is required in addition to careful directions about exertion for some weeks to come. Bleeding of this type usually subsides within a short time. If the hemorrhage is more severe, or if a vessel has ruptured, a hypodermic of morphia and atropia is best given at once. The danger of having blood pass into other portions of the lungs, owing to lessened sensitiveness of the bronchial. tubes, is not very great. These patients often take large doses of morphia without subsequent ill effects. The one great essential is to do everything possible to favor thrombosis. Absolute physical rest and mental quiet are imperative if a low blood-pressure is to be favored. Morphia aids greatly in producing physical rest and no one drug is so effective in allaying mental excitement. The patient is best placed in a semirecumbent position, in which he can expectorate with the least effort; he should not speak above a whisper, and should make no movements which are not absolutely necessary. As physical effort raises bloodpressure, cough should be controlled at all hazards. Codeia or morphia are most effective. The sudden mechanical distension of the lung in the act of coughing may readily dislodge a newly formed clot; or the additional increase in blood-pressure, caused by the physical effort of coughing, may force out a thrombus and renew the bleeding. A hard coughing fit may cause a rise from 90 to 100 mm. in blood-pressure. No physical examination, especially percussion or deep breathing, should be allowed as nothing of benefit can be gained thereby. Since solid food or large amounts of liquid food in the stomach will cause a rise in bloodpressure, nourishment is best given in small amounts and in liquid form so long as there is any sign of bleeding. If high, blood-pressure should be lowered, and if the bleeding is not very severe, a saline laxative may aid greatly; if the bleeding is severe, it should be withheld, since the efforts in bowel movement may raise bloodpressure. Morphia will indirectly help in lowering blood-pressure by its mental as well as physical action. The patient's fears should be allayed if possible. Ice-bags over the heart, if its action is tumultuous, may do good. Common salt and small pieces of cracked ice by mouth are beneficial in the way of suggestion at least. When acute pleurisy complicates hemorrhage the bleeding is often intractable; sudden sharp pain almost invariably raises blood-pressure, and the pleurisy may be painful enough to keep the pressure high. In addition to morphia, strapping may be necessary if the pleurisy and bleeding points are not on opposite sides. A high fever, or even a sudden rise of a degree or two in temperature, usually causes a rise in blood-pressure, and hence

if fever is present it should be controlled. Antipyretics may be needed to lower the fever and indirectly the blood-pressure. Bromides and nerve sedatives are of great value in the nervous. If blood-pressure continues high, in spite of these measures, some of the circulatory depressants, as veratrum or aconite, may be used. However, they are not so efficient in lowering bloodpressure in the excited or hysterical subject unless pushed to almost the toxic stage. Amylnitrite or nitroglycerin give better results with less danger. Over drugging is common in the treatment of hemoptysis, and especially is this true in the use of circulatory depressants, when blood-pressure is already sufficiently low. They are best held in reserve until other and less severe measures fail.

Ergot has no value in pulmonary hemorrhages, either theoretically or practically. Observations made on patients taking large doses invariably showed a rise in blood-pressure with no lessening of the bleeding. Heroic doses, taken on their own. volition for twenty-four and thirty-six hours by two patients, resulted in a blood-pressure of 210 mm. in one case and 185 mm. in the other, with a constant increase in the bleeding. The one subject was of a nervous temperament, which may have contributed to the high pressure; but the other was phlegmatic and not at all excitable. In no instance in a large series of cases could the control of hemorrhage be attributed to ergot. Adrenalin by mouth taken in small repeated doses, or in large single doses, failed to control bleeding. Its effect on blood-pressure in these cases was not marked, though as a rule there was a slow gradual rise in pressure. When given in heroic doses in desperate cases, the results were not satisfactory. Too much dependence is often placed on ergot or adrenalin as specifics in directly controlling hemorrhages. Neither drug has much effect on pulmonary hemorrhage, and certainly the rise in general blood-pressure following their use will tend to increase the bleeding.

Gelatin or calcium-chlorid given in cases which were subject to frequent small oozings, rather than to large hemorrhages, failed to materially check the bleeding. In severe cases, where immediate results were demanded, their action was too slow. In cases where the drugs could be given for some time, rather as a prophylactic than for the immediate control of bleeding, no great benefit could be noted. Neither drug is objectionable since they have no action on blood-pressure. In the same category fall gallic and tannic acids, hydrastis, alum, dilute sulphuric acid, and other drugs given with the idea of increasing the coagula

bility of the blood. Digitalis is dangerous because it causes a decided rise in blood-pressure.

When the hemorrhage has been profuse, and the patient is exsanguinated, normal saline solution by hypodermoclysis may be indicated. It must be given with caution since blood-pressure may be raised to a dangerous level. Small amounts, repeated as required, are safer than one large injection. That the pulse is soft and the blood-pressure is low is beneficial rather than otherwise, since the greatest danger lies in a too high rather than a too low blood-pressure.

The best treatment of hemoptysis requires: (1) absolute physical rest; (2) mental quiet and relief from fear and anxiety; (3) morphin and atropia in sufficient dosage to insure both the preceding; (4) control of cough, fever and pleuritic pain and careful attention to diet; (5) suggestive measures as ice caps over the heart, salt and cracked ice by mouth, etc.; (6) free use of bromides and nerve sedatives in the nervous; (7) nitrites or veratrum when high blood-pressure persists; (8) care in not over drugging or in placing reliance on specifics as ergot or adrenalin; (9) hypodermoclysis with normal saline when indicated.

Notes on Refraction and Eye-Strain, in the Case of 206 Second Grade School Children

BY LEIGH K. BAKER, M. D., CLEVELAND

Two hundred and six pupils, 92 girls and 114 boys, were selected from 12 different schools, the average age being a trifle over eight years. Care was taken to select typical specimens, those nearest the windows being examined, and no pupils were taken from rooms which were not well lighted. The children were examined by rows, from front to rear, just as they were seated, without reference to previous letter-tests by the teachers, and the examinations were made with the ophthalmoscope, in darkened offices or dark halls. In examining each eye, the following steps were taken.

The pupil's accommodation was relaxed and the shadow-test applied, after which the movement of the retinal vessels, in both horizontal and vertical planes, was noted. The general condition of the fundus was then observed and the refraction reading of the ophthalmoscope was recorded. Anomalies of refraction, cataract, and a number of other unusual cases were excluded. The following results were noted.

Qualitative refraction showed 153 cases, or 74%, in which

hyperopia was the prominent refraction feature; 46 cases, or 22.3%, in which astigmatism was the prominent refraction feature; five cases in which myopia was the prominent refraction feature and two cases in which emmetropia was present. Quantitative refraction showed 55 cases, or 26.7%, with more than one diopter of hyperopic astigmatism; 144 cases, or 69.8%, with one, or less than one, diopter of hyperopia or hyperopic astigmatism; five cases with one or more diopters of myopic astigmatism, and two cases with emmetropia,

The general functional condition was found as follows: 65 cases, or 31.6%, showed marked choroidal disturbance, 76 cases, or 36.8%, showed slight choroidal or retinal disturbance, and 65 cases, or 31.6%, showed a normal condition of the fundus at the close of the year.

During the years 1901-2-3, the reports of the second grade teachers, who followed the directions and made the tests correctly, contained the names of 18,798 pupils. According to the Snellen test, 17.4% of these were defective as to vision, but the ophthalmoscopic examination of the 206 children indicates that this was a low estimate, being 9.3% less than appear to have decided errors of refraction. The comparison would suggest that approximately 10% of those children with hyperopia and marked refraction errors are not detected, at this period of school life, by means of the letter-test.

During these years the teachers found an average of 173 pupils (less than one per cent) wearing glasses, whereas the average number reported defective was 1,089. At the beginning of the third year, but a trifle over one per cent of these pupils came to school with glasses, and reports from the different school districts show that most of the children wearing glasses are included within nine of the 87 school districts.

Taking it for granted that the home and school environment of the future will be similar to that of the present, it seems likely that growing eyes will be materially assisted and conserved through the use of properly fitted and adjusted lenses; that following the fevers of childhood greater care of the eyes must establish thorough convalescence, and that more frequent treatment must restore the neglected cases. Among any group of school children a percentage of 22.3 with noticeable astigmatism, of 26.7 with pronounced errors of refraction, and of 31.6 with marked functional disturbance would suggest that a large number of such children could be benefited through the services of an oculist.

These conclusions are not based upon the examination of 206 second grade children alone, but upon the ophthalmoscopic examination of over 7,000 children during my service of nine years in the schools.

Resolutions of the Gallia County Medical Society

Inasmuch as the management of the Ohio Hospital for Epileptics has been subjected to newspaper persecution misrepresenting the conditions in that institution and reflecting upon the ability of the Superintendent; therefore, be it

RESOLVED: That the Gallia County Medical Society protests against the damaging and unfair methods employed by those who are endeavoring to discredit the present management of the hospital; and that it expresses its confidence in the honesty, integrity, personal uprightness, professional and executive ability of Dr A. P. Ohlmacher, the Superintendent of the Ohio Hospital for Epileptics. And be it

RESOLVED: That the Gallia County Medical Society signifies its disapproval of all forms of political intriguery tending to embarrass the authorities of the Ohio Hospital for Epileptics in the honorable discharge of the duties looking to the best medical and administrative interests of the wards of the State. And be it further

RESOLVED: That a copy of these resolutions be transmitted to Governor Myron T. Herrick, and to the Board of Trustees of the Ohio Hospital for Epileptics.

These resolutions were introduced by Dr Charles G. Parker and adopted at the regular meeting of the Gallia County Medical Society held in Gallipolis, November 1, 1904. R. W. HOLMES, Secretary.

Resolutions by the Ninth Councilor District
Medical Society

WHEREAS: Through the medium of the public press the affairs of one of our prominent State Hospitals have been exploited in such a manner as to reflect discredit on the Institution and its authorities; therefore be it

RESOLVED: That the Ninth Councilor District Medical Society, in convention assembled, in the city of Portsmouth, Ohio, this third day of November, 1904, hereby expresses its satisfaction with the high class of scientific work, and its endorsement of the results accomplished by the present management of the Ohio Hospital for Epileptics, and its belief that the executive head of that Institution merits the hearty support of his medical associates generally, and of this organized body of physicians of which he is a member, the same being hereby tendered. And be it

RESOLVED: That this Society sets its definite disapproval on the intrusion into the medical and benevolent institutions of the State of political methods tending to embarrass the governing bodies and executive heads of these institutions in the discharge of the functions looking to the honest and most effective medical and general administration. And be it further

RESOLVED: That the Secretary be instructed to forward a copy of these resolutions to his Excellency, the Governor of Ohio, Myron T. Herrick, and to the Trustees of the Ohio Hospital for Epileptics.

These resolutions were introduced and a motion for their adoption made by Dr S. B. McKerrihan, of Portsmouth. Motion seconded by Dr S. S. Halderman, of Portsmouth, President of the Ohio State Medical Association, and unanimously carried.

The Ninth Councilor District Medical Society is composed of county societies from the following counties: Scioto, Lawrence, Gallia, Meigs, Vinton, Hocking, Jackson and Pike.