He could see perfectly for a few moments, but his eyes would soon tire and trouble him so much that he had to give up all literary pursuits.

His chief complaint to me was, that as soon as his eyes would begin to tire, the print would all run together and mix up so that he could not see any of it distinctly. By examination. I found that the acuteness of vision was normal, and that the refraction was normal; that is, he was neither far-sighted nor near-sighted.

By having the patient fix some small distant object, and covering first one eye and then the other, and observing the covered eye, it was discovered that each eye would deviate slightly outwards under the cover. This proved that there was slight tendency to external strabismus, resulting from defective action or insuffi ciency of probably both internal recti muscles. When he would converge the eyes for a few moments, as he must do in accommodating as in reading, the internal straight muscles, being too weak, would soon give way and the eyes would diverge slightly in spite of the will. This divergence would cause the print to partially double, which would make it seem to run together and mix up so as to make the whole very indistinct.

In this way the chief symptom in his complaint was produced. I prescribed prismatic glasses No. 3, and had the bases placed directly inwards, so as to favor both internal recti muscles; that is to say, the effect of the prisms enabled him to accommodate without having to converge the eyes as much as without them. Thus these muscles are favored by the action of the prisms.

ic glasses, and, notwithstanding the constant use of his eyes in studying, he has had no trouble since. Had not the glasses relieved him, it would have become necessary to perform tenotomy on one or both of the external muscles.

Case 2.—Mr. V., middle-aged man, has always been short-sighted, but No. 10 concave glasses make his vision perfect for distance. Has been wearing glasses, but says he cannot wear them constantly because they make his head ache.

Having the patient fix a small object in the distance, and covering the eyes in succession, I found that each eye deviated slightly inwards under the cover. This showed that there was a slight tendency to convergent strabismus, on account of insufficiency of the external recti muscles, exactly the opposite condition shown in the above case. Upon examining the glasses he had been wearing, I found that they were placed too far apart, so that the visual line from each eye passed through the inner edge of each glass. This position of the glasses produced a prismatic. effect, but, unfortunately, this favored the internal muscles, which were already too strong. This accidental position of the glasses, of course, only increased his trouble. In looking in the distance without the glasses, and more so with them, as he had them, the external recti muscles were not sufficient to hold the eyes straight, consequently they were constantly converging very slightly. This produced a constant tendency to double vision. This caused an unnatural nervous impression upon the brain, which resulted in the constant headache men

I told him to have his glasses set close together, so that each eye would look through the external margin of the glasses, in order that the prismatic effect of the glasses thus arranged would favor the external recti muscles, which are defective or insufficient. The effect of arranging the glasses in this way is the same as if prisms were placed before the eyes with their bases outwards. At the same time the concave glasses correct the myopia.

The patient followed directions, and has worn his glasses ever since without the least trouble of any kind. Had not the glasses thus arranged relieved the trouble, tenotomy of one or both of internal recti would have been necessary

It will be observed that the internal recti in the first case, and the external recti in second case, were at fault. The first patient could not read because the internal muscles were not sufficient to converge the eyes continuously. The second had trouble in looking in the distance, because the external muscles were not sufficient to hold the eyes parallel continuously. This was particularly the case when the glasses were so placed as to produce a prismatic effect in favor of the already too powerful internal muscles, and consequently increased the deficiency of the external muscles to the same exMuscular asthenopia is an interesting subject, but I will go no further into details here.

tent.

SOME

OME two years ago a first attempt was made to issue a Medical Register and Directory of Chicago and vicinity, similar in its scope to those issued by the profession in the larger Eastern cities.

The work was undertaken as a private enterprise by two or three of our well-known physicians. The gathering together of the material for the first issue of such a directory, necessarily involved the expenditure of a very considerable amount of time and labor on the part of the editors. In forming the list of physicians, who were in regular and good standing in

the city, they called in the assistance of a committee consisting of representatives from each of the colleges and public institutions of the city.. The list thus gathered together and passed upon was very good and reliable, as far as it went, although necessarily incomplete, on account of the difficulty of obtaining accurate information.

As a whole, however, the volume was carefully and conscientiously prepared, and met with the general approval of the profession.

The practical value and utility of such a register and directory has been

so far demonstrated by this first attempt, as that a new and revised edition seems to be called for. The former editors being unwilling to take the responsibility of its re-issue, a meeting of the profession was called April 21st, 1874, to consider the best means of continuing the publication. This and a succeeding meeting April 28th, resulted in the organization of the Chicago Medico-Historical Society, which has undertaken to take charge of and continue the publication of the Register and Directory. To that end an editor was appointed with a committee on publication to assist him. A list of all persons styling themselves doctors or physicians was gathered together by the committee, and circulars sent out to each of them, asking for information regarding date and place of graduation, etc. Answers were received, however, from but a small proportion of those addressed.

The complete, entire list, together with such information as the committee was able to obtain regarding those named, either from the answers to circulars or otherwise, have now been submitted to the general Society at special meetings held during the past two weeks. Each name has been called up in succession and the vote passed, after brief discussion, as to whether it should appear in the Register or should be excluded. This, in many instances, has been an extremely difficult matter to decide upon. Persons who had returned no reply to the circular, and regarding whom no information could otherwise be obtained, were justly and necessarily excluded. In several more doubtful cases, however, names have been excluded on mere hearsay evidence or

suspicion of irregular professional conduct, and this, when proper and satisfactory replies had been returned to the circulars. In justice to all parties more time and pains should have been taken to investigate the charges or obtain further information before passing the judgment of the Society.

Again we have to charge that the names of several as grossly irregular advertising quacks as exist in the city, have been passed for admission to the list, and that without the slightest pledge on their part of any desire or intention to reform. The mere fact that a man is not now, at the present time, distributing circulars or handbills or paying for puffs in the newspapers, has no bearing on the matter. What need is there to keep up this expense while reaping a rich harvest of business as a result of former exploits in that direction? Or, after scattering a few thousand puff advertisements, circulars, pamphlets, or books-it matters not which-broadcast through the city, and among our neighboring practitioners' patients, and families, who could not afford to repent and be generous— agree to burn up the few copies that might be left, to be good and do so no more until next time?

The list, as now made up and passed upon by the Society for admission to the Register, is a simple farce. As a list of regular physicians in good standing in the city of Chicago, it is no more worthy of confidence than that given in the general city directory, and which includes everybody, male or female, who chooses to prefix the title of "doctor" to his or her name.

In order to be of any practical

value whatever, the Register should have a full, complete, and carefully revised list of the regular physicians of our city. The formation of such a list must be the work of months, not of weeks. If the Society expect to have the support and endorsement of the general profession in this work, their hasty, inconsiderate action should be recalled, and the list again gone over.

The unworthy names should be expunged and those omitted without sufficient reason be more carefully and deliberately considered. Take six months, if necessary, to do this work deliberately and carefully, rather than disgrace the Society and the profession of our city by the issuing of the list and directory in its present form.

F. H. D.

A

T the last ineeting of the Chicago

Society of Physicians and Surgeons, a very interesting discussion was held regarding the summer bowel affections of children, a full report of which appears in the proceedings of the Society as given in the present number of the EXAMINER. The subject is especially apropos at this season, when this class of affections is so prevalent in all our larger cities.

In a late correspondence received from Dr. B. S. Woodworth, of Fort Wayne, Ind., he states his belief in the essentially malarious origin of cholera infantum and the kindred bowel affections of children. Quinine in combination with opiates he has found most efficient in controlling these cases. He usually combines them as in the following formula:

B.-Quiniæ sulph., grs. xxv.

Tannin, grs. x.

Tinct. opii, gtts. xx.

Ess. menth. pipt., gtts. xx.

Syr. simpl., ii.

M. From half a teaspoonful to a teaspoonful, according to age, to be given every two hours until vomiting and purging ceases.

Dr. Woodworth has had a large experience in the observation and treatment of children's diseases for the past twenty-five years, and his evidence, given as the result of long experience, is therefore of especial value.

These bowel affections of children and the accompanying symptoms which they occasion, undoubtedly vary, however, materially in the type and character which they assume in different localities and in different seasons in the same locality. In the eastern and sea-board cities the malarial element will be found much less evident and frequently manifest than in our southern and western cities. When the distinct exacerbations of fever, and the generally intermitting character of all the phenomena indicate the presence of a malarial element in the disease, quinine is, of course, indicated. In cases of cholera infantum, however, when vomiting and purging is at all active, we have scarcely ever been able to administer the quinine in any form that would