sexual function, calcium sulphide has been given to masturbators in similar doses, with success, and no sign of toxic action.

These methods are at your service, if you desire to try them. It is certain that many physicians in active practice are using them every day, and are enthusiastic in their praise. Moreover, it is stated as a fact that no mosquito, flea or louse, or other insect parasite, will bite a person saturated with calcium sulphide; so that there seems much reason to believe that the parasites of microscopic size should be less able to withstand its influence.

The next point I wish to discuss in the treatment of fevers, is that of intestinal sepsis. This is a matter deserving grave consideration. The contents of the bowels are within the bounds of the body, and yet not in it; in so far as that they are outside the influence of its vital forces. They consist of highly fermentable material, with the requisite heat and moisture, and the constant addition of fresh material to keep up fermentive processes. The safety of the body lies in two factors: The constant movement forward and dejection of these matters, and the disinfecting action of the various digestant fluids, especially the bile.

That the first of these is uncertain requires no proof, cases have been reported in which persons have ejected from the bowels substances swallowed seven months or more previously. What possibilities in the way of decomposition and autotoxemia exist here. The practice of beginning the treatment of every case by completely emptying the alimentary canal, is one strictly in accordance with modern science, and supported by common sense as well as by clinical experience.

The influence of the liver in disinfecting the bowels has been largely overestimated. Recent investigations have shown that the bile is an excellent culture ground for various micro-organisms, and that the colon bacillus may in the gall-bladder acquire pathogenic powers. The typhoid bacillus also retires there for recuperation, and descends thence into the bowels with increased virulence; and this is believed to explain certain relapsing cases of the fever, Besides, one of the invariable results of fevers of all sorts, is to decrease or suspend entirely the secretion of bile, and of all the digestive fluids; so that the means of disinfection is cut off at the very time it is most needed.

From this it is most evident that in every fever a certain proportion of the symptoms is attributable to the decomposition of

the contents of the bowels, and the absorption of the toxic substances thereby formed. The use of intestinal antiseptics is therefore a routine procedure in every case of fever, of whatver nature. And when these agents have been given in sufficint quantities to free the stools from all unpleasant odor, it will be invariably found that about 40 per cent of the fever and other symptoms will have subsided. Especially the muscular aching, delirium, headache, restlessness, general malaise, neurotic phenomena, insomnia, and other general symptoms, will be moderated or entirely removed and when 40 per cent of any febrile attack is dissipated, it must be a pretty poor sort of a doctor who can not handle the balance.

Just here let me ask you, not to tell me that the alimentary canal cannot be sterilized. We all know that; but nobody has claimed that such complete sterilization is essential, and the results of the actual use of this system are amply convicing as to its utility, explain it as you please.

We now come to the treatment of fever, per se; and here again our practice is based on the soundest principles of modern pathology. For it is certain that the first step in every inflammation is the derangement of the circulatory equilibrium, whereby an excess of blood appears in the inflamed part, with necessarily a corresponding anemia elsewhere. Now, if we remove this excess of blood from the inflamed part, and restore it to the parts that have too little, it is obvious that the subsequent steps of the attack, diapedesis of white cells, extravasation of blood, etc., cannot take place; and the malady is stopped—jugulated.

We may accomplish this in two ways-by increasing the tonicity of the dilated vessels, or by relaxing those that are contracted and empty. The first object may be secured by giving the powerful vasomoter tensors, strychnine and digitalin; and these constitute the chief means employed by many leading physicians in the treatment of pneumonia. The second may be fulfilled by the administration of the vasomotor relaxants, veratrine and aconitine; and the first named, under the form of tincture of veratrum viride, is perhaps the most popular remedy to-day in the United States for pneumonia.

Whichever is chosen, the same object is attained the restoration of circulatory equilibrium. It is asserted that both these processes can go on together, the cells whose tonicity is below

par taking up the tensors, while those in a spastic state absorb and utilize the relaxants.

At first sight this seems unreasonable, but when we reflect that every living cell in the body selects from the blood what elements it stands in need of, and rejects the rest, there is no special reason for refusing to credit them with a similar power as to the selection of medicines. And if it comes to that, is it so easy to draw the line between foods and medicines?

Besides, those who have put this theory to a practical test are unanimous in their reports, that the results are better than when either the tensors or relaxants, stimulants or sedatives, are employed alone.

The foregoing principles form the basis of modern treatment of fever, per se. Each special form of fever may require special additions or not, as the case may be; such as quinine for malaria, salicylic acid for rheumatism, pilocarpine for erysipelas, etc. And in every case the duty of rendering the house and vicinity hygienically clean, of enforcing a proper administration of the sick room, of guarding against the spread of the infection, remains as imperative as of yore. In fact, the physician who believes in utilizing the resources at his disposal in the treatment of fever, will find his occupation strenuous enough to satisfy the most exacting.

But by the use of the alkaloids uncertainty gives way to certainty. An exact dosage is easily obtained, when an alkaloid is given but one effect may be expected, while in giving tinctures and fluid extracts, all of which contain several different acting active principles disappointment is too often the result.

The practice of the healing art will never become an exact science until the use of the cruder preparations give way to the active principles of plants as represented in the alkaloids. And to-day when alkoloids of most of the drugs used by the medical profession are readily obtained there can be little excuse for not prescribing them.

In closing, I think I am safe in predicting that the time is not far distant when tinctures and fluid extracts will be relics of the past, and all advanced physicians of the day will be using the arms of precision as represented in the alkaloids.

DISCUSSION.

DR. WYMAN-I do not know that I have anything to say on

the alkaloidal feature of the paper; but one remedy that was spoken of, the echinecea agustifolia, is a remedy I have used for a number of years in typhoid fever and from which I have received very satisfactory results, and I consider it one of the most satisfactory antiseptics I have ever had. Sulphate of soda is also another very valuable antiseptic, as you all know. But the remedy suggested is one that is not very commonly known.

THE NEW SURGICAL TREATMENT FOR

GLAUCOMA.*

By DR. HENRY LAMOTTE,

Salt Lake City, Utah.

To

Glaucoma is a disease of many varieties, but the essential condition of all forms is that of increased intra-ocular tension. this condition can be referred all the symptoms of the numerous forms of the disease, but while the symptoms can be so explained, we have hitherto been unable to satisfactorily account for the reason for the increase of tension. The disease was regarded as hopeless as far as treatment was concerned and all cases were allowed to terminate in inevitable blindness until 1828, when Von Graefe discovered that in many cases iridectomy was a curative operation for some forms of glaucoma.

Knies and Weber attempted to explain the increase of tension by attributing it to an adhesion between the root of the iris and the posterior surface of the sclera (the existence of this condition we are able in many cases to demonstrate anatomically). They assume that this adhesion is produced by an adhesive inflammation taking place in the tissues lining the anterior chamber of the eye. Weber claims that in many cases the original seat of the swelling is in the ciliary processes. On account of this swelling the iris is pushed forward until its root is in contact with the posterior surface of the cornea, thus occluding the canal of Schlemm and the spaces of Fontana, the only outlet for the lymphatic fluids of the interior of the eye. The outlet being thus closed and the influx not diminished, the excess of fluid is re*Read before the Rocky Mountain Interstate Medical Society, Cheyenne, Wyo., Sept. 9th, 1902.

tained in the eye, producing the increased tension and change in the shape of the organ.

This otherwise reasonable explanation does not account for the shallowness of the anterior chamber, which, according to the theory just mentioned would naturally, if that theory explained everything, be deeper. Priestly Smith believes that in connection with a retention of fluids in the eye there is an actual growth in the bulk of the lens. In this way he accounts for the shallowness of the anterior chamber, and this explanation is more plausible when it is remembered that glaucoma almost invariably attacks the eyes of the far-sighted.

An explanation which I have not as yet seen in print, but which I have heard several times discussed by oculists, and which seems to me worthy of some consideration, is one which regards the seat of the primary trouble in the nervous structures supplying motor and trophic fibers to the iris and ciliary body. In this connection I would like to call attention to the fact that in about forty cases of glaucoma which have come under my personal supervision the origin of the trouble in all but one case could be traced to a severe nervous shock, to chronic drug poisoning, or to the injudicious instillation of atropine, the latter cause being responsible for somewhat more than half of the cases, and in my opinion does not produce glaucoma on account of its action as a cyclopegic, because other drugs equally as powerful as mydriatics and cycloplegics seem to have no record as factors in the causation of glaucoma.

Let us now consider the treatment of the disease under consideration: Myotics in many cases check the symptoms from which the patient with glaucoma suffers; but the effect of the drug in the class of cases which it most benefits-that is to say, in young, well-nourished patients with acute inflammatory glaucoma -becomes lost from frequent use, and the patient's vision is gradually destroyed during repeated attacks of glaucoma only partially controlled by the diminishing effect of the pupil contractor. As a very learned aphthalmologist recently said to me: "Unfortunately eserine acts very nicely for a short time." In my practice I regard myotics as a temporary means of preventing further destruction of vision until I can gain the consent of my patient to an operation.

Until a few years ago the operation of iridectomy has been