late in the disease. As a rule the more vascular the cornea and the more violent the circumcorneal congestion, the more rapidly does the deposit disappear.

Parenchymatous keratitis has for its etiological factor some constitutional dyscrasia, and inherited syphilis has: been put down as the cause of sixty to seventy-five per cent. of all cases. In the vast majority of instances both eyes are involved, but one is usually attacked a few weeks, or even months, before the other. It generally occurs between the ages of five and twenty, rarely later than thirty.. It is not difficult to make a diagnosis in fully developed cases if we bear in mind certain pathognomonic characteristies, namely: that the deposit is situated in the deep layers of the cornea; that the blood-vessels are in its substantia propria, and disappear abruptly at the sclero-corneal junction in contradistinction to superficial vessels that can be traced from the cornea into the conjunctiva; that mucous or muco-purulent secretion is never present; and that there is a total absence of any tendency to ulceration or abscess. In many cases, during the first few days of the disease, at diagnosis cannot be made with certainty, especially where the punctated spots of infiltration appear primarily near the margin. It is important (for the physician's reputation at least) that a diagnosis be made as early as possible, and the patient's mind impressed with the fact that the disease is always a chronic one; that he may not hope to recover sooner than from six to twelve months; that the fellow eye will probably become similarly involved and run a similar course, and that in nearly every instance the vision is restored to approximately its original degree of acuteness. The prognosis is therefore good as regards ultimate results, but unfavorable as to time, since from six months to two years are required for a case of interstitial keratitis to run its course.

Treatment is divided into local and constitutional, and

is directed to an amelioration of the local symptoms, the prevention of synechia, and the removal of the inflammatory deposit in the corneal tissue.

Locally, then, we use atropia, antiseptic lotions and hot fomentations, and when the eye tolerates it well, yellowoxide-of-mercury ointment or calomel dusted in the eye may hasten the process of repair.

Constitutionally, such remedies are indicated as will hasten absorption, and, since nearly all cases are due to syphilis, either acquired or inherited, there is a twofold reason for prescribing idodide of potash and mercury, the former in large doses (gr. 60 t. i. d.), the latter by inunetion or in the form of the bichloride (gr. 1-24 t. i. d.). As adjuvants to this, iron, cod-liver oil, and generous tonics, when indicated.

Case 1.-Miss E. B., æt. twenty-six, came in March, 1894, with a deep-seated opacity in the pupilary area of the left eye. Had been two weeks in forming. Irritative symptoms very slight. The opacity increased very little in density or extent after I saw the patient. She was dismissed well in six months with vision equal 20/xx w+50 sph◇+50 cyl ax at 120 degrees.

Case 2.—J. H., æt. twenty-three, came in July, 1894, with a slight infiltration near the lower margin of the cornea of right eye. There was quite a good deal of circumcorneal injection, pain, photophobia and lachrymation which persisted till the disease had run its course. In two weeks the entire cornea was hazy and studded with spots of dense opacity. Improvement began in four or five months and continued with a few intermissions till the end of the tenth month when the patient was dismissed well, with vision equal 20/xxw50 sph 50 cyl ax at 105 degrees.

Case 3.-Mrs. L. II., æt. twenty-four, came in February, 1895, with an opacity of the right cornea so dense that the iris could be seen only by focal illumination. This condition.

had been about one month in developing. There was at no time any considerable amount of subjective symptoms, and the patient who was a seamstress continued her work. At the end of the second month many blood-vessels had formed in the deep layers of the cornea, and coincident with this vascularization the infiltration began rapidly to disappear. The patient was discharged well in five months from the beginning of the trouble with vision equal 20/xx.

Case 4-Miss S. S., æt. thirty-two, came in August, 1895, with a deep-seated infiltration of the left cornea. The opacity was central toward the nasal side and gradually faded into the transparent cornea. All the subjective symptoms were quite severe and persistent though the opacity did not increase in extent. No improvement was apparent for several months though she made a good recovery and was dismissed in ten months with vision under atropine equal 20/xx w 1.00 sph÷ 50 cyl ax at 45 degrees.

Case 5.-Master Frank T., æt. twelve, was brought in April, 1896, with punctated spots of inflammatory deposit over the entire cornea of the left eye, the intervening spaces being hazy. There was much circumcorneal congestion, photophobia, lachrymation and pain. The condition .had been developing during several weeks. Two months after I saw the patient the opacity was very much less and the subjective symptoms had subsided. The right eye now became involved and ran a course similar to that of the left one. The patient was dismissed in nine months with normal vision in either eye.

Case 6.-Mary L., mulatto, æt. eighteen, came in May, 1896, with the entire cornea of the right eye densely opaque. It was with difficulty that the pupil could be seen even with focal illumination. There was considerable iritis and the pain, lachrymation, and photophobia were extreme. In three weeks the left eye was in a similar condition.

The

patient was most comfortable with a thick protective bandage over both eyes. She had to be led from place to place. In six or eight weeks improvement began and progressed very rapidly until the subjective symptoms were quite all gone and only a milky film was left as a remains of the opacity. In this condition, six months after I first saw the patient, she passed from under my observation.

Case 7.—J. W. H., æt. twenty-four, came 15th of November, 1896, complaining of "weak eyes." A moderate amount of photophobia, pain, lachry.nation and circumcorneal injection had been developing during two or three weeks. Gave a specific history dating back three years. In another ten days there was a double iritis and deep-seated spots of infiltration in both corneæ. In a short while the iritis subsided and soon thereafter the corneal opacity began to disappear. The acme of the disease was reached sooner in the right eye than in the left. Five months after the first symptoms, the right eye is normal in appearance and only a milky film of the opacity remains. This is the only one of the seven cases reported that has an acquired specific history.

20

[NOTE.-Case 7 was dismissed well, May 15, 1897, with vision under atropine equal in the right eye and in the left eye, with +2.00 sph +75 cyl ax at 90 degrees in front of either eye.]

XX

20 XXX

REPORT OF CASE OF EXTRA-UTERINE

PREGNANCY.

BY JOHN R. SHANNON, A.B., M.D., CABANISS, GA.

I report this case because of the rarity of such cases and the peculiar conditions and the very happy results of the operation. I will give the history of the case as obtained from the woman and the midwife exactly as they reported it to me.

Susie; aged twenty years; married at fifteen years of age; mother of four children, three dead and one living. The operation was in the spring of 1896. One year before the operation, she was taken with severe labor pains; the patient said it was her expected time. It was on Saturday night. The midwife remained with her until late the following Sunday night. A physician was called Sunday morning. The doctor did not think it was full time, but said it was about six or eight months advanced. Pains (the severe pains) ceased in a few days-the doctor having left and likewise the midwife-both despairing of the birth of child. Pains continued to come at intervals, though slight. In the course of a few days-about a week- another physician was called and poulticed the abdomen, and in a short while opened a supposed abscess and a small quantity of pus came from the place. In the course of several months, the opening healed only to break in another place in a few weeks. This place was only about one-fourth inch in diameter; and continued its discharge more or less all the time; though in very small quantities. She continued her household duties until about a month before the operation, when,