yielded to treatment, but the annoyance still continued. On investigating her habits of life, I ascertained that she was inordinately fond of coffee and gratified her taste very freely. As it seemed difficult to find out other cause of her trouble, I thought that intemperance in this respect might have to do with it, and persuaded her to give up coffee entirely, taking a cup of weak tea at breakfast instead (she had formerly taken two or three cups of coffee at each meal). The patient quickly showed improvement, and within a comparatively short time reported herself as relieved of all eye trouble. Perhaps it might be held that the better sleep which followed giving up excessive coffeedrinking was the chief factor in her improvement, and this may have had its influence, but I have seen some cases of asthenopia in patients who slept well, in whom beginning improvement and final relief from annoying symptoms could be traced, I was convinced, directly to abstention from coffee-drinking.

Cases of asthenopia, reflex to uterine displacement or ovarian disease are certainly not extremely rare.

This entire paper is, I fear, rather elementary and much of it suited to undergradutes, but it may perhaps point one or two lessons. First, not to promise too certainly sudden relief or rapid cure in cases of functional eye trouble, but to give always a guarded prognosis, if we would avoid risk of disappointment to ourselves and loss of confidence of the patient. Second and chiefly, not to confine our investigation exclusively to the eye itself and its appendages, but to extend it when necessary to the entire bodily functions, remembering that all patients complaining of asthenopia have, in addition to the visual organs, a digestive, genito-urinary and nervous system as well.

EUCAINE, WITH REPORT OF A CASE.

BY D. D. QUILLAN, M.D., ATHENS, GA.

It is not the purpose of the writer to enter into a discussion of the various uses of the new anesthetic, eucaine. The profession is familiar with the various, and I might say uncertain, effects of its twin derivative, cocaine. That the latter drug has been of undoubted value all know, but owing to its uncertain effects, it is used by the conscientious physician with great caution-he knowing that very small quantities often produce serious and even fatal results. If these results were produced by the quantity used, they could be avoided, but unfortunately they usually occur when least expected.

It has been claimed by some that eucaine is devoid of danger and produces no bad after effects-that there is no sloughing, as we sometimes have after the use of cocaine. Having seen many flattering reports of the use of eucaine and no reports of any bad effects following its use, prompted me to report the following case:

U. L. H., machinist, aged twenty-two, consulted me on Saturday, February 27, for phimosis. I advised circumcision, which was readily agreed to. After thoroughly washing the parts with soap and water, creoline and bichloride solutions, I injected about one drachm of a four per cent. solution of eucaine, in the line of intended incision encircling the organ, then applied phimosis forceps, introduced catgut sutures and cut off the foreskin, removed the forceps and clamped the penis with them thus entirely preventing hemorrhage-tied sutures and applied dressing to cut surface of absorbent

cotton, sealed over with flexible collodion, completing the dressing by wrapping the entire organ in bichloride gauze. I noticed, immediately following the operation considerable swelling of the foreskin, but the patient experienced no inconvenience from it. On Monday, second day after the operation, the patient resumed his usual work. Four days after I noticed sloughing on both sides in the line of incision, but none on anterior or posterior surface; here we had union by first intention. I used antiseptic washings and dressings daily, and the patient continued his work until the tenth day after the operation. About 8 p.m. I was called hurriedly and found him suffering intense pain, beginning in the foreskin and passing along the organ through the pubic region extending to the spine. I also found clonic spasms of all the voluntary muscles, stiffness of the jaws, indicating tetanic spasms. I at once gave one-half grain sulph. morphine with 1-150 gr. of atropia hypodermically, and one drachm of sodium bromide per orem, followed in thirty minutes by 30 grains each of bromide potash and chloral hydrate. In about two hours the spasms were controlled, except in the left shoulder. This continued during the night and there. was a tendency to return of spasm in all the muscles the following day; but it was controlled by bromide pot. and chloral hydrate. After this the patient made an uninter

rupted recovery.

Did the eucaine have anything to do with the muscular spasms? It certainly produced sloughing of the tissue, which I think likely would not have occurred had I allowed the solution to bleed out of the tissue after making the incision.

I have reported this case to show that there is danger in eucaine, that it will cause sloughing if not allowed to bleed out of the tissue, and that it may be the cause of other bad symptoms, and that it is wise to be cautious in the use of new drugs.

OBSTETRIC SURGERY.

BY JOSEPH EVE ALLEN, M.D., AUGUSTA, GA.

The scientific obstetrician of the present day has to be a surgeon, for the conditions he ordinarily meets with in practice, as well as all unusual accidents and emergencies, have to be treated according to principles that govern in surgery. During the past twenty-five years all progress. in obstetrics has been along surgical lines, and it is certain that the achievements of the future lie also in this direction. The man, therefore, who would keep up with his profession and treat his patients according to the latest science, must. bring to bear in midwifery practice everything that characterizes and makes successful the work of the modern practitioner of surgery.

The brilliant results that are now attained in obstetric surgery are due entirely to precision in diagnosis and rigid asepsis in technique. Before exact methods of diagnosis were known and the necessity for absolute cleanliness in operating recognized, the fear of puerperal fever prevented handling of the parturient uterus and effectually barred all advance in operative obstetrics. The average obstetrician was limited in conservative procedures to version and the forceps, while infantile life was sacrificed to a frightful extent by frequent resort to the perforator and the knife.

In preaseptic times few lying-women escaped some form of infection, and delivery was often accomplished by methods now known to have been improper. Puerperal fever was regarded as a specific affection and frequently raged with epidemic violence, sweeping off thousands of victims,

or leaving them permanent invalids suffering with chronic septic inflammations.

In lying-in hospitals the usual mortality from septicemia was from two to ten per cent. and even higher, and childbirth in such wards was justly looked upon as almost certain death.

The experience of the City Lying-in Hospital of London, which was made the text of Dr. Godson's address before the British Gynecological Society at its last annual meeting, is the common history of all such institutions. This hospital is one hundred and twenty-four years old, and it was quite a common occurrence for it to be closed on account of puerperal fever, while many thousand pounds have been spent in structural alterations, remodeling, demolitions, and rebuildings, carried out under the superintendence and advice of the best sanitarians of the day. All efforts had, however, failed to bring about more than temporary reduction of the death-rate prior to the time when the great discoveries of Semmelweiss and Lister wrought such a revolution in practice. In 1880 the mortality in this institution was one to nineteen. In 1886 the use of antisepties was begun and that year 480 women were delivered without a single death.

The statistics of other public maternities also demonstrate the inestimable benefits arising from change of methods. Thus Leopold in 1887 records 3,089 deliveries, in cluding many operative cases, without a death from septic infection. Slawiansky reports 176,646 labors occurring in Russian hospitals with a mortality of three-tenths of one per cent. and a morbidity of eight and five-tenths per cent. The Boston Lying-in Hospital in 1891 records 550 deliveries with no death. The Sloan Maternity of New York had one septic death in 3,000 cases, and the New York Maternity 957 deliveries with no death from infection.