railway spine nowadays; the latest literature that he recalled is Erichsen's arguments back in 1876. It is a well-known fact that all the symptoms described by Erichsen were due to lesion of the spinal cord itself. The fact is that cases are quite apt to improve after recovering a substantial sum for damages.

GRANULAR LIDS.

BY B. C. COLLINS, M.D.,

Surgeon Brooklyn Eye and Ear Hospital, Ophthalmologist and Otologist Bushwick and East Brooklyn Dispensary.

My idea of this short paper is to call your attention to that condition of the eyelids which has been very common during the past two years, and which has crowded all eye hospitals and dispensaries in New York City. This condition is caused by the vigilance of the health department, especially of the school examiners, who visit the public schools and examine the eyes of the pupils. This examination is certainly a step in the right direction, but it is carried on in a hurried way by men inexperienced in eye diseases. The inspector pulls down the lower lid. It is somewhat granular in appearance. He fills out a card, usually calls the trouble trachoma, and refers the case to some charitable institution or physician for treatment. The history of a case is about as follows: The patient is generally not aware of any eye trouble, and the parents have not observed that the eyes are out of order, but have brought the child for treatment because they have been told that unless the eyes are treated the child cannot return to school. I have seen as many as 34 such cases in one day at my clinic32 having cards marked trachoma, 2 sore eyes. The cases called trachoma were not trachoma in any sense. In some the conjunctiva was merely congested, blood vesels engorged; others had a blepharitis, and the larger portion showed a follicular conjunctivitis. The simple congestion was due frequently to eye strain from hyperopia, and disappeared under correcting glasses.

The last named condition might be easily taken for trachoma to the untrained eye, and even to those of great experience a case, now and then, may resemble trachoma in some of its symptoms, and a mistake in diagnosis may readily follow.

Some of the text-books do not seem to make a distinction between trachoma and follicular inflammation. Much difference of opinion exists as to whether follicular conjunctivitis should be

placed as a separate disease, or be regarded as a forerunner of trachoma. forerunner of trachoma. It is not possible to classify trachoma otherwise than clinically. The pathologists are unable to find a germ peculiar to it, or one which, if introduced into a healthy eye, will produce trachoma.

Trachoma is a chronic disease of the conjunctiva, subject to remissions. It is due to morbific deposit, which in time causes a destruction of the tissues surrounding it. Repair takes place by cicatrization. The scar having a great tendency to contract The appearances of the different stages differ widely. In the early stages the symptoms are those of a conjunctivitis. The trachoma granules are best seen in the early stages. They are embedded in the conjunctiva, but rise above it. They are irregularly arranged in masses, more numerous on the upper lid, almost wholly confined to the palpebral portion, and the retrotarsal folds.

The following table from Stephenson (Epidemico Ophthalmia, 1895), modified by Norris & Oliver's System:

7: Keratitis in the form of pannus, or ulcer, in about 25 per cent.

8: Frequent. 9: Any age.

10: Conditionally contagious.

In spite of the negative results of the bacteriologist, clinical evidence proves the contagious nature of trachoma. In 1886, a committee of the New York Academy of Medicine, headed by Dr. Derby, called the attention of the Health Department to the prevalence of this disease in homes and asylums, and succeeded in passing a law requiring special precaution to prevent the spread of this disease. The school children of to-day are indebted to this committee for the care they are receiving. From 1886-1902 shows a reduction of 30 per cent. in the number of trachoma cases appearing in New York institutions. The fact that the school children are prevented from attending school, unless they can show evidence that their eyes are receiving attention, is of great benefit.

To quote Jackson (Progressive Medicine, 1903): "Without knowing anything about the microbe that causes it, we do know these things about the disease: 1. Trachoma untreated is highly contagious. 2. Local treatment renders it practically non-contagious. 3. The observance of certain reasonable precautions will practically eradicate the disease."

It must not be confused with follicular conjunctivitis. Standish says that those who doubt its contagiousness confuse it with follicular conjunctivitis. From the great similarity of the two conditions I think it wise that follicular conjunctivitis receive as great attention as trachoma, else an untreated case may be left until the lid changes, leaving a deformed and possibly a sightless eye. The number of cases that I have seen proved to be largely follicular, as I have had them under observation for over three years in some cases, and in most of them a spontaneous cure was the result without a scar. I have also observed large frog-spawn granulations present on the lids of a patient 4 years without inflammatory disturbances. In my early practice I operated on a number of cases of granular lids with perfect results, the lids returning to normal condition in two or three weeks. I thought that trachoma was easily eradicated, but I now believe that my cases were follicular and not trachoma.

The prognosis in the two conditions is entirely different. A complete cure can be promised in the cases of follicular inflammation, but in trachoma we must be very careful of our promises.

In the treatment of these cases, almost every operator has his own preference. In the early stages of both conditions, an operation consisting of the expression of the granules as indicated. In trachoma in this stage it is always indicated and the patient should be warned of the dangers of neglect. After the granulations begin to break down, and cicatrization has begun, an operation is not of much benefit. The old method of treatment with Copper Sulph. is not used so extensively as in years past. But it can be used with great benefit in some cases. The pannus of the late stages is often very difficult to clear, and if dense, may remain in spite of treatment. A new remedy, Copper Citrate, used in the form of ointment 5-10 per cent., is said to be useful. Personally I have observed marked improvement in the pannus in the use of argyrol 20-30 per cent., and also its use in follicular conditions has been followed by brilliant results. Fresh air, good food, exercise, care of the digestive tract, are of great importance.

Numerous instruments have been devised for the operation of expression, but as in every other operation, practice with a certain instrument makes that one the favorite.

Dr. P. Chalmers Jameson's remarks corroborated the experience of Dr. Collins and many others made in children sent out from the Public Schools, many cases being erroneously diagnosed which undoubtedly inflicted an injustice on parents and offspring. On the other hand, every one would admit that a great and good work was being accomplished in that while some were eliminated from the schools unnecessarily, yet with them were the genuine cases of trachoma and other infective diseases of the eye. These were taken out of the schools and subjected to active treatment. It was to this and the precaution taken by the Board of Health as to the prevention of emigrants afflicted with this disease landing in the country that we saw less frequently the marked sequalæ, Leucoma, Ectropiom, Entropiom and blindness which so frequently marked the disease in its chronicity. Dr. Jameson was not quite willing to accept too unreservedly the classification of the follicular types as being altogether distinct from true trachoma. Certainly they were much more amenable to treatment and presented in many instances a different clinical picture, but his own observation corresponded with some others who had seen these types under certain conditions develop into what might be considered genuine trachoma. As to the treatment of this disease by Sulphate of Copper pencil, it was becoming more generally recognized that

while the constant use of cauterizing agents undoubtedly stamped out the disease, the amount of cicatrization produced thereby was greater in the aggregate than that if the disease were let to pursue its own course of cure by self limitation. They would destroy the disease, but the normal mucous membrance was so changed by cicatrization as to become a constant irritant to the cornea as well as to bring about the deformities above. mentioned. The advantages of surgical methods now in vogue were their selectiveness for the abnormal tissues leaving as far as possible the normal alone. This distinction could not be made by the caustics so frequently used in the past. He felt, however, that sulphate of Copper undoubtedly had a place in the treatment of conjunctival affections, when used judiciously on the superficial types of conjunctival disease, not too frequently, nor for too long a period of time.

DISCUSSION OF DR. COLLINS' PAPER BY
J. C. HANCOCK, M.D.

There seems to me to be no reason why an immediate operation in a case of granular lids should not be the rule. We have to deal with an hypertrophied tissue liable to set up a mechanical irritation at any time resulting in pannus, and even in loss of the eye, but also very important is the fact that this tissue is the habitat of an infectious germ, and it should be exposed by incision, and sterilized at once. Treatment with copper sulphate, at the very best, carries the case along for months, and actually often leaves the lid in a condition worse than it would have been had no treatment been employed.

The ideal operation, to my mind, is scraping the lid surface with the Jameson trachomatome, expressing the contents of the granulation tissue, and then for a number of days applying an antiseptic to the lid, at first argyrol 15 per cent., and later an astringent, antiseptic solution.

BRADLEY PARKER, M.D.

BY WILLIAM SCHROEDER, M.D., Chairman of the Hist. Com.

During the last ten years the writer has made an effort to secure a portrait for publication in the Journal of the Medical Society, County of Kings of those of its members who have been called upon to occupy the position of President of the Society and who have completed their life work among us.

From 1822 to 1904 the Society has had fiftyfive presidents. Of these, three have served at different times, of the fifty-two remaining, seventeen are still active members of the Society, thirty-five have passed away. Of this number portraits of twenty-eight, with short sketches of their professional lives have been presented through the medium of the Brooklyn Medical Journal. Of the seven remaining the writer has the pleasure of presenting one, namely, Bradley Parker. He was born in the United States on December 15, 1800, and died in Brooklyn, N. Y., January 16, 1869.

His son was the well-known druggist, Herschell Parker, and a daughter the wife of Oliver N. Bostwick, of this city.

Dr. Parker received the degree of M.D. from the Medical Department of Dartmouth College in 1824. He engaged in the practice of medicine in New York City, but in 1835 located in Brooklyn, for a time at Fulton and Jay streets, and later at 148 Joralemon street. He was physician to the Brooklyn Dispensary in 1846, and became a member of the Medical Society County of Kings in 1836. He held the position of censor in 1838, 1840-41 and 1846-47, Secretary in 1842-43, and President in 1844.

The portrait of Dr. Parker is a copy of a large

one in the possession of Joppa Lodge No. 201, F. A. M., and through the courtesy of that lodge the writer is able to present it. The doctor is here represented as master of that lodge in the year 1853. In 1859 he affiliated with St. Albans lodge, No. 56, of which he was master in 1860 and 61. He was D.D.G.M. of the third Masonic District in 1862, a member of Brooklyn Chapter No. 148, R. A. M., of which he was High Priest in 1858; knighted in Friendship Commandery No. 27, K. T., in 1857, and held the position of Eminent Commander in 1858. In 1859 he affiliated with Clinton Commandery No. 14 K. T., of which he was Eminent Commander in 1860; he also held membership in the Ancient and Primitive Rite 33° Rite of Memphis.

A special conclave of Clinton Commandery No. 14 K. T. was held on Tuesday, January 19, 1869, to attend the funeral of Eminent Sir Bradley Parker, M.D. Full Templar service at Greenwood. St. Albans Lodge No. 56, F. A. M., and Brooklyn Chapter No. 148, R. A. M., were invited and attended the funeral.

WILLIAM SCHROEDER, M.D.,
Chairman of the Hist. Com.

PROCEEDINGS OF SOCIETIES.

THE MEDICAL SOCIETY OF THE COUNTY OF KINGS.

STATED MEETING, FEBRUARY 16, 1904.

The President, J. E. SHEPPARD, M.D., in the Chair.

The meeting was called to order and the minutes of the previous meeting and of the special meeting held February 13, 1904, were read and approved.

The President announced the following deaths: Frederick Randall Winter, died February 5, 1904, member 1893 to 1904.

Henry Jackson Seely, died February 7, 1904, member 1900 to 1904.

George Henry Robins Bennett, died February 6, 1904, member 1865 to 1868.

REPORT OF COUNCIL.

The Council reported favorably upon the following application for membership:

Johns A. Shields, P. & S., 1898.

APPLICATIONS FOR MEMBERSHIP.

Applications have been received from the following:

Charles J. Walker, 2 Brevoort Place, L. I. C. H., 1903. Proposed by J. C. Cardwell, seconded by J. H. Raymond.

Theodore F. Trumpp, 204 Nostrand Avenue, L. I. C. H., 1903, proposed by Membership Committee.

Clayton Sharp, 373 Twelfth Street, P. & S., 1901, proposed by Membership Commitee.

ELECTION OF MEMBERS.

The following having been duly proposed and accepted by the Council were declared, by the President, elected to active membership. C. G. Crane, P. & S., 1900. P. J. Murray, Bellevue, 1895.

SCIENTIFIC PROGRAM.

1. Paper: The Pathology of Nephritis. By Dr. Archibald Murray.

2. Paper: The Clinical Aspect of Nephritis. By Dr. J. C. Bierwith.

3. Paper: On Renal Decapsulation. By J. M. Van Cott.

4. Paper: On Renal Surgery. By. H. B. Dela

tour.

EXECUTIVE SESSION.

The following resolution was offered by Dr. J. H. Raymond, Chairman, Public Health Commit

tee:

Whereas, There is attached to the Department of Health of the City of New York an Advisory Board, whose function it is to advise the Board of Health when called upon in matters pertaining to the public health; and

Whereas, This Board, consisting of eleven physicians, contains no representative from the Borough of Brooklyn, although of the total population of 3,838,024, the Borough of Brooklyn contains 1,334,952; and

Whereas, The residents of Brooklyn, and especially its medical profession, are equally interested with the other boroughs in all matters pertaining to the public health of the city; therefore be it.

Resolved, That the Medical Society of the

County of Kings request the Board of Health of the City of New York to appoint on its Advisory Board such a number of physicians of the Borough of Brooklyn as will adequately represent it; and

Resolved, That the Committee on Public Health be instructed to present in person these preambles and resolutions.

On motion, duly seconded, the resolution was adopted.

The following resolution was also offered by Dr. J. H. Raymond, Chairman, Public Health Committee:

Whereas, There exists in connection with the contagious disease hospitals of the City of New York located in the Boroughs of Manhattan and the Bronx, a visiting staff of physicians and surgeons; and

Whereas, There exists no such staff in connection with the Kingston Avenue Hospital, the contagious disease hospital of the Borough of Brooklyn; and

Whereas, In the opinion of this Society such a staff is of great value, not only as a stimulus to the resident staff to maintain their methods of treatment at the highest possible standard, but also as an assurance to the public that patients sent to such hospitals are receiving the best possible treatment, and further as a help to the Department of Health in establishing in the community a confidence in such hospitals; therefore be it

Resolved, That this Society requests of the Board of Health the appointment of a visiting staff of physicians and surgeons for the Kingston Avenue Hospital, such staff to be selected from the profession of this Borough; and

Resolved, That the Committee on Public Health be instructed to present in person these preambles and resolutions to the President of the

Board of Health.

On motion, duly seconded, the resolution was adopted. Adjourned.

WM. S. HUBBARD, Secretary.

THE MEDICAL SOCIETY OF THE COUNTY OF KINGS.

SPECIAL MEETING, FEBRUARY 13, 1904.

The President, J. E. SHEPPARD, M. D., in the Chair.

The meeting was called to order.

The Secretary read the call for the meeting, announcing that the object was to consider and act upon the recommendation of the Medical Society of the State of New York, that the following form of ratification of the agreement for the consolidation of the Medical Society of the State of New York and the New York State Medical Association be adopted:

Resolved, That the Medical Society of the County of Kings hereby ratifies, approves and adopts the agreement for the consolidation of the Medical Society of the State of New York and the New York State Medical Association, which was unanimously approved and adopted at the annual meeting of the Medical Society of the State of New York held at Albany on January 26, 1904; and the Medical Society of the County of Kings hereby waives notice of an application to Court for an order consolidating said corporations pursuant to the terms of said Agreement, and hereby consents to the entry of such an order without notice; and be it further

Resolved, That the Secretary of this meeting be, and he is hereby authorized and directed to send a copy of these resolutions, duly certified by the President and Secretary of the meeting, to the Secretary of the Medical Society of the State of New York, and to execute and deliver any and all waivers of notice of an application for such order as the Court may require.

A motion was made by Dr. Bristow that this Agreement be adopted, and that the Medical Society of the County of Kings make this Agreement its own Agreement and ratify this proceeding. Seconded.

The motion was discussed by Drs. Bristow, McNaughton, Tredwell, Schroeder, Evans, Delatour, Maddren, Fowler, Stuart, Murray, Browning, Fleming and Jewett. An address was made by Dr. A. Jacobi, and inquiries answered by Dr. W. R. Townsend, Secretary of the Joint Committee of Conference, and Mr. Howard Van Sinderen of Counsel.

Dr. Fleming moved that the invited guests be accorded the privileges of the floor. Seconded and carried.

Dr. Browning moved as a substitute motion that the President, Dr. Bristow and Dr. McNaughton be a committee to take the matter of ratifying this Agreement in charge, and see if some arrangement satisfactory to the Medical Society of the County of Kings could not be made regarding the dues or assessments to the State Society.

Dr. Jewett moved the previous question. The motion to ratify the Agreement for the consolidation of the Medical Society of the State of New York and the New York State Medical Association was put before the house and declared by the President to be carried.

The meeting then adjourned.

WM. S. HUBBARD, Secretary.