A digestive remedial agent of pronounced physiological activity derived from the Dolikos bean of Mexico. 1 promptly converts animal and vegetable aliment into assimilable material for nutrition. Phaselin exhibits a powerful amylolytic and proteolytic action and promotes normal production of natural digestive fluids. Phaselin promptly relieves Dyspepsia, Nausea, Flatulence and Colic. It forms a rational therapeutic basis for the treatment of Ulcers, recent, chronic or indolent, and many obstinate and inflammatory lesions of the skin. For internal administration, tablets; topical application, powder. Liberal samples on payment of express charges. Literature on application to the ALTA PHARMACAL COMPANY, St. Louis, Mo. NEW REVISED EDITION OF THE MEDICAL BULLETIN VISITING-LIST, OR PHYSICIANS' CALL-RECORD. Arranged upon an Original and Convenient Monthly and Weekly Plan for the Daily Recording of Professional Visits. Frequent Rewriting of Names Unnecessary. Physicians of many years' standing and with large practices pronounce it the Best List they have ever seen. It is handsomely bound in fine, strong leather, with flap, including a pocket for loose memoranda, etc., and is furnished with a Dixon lead-pencil of excellent quality and finish. It is compact and convenient for carrying in the packet. Size, 4x 63 inches. IN THREE STYLES. No. I. Regular size to accommodate 70 patients daily each month for Net, $1.25 month for N. B.-The Recording of Visits in this List may be Commenced at any Time during the THE F. A. DAVIS COMPANY, Medical Publishers. PHILADELPHIA: 1914 and 1916 Cherry Street. NEW YORK: 117 West Forty-Second Street. CHICAGO: 9 Lakeside Building, 214-220 South Clark Street. = Clinical Lectures. THE PREVENTION AND TREAT No. 2. its own course, is demonstrated in these children before you from the Blind Institute. The sight really makes one's heart ache to think that all that is beautiful on MENT OF OPHTHALMIA NEONA-earth is blotted out of their lives; sad, too, TORUM.1 BY L. WEBSTER FOX, A.M., M.D., Professor of Ophthalmology in the Medico-Chirurgical ONE of the foremost diseases that confronts the practitioner to-day is that of ophthalmia neonatorum. This disease is one that may not always be brought before the specialist in its incipiency. On that account I shall endeavor to impress upon you students the importance of knowing what treatment to pursue, as well as the necessity of using prophylactic precautions. I desire that each of you, even though you become general practitioners, shall know the first sign of the development of this disease, for the eyesight of the child depends upon the treatment in its beginning. When we consider the abject misery and unhappiness that is before the blind child, we would be derelict in our humane and professional duty if, by our neglect, the sad calamity of blindness fell upon any creature. The treatment for the prevention of this disease is so simple that even the most ignorant can carry it out successfully. is that spirit of dependence that must be theirs; but saddest of all is the thought that, in many cases, with proper prophylactic measures the sight could have been saved. Gentlemen, when present at the birth of a child let this picture come before you and make you even more wary in using every opportunity that is in your power to prevent its formation, or if the disease has already developed then take all precautions to arrest further developments. This disease is one of the most frequent sources of blindness, and is caused by the secretions of the mother infecting the conjunctiva of the eyes in the passage of the child through the vagina during parturition. It is a wellknown fact that during pregnancy there is more or less discharge from the vagina. First impress upon the mother how important it is that there be thorough disinfection of the vagina previous to labor-let her syringe daily that the inner walls may be more thoroughly cleansed with an astringent wash. The environments must be hygienic and all contagious diseases must be precluded. If there is any suspicion that the secretion is purulent, it is the duty of The gravity of the disease, if left to run the attending physician to render the 1 An abstract of a clinical lecture delivered to the senior class of the Medico-Chirurgical College. vagina, as far as posible, aseptic. Thorough vaginal irrigation with antiseptic solutions should be carried out regularly, and more | physician should insist upon, is that the frequently with the approach of labor. mother be wise and cautious in selecting her nurse, for not only her own life, but that of the innocent little one, is at the mercy of the nurse, though I must admit that now in these enlightened days, where our training-schools have reached that high state of perfection and the training for the lifework is so thorough that cases of this character are infrequent. In handling the eye it is so essential that it be done gently, for in many cases the treatment is a failure almost entirely through rough handling by ignorant attendants. Immediately upon the birth of the child take a piece of clean linen or absorbent cotton and wipe both eyes carefully to prevent contamination acquired during its passage through the vagina; then bathe the child, being careful that the water from the bath does not come in contact with the eyes. Drop into the eyes 1 or 2 drops of a 2-per-cent. solution of nitrate of silver (Credé's method). I would suggest that this method be carried out even though there be no discharge of the mother, as this solution is mild and only produces a smarting sensation, and no harm can come from its use. If the nitrate of silver be not on hand at the birth of the child, such simple remedies as lemon-juice, alum, or even hot water may be applied very efficaciously. Professor Pinard, of Paris, recommends the use of lemon-juice as a prophylactic against a prophylactic against ophthalmia neonatorum, instead of nitrate of silver, being efficient, less irritating, always at hand, and can be handled without harm. Then, too, I would suggest in addition to any of the above-mentioned remedies a mild astringent wash: R Hydrarg. bichlor., gr. 1/50- Sodii chloridi, of each, gr. xx. Aq. destil., of each, 311.-M. To Credé is due, more than to any one else, the credit of prophylactic treatment. The efficiency of this procedure in diminishing the number of cases of ophthalmia neonatorum is shown in all maternity hospitals where this line of treatment is carried out, the prevalence having diminished from 10 per cent. of all cases of confinement to less than 1 per cent. Since Credé obtained such wonderful results in his institution at Leipzig, in 1880, it has led to its universal adoption. Another important fact which should not be overlooked, and which you as family Possibly 70 per cent. of the children filling the blind-asylums to-day are left in darkness because the attending physician or nurse failed to use every precaution necessary, either from carelessness or lack of proper knowledge to combat this disease from its incipiency. I am so desirous of making this subject impressive that I shall take every opportunity of bringing patients before you, as they present themselves at our clinic during the winter term. The first evidence of this disease is a teardrop in the inner canthus of the affected eye. This glairy fluid, for it is not a natural tear, if examined closely will be found to resemble gum arabic and appears during the first twenty-four hours. At the end of the second day this sticky fluid has changed its consistency and appearance and it has become muco-purulent at this time. If examined under the microscope, you will find it filled with pus-cells, while it may not have assumed the characteristic of pus to the naked eye, which occurs usually on the third day, when the lids become puffy and swollen-the mother frequently referring to this condition as "a cold in the eye." TREATMENT. This depends largely upon the nature of the infection. The most dreaded complication is the involvement of the cornea, resulting mostly in total blindness. If the cornea assumes a yellow appearance upon everting the lid, then we are warned that | sults; yet it is too early to say that this drastic measures are essential, else the treatment is all that should be desired. ulcer's leading on to perforation will follow. Then, too, applications of trichloracetic If the disease has reached this state, apply acid (solutions of 10 to 20 per cent.) have a 5-grain solution of nitrate of silver to the produced a most excellent effect in beginconjunctiva of lids, and this followed dur- ning ulcerations, only applied to the ulcer, ing the day with a sublimate solution of 1 however, once daily, so that I am led to beto 5000. We must dry up the mucous mem-lieve in the efficaciousness of this treatment. brane and cleanse the surface from pus by applying the above solution to a cotton swab. After placing the head of the child between the knees of the attendant, the body of the child being held by the nurse, evert the upper eyelids and by gentle manipulation the lower one may also be turned out. Anoint the edges of the lids with a yellow salve (hydrarg. ox. flav., gr. 1; ung. petrolei, 3j). The cul-de-sac, up and about the retrotarsal fold, must be thoroughly irrigated. If there is tumefaction of the eyelids, causing the nourishment and circulation of the cornea to be impaired after the fourth or fifth day, apply a solution of eserine sulphate, gr. 1/4, to aq. rose, 3j, in addition to the above treatment, when a decrease of suppuration of ophthalmia will be seen. It will be safe to use eserine earlier in the disease. Since the antiseptic treatment of the disease serious cases of corneal ulcerations are rare, and when the public understands the danger of ophthalmia in the newborn, the number of victims from this cause will be still more reduced. If the patient is placed on treatment while the cornea is intact it can be preserved in a healthy condition. Contrary to the reports made by other ophthalmic surgeons of the favorable results obtained by instillations of atropine, I have failed to see one cornea saved after cloudiness appeared. If the conjunctiva become thick and velvety, apply a stronger nitrate-of-silver solution. The conjunctiva may even be scarified and applications of sulphocarbolate-of-zinc lotion or even the silver solution (20 grains to an ounce) applied. In many cases of recent date where there has been ulceration I have applied protargol -a solution of 50 per cent.-with good re While I am dwelling on the line of treatment to be pursued in this disease, yet I feel that more stress should be laid upon prophylactic treatment and still more force be brought to bear upon legislative measures, for in that alone is our hope for the alleviation of much of the calamity as a consequence of this disease. We know that much has been done in many States for the enactment of legislative laws, compelling ophthalmia neonatorum to be placed among infectious diseases, and rightly so. Then the Section on Ophthalmology at the meeting of the American Medical Association in 1893 adopted a resolution approving of legislation that would compel midwives to promptly report cases of ophthalmia neonatorum to some qualified physician. The inauguration of this movement resulted in the following States taking a stand on the right side: Maine, New York, Connecticut, Rhode Island, Minnesota, Maryland, Ohio, Pennsylvania, Mississippi, Iowa, South Carolina, New Jersey, California, Illinois, and Michigan (there may be other States also, but I failed to discover a record of same). These States cover, as some one has quoted, a population of thirtyfour millions. The difficulties which surround this measure seem almost insurmountable. Owing to this, there has been very little enforcement of this enactment, but when the laity know that a law of this character is on the statute-book, it has its effect and much blindness is prevented. New Superintendent.-Dr. Amand Ravold has been chosen Superintendent of the City Hospital, St. Louis, to fill out the unexpired term of Dr. Sutter. LUPUS VULGARIS-TERTIARY SYPHILIS-PUSTULAR BY JOHN V. SHOEMAKER, M.D., LL.D., Professor of Skin and Venereal Diseases in the Medico- GENTLEMEN: This woman, 60 years of age, applies for treatment on account of an unsightly lesion upon the nose. The external surface of that organ is well-nigh covered by a mass of infiltration. It is red and incrusted. The disease has been in existence for three years. It began in the form of reddish spots, which were very slightly raised above the general level. There is no pain, but considerable itching. Sometimes ⚫ there is a sensation of burning in the parts. The body and alæ of the nose exhibit a general congestion. Upon close inspection I perceive that the affected surface is studded with small elevations or papules, which have a gelatinous appearance. This is manifestly a very chronic affection. Its progress has been tardy, but steady. There has been no disposition to improvement. On the other hand, the papules have not broken down into ulcerated spots. I may say at once that the crusts present in this case are due to an application which has been made. This is not a tubercular syphilide, for the reasons that it lacks the distinctive coppery hue, it is of much slower development and course, and there is no evidence of syphilis elsewhere upon the body. The age of the patient might suggest a thought of epithelioma, but an epithelioma would not remain so long present without progressing to the deep and incurable ulcer characteristic of that disease. Malignant disease is almost invariably attended by pain, but the woman before us has been free from pain. The papules or tubercles of this case evidently originate in the true skin or corium and approach the surface as they enlarge. In bulging upward they give a look and feel 'Delivered in the Amphitheatre of the Medico-Chirur. gical Hospital. of roughness to the skin. The diagnosis is more difficult than usual, from the fact that the disease has not run through all its stages. Its complete evolution is arrested. You have already seen in this arena cases of the same malady which have progressed to the final stage and in which we consequently have the advantage of obtaining a fuller picture of the disorder, for the later stages are quite distinctive. If the case progress unchecked, we should, in course of time, witness ulceration of some or all of these papules. The ulcer, having remained open for an indefinite length of time, would either partially or wholly cicatrize. In that event, the combination of papules, tubercles, ulcers, and scars would be diagnostic of lupus vulgaris. The gelatinous papules of that disease are caused by a small-celled infiltration. While by no means a common affection of the skin, lupus vulgaris is not extremely rare. From time to time I have the opportunity of bringing cases before you, and if you will call upon your memory you will recognize the fact that almost invariably the patients have been youthful. The disease generally commences in childhood. To the rule, there are, however, exceptions. We have, within the last year, had several persons in whom lupus did not develop until the twenty-fifth to the thirtieth year of life. It is very unusual, nevertheless, to meet with one in whom the disease did not begin until the age of fifty-seven. Another uncommon symptom is itching, which is so marked in this case. There is another disease, classified as lupus erythematosus, which sometimes bears considerable resemblance to lupus vulgaris. In the former, however, there are no papules or tubercles, but the patches are covered, especially in the centre, with fine scales, beneath which may often be seen the patulous orifices of sebaceous ducts. varieties of lupus belong to the category of neoplastic affections, and both occur more frequently upon the face. A symmetrical arrangement is described as rather charac |