Trachoma or granular lids and its sequelæ come next in frequency with thirty-three cases, all white, or 14.5 per cent of the total number examined. The local conditions found were corneal opacities with pannus, or atrophy of the eyeball following perforation of the corneal ulceration caused by the trachoma. Some showed the inturning of the lids, or trichiasis, due to contraction or shrinkage of the scar tissue on the under surface of the lids. Please notice that all of these cases were found in the white children; very few cases have ever been found in the colored race, and those found were in the light mulattoes.

Phlyctenular keratitis or eczema corneæ is the cause of twenty-nine cases, sixteen white and thirteen colored, or 12.7 per cent. This is the scrofulous or strumous disease of the eye, and this will, therefore, account for the large proportion of the colored cases due to this disease, for we all know, being poorly fed and nourished, that he is more prone to this variety of eye trouble than any other during youth. Of all the colored cases in the institution, 33.3 per cent are due to phlyctenular keratitis. The histories of all the cases are about the same, a recurring ulceration of the eye resulting in perforation and collapse of the eyeball or large opacities of the cornea with anterior synechiæ. Nearly all of these cases have eczema about nose, mouth, and eyelids, and enlarged lymphatics or scars showing former suppuration of these scrofulous glands.

Congenital cataract occurs in twenty-four cases, twenty white and four colored, or 10.5 per cent. The most interesting part of these cases were the family histories of those that could be followed. Five of these twenty whites were in one family and two in another, while two others reported other members of the same family at home similarly affected. Some of these cases had been benefited by the Needling operation.

Irido-cyclitis was found in nineteen (19) cases, fourteen white and five colored, or 8.3 per cent. In these cases there were evidences of extensive inflammation of the uveal tract, the pupils being occluded, complete posterior synechiæ, and the eyeball diminished in tension. In several cases there was a history of blindness of other members of the same family; one showed evidences of congenital syphilis in notched teeth and facial expression.

Atrophy of optic nerve found in seventeen cases, thirteen white and four colored, 7.5 per cent of total. On account of the nystagmus or oscillation of the eyeball in a majority of cases it was difficult to deter

mine the exact nature of the atrophy. Seven, all white, had been blind since birth; two were accompanied by microphthalmos; five gave a history of blindness following meningitis, and two measles; two, both colored, were hydrocephalic.

Traumatism in both eyes, or in one accompanied by sympathetic ophthalmia in the other eye, occurred in fifteen cases, twelve white and three colored, or 6.6 per cent. The sympathetic cases showed complete posterior synechiæ and cataract, in fact a degenerated eyeball following a penetrating wound in the sclero-corneal region of the other eye. Sympathetic inflammation is more likely to follow wounds in this location in the eyes of children than in adults, therefore such injuries in children should be watched closely.

The cases discussed above compose about 87 per cent of all the cases examined, and I will go no further into the discussion of diseases that caused only a very small per cent of the total number. I will only mention one other case, which is interesting on account of its rarity, as only about forty cases, I believe, are on record. It is a case of anophthalmos, or congenital absence of both eyeballs. In this case the family history was good, both parents being healthy, but one other child, a sister, was blind. This child otherwise was well developed physically and mentally.

Reports of Societies.

FALLS CITY MEDICAL SOCIETY.*

Stated Meeting, December 4, 1902. Dr. G. A. Hendon, President, in the Chair. Paper by Dr. W. O. Bailey, "The Causes of Blindness in Kentucky." (See page 449.)

Discussion. Dr. Adolph O. Pfingst: I am sorry that I am not able to speak to this paper as I should like, for it is a very interesting one. It takes some one who has examined a large number of blind to get an idea as to the causes. I have looked up the subject somewhat, and believe that the statistics given by Dr. Bailey correspond pretty well with the general statistics. This is surprising, because the figures are generally taken from the standpoint of the laity, and those cited by the essayist are, I would say, cases of real blindness. Blindness means to the layman those cases which are blind for all practical purposes, while ophthalmologists consider an eye blind that has lost absolutely all sight, even perception of light. This accounts for a certain amount of fallacy in all statistics gathered for general use.

We can readily see that there would be a great many blind persons whose sense of pride would influence them not to give in their names for census purposes, and this is another cause of fallacy.

As to the causes of blindness, I think we all ought to be struck with the frequency of cases due to gonorrhea, and realize the importance of washing out the conjunctiva in newborn children. I think the average of blindness attributable to this disease for the entire United States is even greater than 26 per cent. Fortunately, gonorrheal conjunctivitis is much less common in adults than in children, as they do not offer the same possibilities to cure as children.

There is a certain number of cases of blindness, probably 14 to 18 per cent, in which the causes are not known. It is my opinion that in the entire United States about 60 per cent of the cases in which the cause is known may be ascribed to idiopathic causes. Traumatic loss of the eye include a great number lost during the first few years of life. Between one and five years is the period of greatest danger to the eye.

*Discussion reported by Edgar Allen Forbes.

A point which the doctor did not sufficiently impress is the importance of considering brain and spinal conditions in connection with blindness. In the adult the most common cause of blindness is optic atrophy, occasionally associated with brain conditions. I think this takes up the most common causes, but we might enumerate a host of others. These are the ones that interest us most, for these are the ones we come into contact with every day.

Dr. I. Lederman: This paper does not cover all the ground, as it is a tabulation of observations on persons who have become blind in childhood, and does not consider those who have become blind later in life. Of course, adult cases of blindness do not go to an institution. It occurs to me that the important point to consider in connection with this report is, What are we going to do for prevention?

Another thing must be borne in mind, that these statistics cover cases in which the cause of blindness is some years back, and I believe the statistics of a few years hence will give a more favorable report. A great many of these cases of blindness are due to gonorrhea, caused before the introduction of the Credé method. The principles of asepsis are more thoroughly applied now than ever before, and the census of 1900 will show a much better report than the census of 1890. An examination of the children in institutions like this a few years hence will give more favorable results.

It is my impression that most of the children in the institution come from country places and small towns throughout the State, and comparatively few from the large cities. We know that a great many of our trachoma cases come from such sections, where they have not had the benefit of modern knowledge of ophthalmology. Now that this knowledge has been more widely disseminated the general practitioner is giving more attention to diseases of the eye than he did formerly. He at least recognizes the serious nature of certain eye diseases, warns the patient of the dangers, and promptly refers him to the specialist.

Dr. J. M. Ray: I do not know that I can add very much. I have prepared and read two or three papers on similar subjects in various societies, State and local.

I have forgotten the statistics, but one thing that has impressed me is the large number of so-called contagious preventable cases. Purulent ophthalmia has the largest number, and next trachoma, both of which are looked upon as preventable. Both are due to a specific

organism, and both are contagious. I think these statistics will show that nearly half the blind in this State are blind from one of these two causes, and it should impress on us the importance of teaching the people with reference to these diseases and the methods of their prevention.

The question of trachoma is most in the public mind, for the newspapers have been full of an epidemic of acute granular lids in the public schools of New York City. The schools were closed, and I am informed that the institutions were so overrun that they were unable to take care of the cases.

Here in Kentucky we have in certain localities a very virulent form of trachoma. I have seen so much of it that as soon as I look at the case and note its characteristics I can guess quite accurately from what part of the State the case came. There are at least three wellknown centers for trachoma in this State, from which come to us many cases of blindness or hopelessly defective eyes.

Another point brought out in connection with the examination of these cases was the fact that there is no trachoma among the colored children. I have never seen a case of true trachoma with secondary corneal involvement in the colored race. They suffer quite as often with phlyctenular conjunctivitis as the white race, but the clinical distinction between the two is very great. I have never seen in phlyctenular conjunctivitis involvement of the cornea, and they all get well by

treatment.

The paper is a very interesting one, and I am glad that Dr. Bailey has brought the statistics together more compactly than I have ever done in papers on the same subject.

Dr. Pusey: Dr. Ray spoke of the conditions in New York, and I read in a paper a week or two ago that fourteen thousand children had been excluded from the public schools on account of trachoma. To one who was born in a town of seven hundred people that seemed like a lot of people, but the article in the paper was to that effect. The paper by Dr. Bailey does not deal with trachoma, but I think that is one of the most obstinate and disagreeable diseases we come in contact with, and I think it causes more blindness than ophthalmia neonatorum. This has been my experience. As to blindness from other causes, that brings up another phase of the subject, that is, the detection of blindness. I have had to deal with a case of this kind very recently. It was that of a man who claimed to be blind, but so far as