 1904, his temperature was 38.8° C., spleen soft and palpable, tonsils enlarged, lymphatic glands of the neck, axilla, and inguinal region swollen, and there were anemia and emaciation. Within a few days the temperature returned to normal with occasional rises to 38.1°C. The hemoglobin was 60 per cent., the red and white corpuscle By the end of June there was no improvement. The spleen was larger and harder, and the margin uneven. The glands were larger and additional ones involved, especially in the region of the spleen and scapula. The temperature and the blood-findings were unchanged. The friction murmur had disappeared. July 26 there were marked ciliary injection (left eye), photophobia, lachrymation, clouding of posterior surface of the cornea, precipitates in the anterior chamber, and somewhat deepened, clouded aqueous. The iris was injected, and on the outer margin of the pupil were two yellow, confluent tubercles. Below and to the outer side, surrounded by a network of capillaries, growing from the anterior chamber, there were two similar tubercles with fine capillary network on the surface; in the ciliary margin of the iris four miliary tubercles surrounded by capillaries. The pupils were medium wide, the margin adherent to the capsule and surrounded by a wide pigment band. In the region of the pupil was a slight exudate. Ophthalmoscopically the weak, red, light fundus was not visible. free from injection and there was no photophobia. November 9th, both lower tubercles were smaller. November 11th, in the ciliary region of the iris two new tubercles appeared. November 15th, one of the lower tubercles was reduced one-half in size and the other was smaller than at the beginning of the treatment. November 23d, both lower tubercles were very small and the external miliary tubercies had all disappeared. The inner ones were still visible, but less vascular. December 12th, both lower tubercles had disappeared, the exudate in the region of the pupil was diminished, and the miliary tubercles in the iris were visible as small clear spots. The general condition was good. December 24th, the iris in the region of the former miliary tubercles was atrophic, "slate gray"; the precipitate on the posterior surface of the cornea was much iess; the aqueous was clear and the iris free from capillaries. December 31st, the pupillary exudate was diminishing and the lens was clearer, S=0.3. January 10th, 1905, aside from partial atrophy and posterior synechia (almost total), the iris was normal, the precipitate almost entirely disappeared and the pupillary exudate less marked, the fundus visible and normal, S=0.4. February 5th, the patient was discharged cured; S=0.6. The tuberculin treatment was borne without local or general reaction, and the weight gradually increased-10 pounds in six months. The influence of the treatment on the glandular enlargement was sur prisingly favorable. February 5th, the spleen was reduced to at least onethird its former volume, the margin and surface were smooth, and there was but slight swelling of the glands in the axilla, palpable in the neck and in the inguinal region. Injections (tuberculin) were continued to May 1, when the spleen was further reduced in size; S=2/3. In view of the results of treatment we are justified in believing that this was a case of glandular tuberculosis simulating Hodgkin's disease, and that similar cases should be given the benefit of the therapeutic test-tuberculin. BOOK REVIEWS. ARTERIA UTERINA OVARICA. The Utero-Ovarian Artery or The Genital Vascular Circle. Anatomy and Physiology, with their Application in Diagnosis and Surgical Intervention. Byron Robinson, B. S., M. D., Chicago, Ill. Author of "Practical Intestinal Surgery," "Landmarks in Gynecology," etc. E. H. Colegrove, publisher, Chicago. 1903. Price $1.00. The data on which this monograph is based the author claims to have secured through fifteen years of experimental research and many years as a gynecologist. It is presented to the medical profesison in the hope that it will contribute to the progress of medical science. Although this artery with a part of the abdominal aorta, common iliac and internal iliac was fully described in a monograph, published by the author some years ago as the "Circle of Byron Robinson," the new feature of this book is the utility of the genital vascular circle in surgical intervention on the tractus genitalis. The author endeavors to impress the reader with the fact that the genital vascular circle has more utility in medicine than the circle of Willis, which so greatly governs cerebral phenomena. Since hysterectomy has become a recognized, useful operation, the uteroovarian artery should be studied with care and detail. We know of no other work upon this subject that will supply the reader with so much information as the one under discussion. The numerous colored plates and half tone illustrations enhance the value of the book greatly. This monograph constitutes a good introduction to a wider and deeper study along gynecology. O. M. S. LEA'S SERIES OF MEDICAL EPITOMES. Edited by Victor C. Pedersen, M. D. Arneill's Epitome of Clinical Diagnosis. A Manual for Students and Practitioners. By James R. Arneill, A. B., M. D., Professor of Medicine and Clinical Medicine in the University of Colorado, Physician to the County Hospital and to St. Joseph's Hospital, Denver. In one 12mo volume of 244 pages, with 79 engravings and a colored plate. Cloth, |