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Get Both and You Will Not Regret It. Ø

A prominent surgeon of a Southern State communicated with a well-known specialist of Philadelphia, asking him to recommend a good work on Genito-Urinary Diseases. The following was his reply:

PHILADELPHIA, March 10, 1901.

DEAR DOCTOR: Your letter was mislaid, and hence my delayed response, for which I ask pardon.

I think LYDSTON'S book the best general one that can be had. It is published by F. A. ĎAVIS CO., this city. They also publish PSYCHOPATHIA SEXU. ALIS," a translation of Krafft-Ebing's celebrated book. Get both, and you will not regret it.

Very cordially yours,

It may be well to state that neither physician is personally known to the publishers of these two publications.

LYDSTON-

"Genito-Urinary Diseases."

The most marked characteristic of Dr. Lydston's book is the pronounced originality of the views stated, and the personality which enters into every page. Dr. Lydston has had an experience of a great many years, and during that time has developed conclusions which are not based upon a careful study of medical literature. A physician

who secures this book is brought directly to the author, and receives his suggestions at first hand.

Another noteworthy feature of the book is its remarkable comprehensiveness, covering in full detail a wide range of subjects, although presented in one compact volume at a moderate price. No single volume has been issued in recent years on any subject which has called forth more enthusiastic reviews.

Illustrated with 233 Engravings. 1030 Royal Octavo Pages. Bound in Extra Cloth, $5.00, net; Sheep or Half-russia, $5.75, net. Delivered.

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DISEASES OF THE NOSE AND THROAT.

BY

J. PRICE-BROWN, M.D., L.R.C.P.E.,

TH

TORONTO.

HIS volume is pre-eminently a General Practitioner's book, taking up each subject from a practical stand-point and taking nothing for granted. It has been prepared by the author as a treatise which the General Practitioner can utilize throughout, there being no long elaborate chapters devoted to topics only of interest to a few specialists. Subjects which are only of importance to surgeons are omitted, as well as other elaborate chapters on Diphtheria and Hay Fever, now included in many works on general medicine. The General Practitioner can purchase this volume with the knowledge that it will give him a concise, yet detailed, description of the different Nose and Throat conditions which he is likely to meet in his every-day routine, thus rendering the book entirely practical to his uses. The scope of this volume is given by the following review from a well-known authority:

"The whole book bears an individual stamp and will be of the greatest utility, and is much to be recommended to practitioners of general med icine and to students, especially those intending later on to spend more time over the specialty, and who want a clear and sound groundwork."-Journal of Laryngology, Rhinology, and Otology, London, England.

Royal Octavo. 470 Pages. Illustrated with 159 Engravings, including 6 Full-Page Colorplates and 9 Color-cuts in the Text. Extra Cloth, net, $3.50.

F. A. DAVIS CO., Publishers, 1914 and 1916 Cherry Street, Philadelphia, Pa.

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Clinical Lecture.

ONE THOUSAND OPHTHALMIC

OPERATIONS.

(Continued.)

BY L. WEBSTER FOX, A.M., M.D., Professor of Ophthalmology, Medico-Chirurgical College, Philadelphia, Pa.

EPIPHORA, OR WATERY EYE; LACRYMAL

ABSCESSES (80 CASES).

Treatment.-Local applications are only palliative measures when epiphora exists; this is due to the narrowing of the puncta.

No. 2.

danger: false passages are easily made or the knife may break by wedging it within the bony wall. (Figs. 5 and 6.)

In cases where there is pronounced swelling and oedema of the lids it is better. to use an antiphlogistic lotion for several days before opening the canal with the knife. If the abscess has come to a head, Petit's method of operation should be followed: that is, incising the abscess and passing the knife into the canal below the lacrymal sac. In the whole range of ophthalmic surgery this class of cases gives more trouble and annoyance to the sur

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Relief may be obtained by dilating the duct with a fine-pointed probe. (Fig. 1.) When, however, one is dealing with a stricture or an abscess of the lacrymal canal, more radical measures must be applied. Where this condition exists we slit up the canal with a Weber knife. (Fig. 2.) This is followed by passing a goodsized probe (Fig. 3) through the canal, dilating it to its fullest extent, and then inserting a gold cannula. (Fig. 4.)

The slitting of the canal and passing the knife downward is apparently a simple operation, but, still, one not free from

geon and more discomfort to the patient than any other disease with which we have to deal. They are practically never cured; the least exposure to colds or draughts of air causes the tears to flow over the margins of the eyelids, and in many cases produce eczematous eruptions on the cheeks. The presence of pus in the lacrymal sac causes not only an inflammation of the nasal cavities, but also of the conjunctiva, and this condition leads to radical changes in the delicate tissues of the eyelids and Schneiderian membrane of the nose. Not only is the appearance of the eye repug

nant, but the foul odor from the diseased bone in the nasal cavity is most offensive, and renders these unfortunate patients objects of sympathy. It, therefore, becomes your duty as surgeons to try to alleviate their sufferings as much as possible. (Fig. 7.)

The details of the operation are carried out as follows: The surgeon stands behind the patient, supporting the latter's head against his body, and, if the operation is being performed upon the left eye, press the thumb of the right hand over the cheek-bone and just along the lower edge of the eyelid, which by this action is drawn slightly downward and outward. The bulbous point of the Weber knife is inserted into the punctum, and the handle is dropped below the horizontal plane of the

cleansed, and returned to its place. This may be repeated at intervals of several days, until the secretions have disappeared and a free opening is obtained. When a cannula is to be worn permanently, it should be made of gold.

When we meet with a patient who has had more than one operation performed, and cicatricial tissue has formed along the mouth of the sac, it is impossible to use a Weber knife. We must try to make the opening with a different knife, and for this purpose nothing approaches a Stilling blade (Fig. 8).

The method of inserting and passing the knife downward is the same. The incision is followed by the insertion of a large-sized probe and cannula. A very simple method of proving whether the canal is open is to

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eyelid. With the cutting edge of the blade inclined toward the eyeball, the knife is pushed toward the nose, and, when the point has touched the nasal bone, the handle is raised to the vertical position; the cutting edge is rotated forward and is pushed firmly, yet gently, into the canal, burying the blade well up to the handle; this is done without difficulty and without giving much pain to the patient. The knife is withdrawn and by gentle pressure the bleeding is stopped in a few minutes. A silver probe of a large size, which passes well down into the canal, is now inserted, and it is allowed to remain for several minutes; then withdraw it and place a silver cannula in permanent position. The tube is allowed to remain in the canal for several days, when it will be removed,

have the patient shut his lips and close his nostrils with his thumb and finger, and then try to force the air through the lacrymal canal.

As regards treatment in general, mild astringent washes do good in certain cases, as do also dilatation of the puncta or the whole of the canal, and syringing, as first suggested by Anel in 1712; but all of these methods count as many failures as cures. The modern treatment, as practiced by the French and German ophthalmic surgeons, consists in the introduction of fine probes, which, of course, do not dilate the canal to any extent, while many of the English surgeons, on the other hand, dilate the canal to its full caliber. In this country ophthalmologists are divided in opinion ast to which is preferable. My experience

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Fig. 5.-Sciagraph of two Cannulae in Lacrymal Ducts. Occipito-frontal View,

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