sure, in fact, that the projectile did not cut through the membrane of Descemet. He was suffering very severely from acute irido-cyclitis, and here also the lens was well advanced toward complete opacity. Under the use of atropine-which had not been used before-the fact of the existence of a posterior syneehia was developed. The ophthalmoscope gave a very faint red reflex. Saw this case ten weeks later at my office. Cataract was then complete. Posterior synechia no worse than when I first saw it. The inflammatory action had about subsided, leaving, however, an annular staphyloma. The eye was at this time still very painful, and vision in the other eye was not normal. Two week later vision in the uninjured eye being still worse, I performed optico-ciliary neurectomy with entire success. At present, five months after, the eye is free from pain, the annular staphy loma has faded to a mere trace, and vision in the good eye is normal.

I have thirteen other cases before me, wherein is recorded the fact of the lens becoming totally opaque in from five to seventeen days. In some of these there was no wound of the cornea, the injury to the lens resulting entirely from shock. In these cases I use instillations of atropine or eserine, as the first indication, in order to keep the iris out of trouble. As the wound is generally deep, the atropine is called into use the most frequently to prevent posterior synechia, and not that I think atropine capable of lessening intra-ocular tension. According to the best authority, it is claimed that atropine does not lessen intra-ocular tension as it was once supposed to do; but, on the contrary, the intraocular tension in the vitreous is increased by its use. It has the faculty, however, of diminishing intra-vascular tension by paralyzing the muscular coats of the vessels. Eserine has been proved to be capable of lessening very materially the persistent high intra-ocular tension in glaucoma. If our general practitioners were a trifle more persistent in their use of atropine and eserine, there would be a deal of troublesome synechia prevented. And why they allow themselves to be so helpless in this matter is a question that sorely puzzles me. It is not expected that the general practitioner shall enter into the difficult part of eye prac

tice, yet he should by all means be ready with a little knowledge on this important subject for cases of emergency. A little proper aid at the outset has saved many an eye, where neglect would have placed it beyond the reach of all the oculists in Christendom.

PLACENTA PREVIA.

BY

J. W. GRACE, M.D., OF GRACE, JOHNSON COUNTY, ARK.

EDITORS SOUTHERN PRACTITIONER - GENTLEMEN: Please give me space in your valuable journal to mention a case of placenta prævia which came under my observation recently.

On the 2d of February, 1886, I was called to see Mrs. N., æt. 39, who had previously given birth to six children. When I arrived I found a slight hæmorrhage, with little or no pain. She informed me that she had passed several clots the size of a hen's egg. On examination, I found the os dilated only sufficient to admit the end of the index-finger. After a careful examination, I informed her husband that I feared trouble in the wind up, as I believed it to be a case of placenta prævia. The hæmorrhage ceasing, and no pains troubling her, I left, giving directions for Mr. N. to let me know immediately if there appeared the slightest hæmorrhage or pain. She remained quiet and rested well until the evening of the 15th of February, when she was again attacked with slight pains and considerable hæmorrhage, and I was immediately called. On arriving I found my first suspicions to be correct; and upon examination I found that it was a vertex presentation of the first position.

It may be proper here to state the exact location of the placenta, it being attached to the left side of the neck, completely covering the os when undilated, but when dilated to the size of a half-dolla, I could pass my finger by the placenta to the right. All accoucheurs are aware of the difficulties that may occur during the process of turning and delivering. Being loth to give up the advantages of a natural presentation, and seeing tha

there was no time to be lost, on account of the hæmorrhage which was now very alarming, I thought I would try the following measure (knowing that the womb could not, with the child, placenta, and ammotic fluid, hold blood enough to destroy life, especially if it was kept firmly contracted): I first introduced a tampon, consisting of cotton rags well oiled, into the vagina, completely filling it. I then gave a teaspoonful of fluid extract of ergot. I also saturated a handkerchief with chloroform and let her inhale it while a pain was on, taking it away when the pain was off, and applying it again when the pain returned, so as to have her partially anesthetised by the time the ergot began to have its effect, thereby thoroughly relaxing the system, so that there was no danger of rupture. The result was that within forty-five minutes from the time I gave the ergot she was delivered of tampon, placenta, and child, and afterward did well and made a quick recovery.

What I am after by contributing the above, is to know whether it would be as safe as the old method of turning and delivering. If it is as safe, I would much prefer it, as the method of turning and delivering was always complicated with difficulties with me.

OTALGIA.

BY

J. B. CHISHOLM, M.D., Orlinda, tenn.

EDITORS SOUTHERN PRACTITIONER-GENTLEMEN: My attention having been called to a case of otalgia of purely reflex, neurotic origin, I herewith, with your permission, assume the liberty of giving to your readers the somewhat unusual details of the case, with its attendant circumstances.

The subject, in this instance, is a boy, aged eleven years, of a well-defined and delicately sensitive nervous organization - a well-marked exemplification of the nervous temperament. He is of delicate build, exceedingly quick in comprehension, and, as

might be expected, suffers intense anguish during his attacks of otalgia, to which he has been accustomed since early childhood. These attacks are ushered in by acute pain in the ear, constantly augmenting in severity until the climax is attained, when the anguish of the child is revealed in every lineament of the countenance, and vents itself in cries and groans. The climax is preceded and accompanied by an active febrile movement, after which there is a gradual cessation of pain and subsidence of symptoms. The pathology of this case seems to consist in marked hyperæsthesia, reflected from a disordered stomach as the focus of irritation. There seems to be no organic lesion of the structures about the ear, no otitis or otorrhoea, properly so called, and, moreover, these attacks never supervene unless upon an impaired state of the digestive organs, but are not infrequent when the integrity of the digestive system is not perfectly maintained. If the habitual tendency to indigestion inherited by the child from its mother could be aborted, I feel satisfied the otalgia would be of rare occurrence; and impressed with this idea, I directed the use of Lactopeptine when the digestive function became impaired, and a rigorous out-door hygiene for the child, thus endeavoring to foster general physical vigor, and to restrain a highly sensitive nervous organization to which the child has been a helpless victim since the dawn of its existence. The satisfactory results following the maintenance of the integrity of digestion by the means suggested, together with the unsatisfactory results of local palliatives, confirm me in the diagnosis expressed aboveviz., that this is a case of otalgia, due to hyperæsthesia of the tympanic plexus of nerves, reflected from a depraved stomach as the focus of irritation, and unaccompanied by any local inflammation or organic lesion of the aural structures.

Selections.

MANAGEMENT OF BREECH PRESENTATIONS.- At a recent meeting of the New York Academy of Medicine Dr. Robert A. Murray read a paper with the above title (New York Medical Journal, March 13, 1886), which deals principally with the measures necessary to be taken to deliver in breech cases and to diminish the percentage of mortality. The importance of an effort in this direction was apparent from the fact that the statistics quoted from authorities gave a mortality in breech presentations of about one in eight and half cases. Among the causes of this class of presentations were a contracted pelvis, an excessive amount of liquor amnii, violent movements, and a peculiar formation of the lower segment of the uterus. It was also remarkable what a large proportion of the cases occurred in premature labor and multiple pregnancy. The statistics of Simpson went to show how frequently, the child being dead, the loss of tonicity of the spine and the presence of flaccidity in the tissues caused malpresentations; those tables demonstrated that there was a tendency after the sixth month of pregnancy for the head to present.

In a case of breech presentation in which the mother's pelvis was of full size and regular form, and the child of moderate proportions, labor would probably be accomplished without particular difficulty, and the obstetrician had only to wait. If, however, the indications were that the labor would be difficult, if the pelvic cavity was not roomy, or the child of large proportions, version, if it was to be performed, should be done early, before the rupture of the bag of waters. If the case was allowed to progress, no obstruction being met with, the critical moment for the child would be just after the birth of the trunk and lower extremities, for now the cord was in danger of becoming compressed between the unyielding head and the pelvic wall. The cord should be pulled down and placed next the sacro-iliac