the bowels in one locality, then in a few hours there would be a protrusion in some other region; so that the external appearance of the abdomen was constantly changing. The distention of the abdomen was so great, that it forced its hips and head so far back that there was a backward curve of the body, which could not be changed without the child suffering the most extreme dyspnoea.

The constant attention of the father and mother was required, as there was but one position in which the child could get any rest; and that was in their arms, in the sitting position, with its head thrown far back; and then frequently I was obliged to administer some narcotic to alleviate its suffering. After the child was one year old, there appeared to be a slight change for the better. The abdomen began to diminish gradually in size, the limbs to develop, the dyspnoea to disappear, the appetite to improve, and the child had commenced to assume its normal position. The above changes were quite gradual, but very marked; so much so, that, when the child was eighteen months old, I had its photograph taken again, when the abdomen measured nineteen inches (eight inches and a half less than its former measurement), and its weight was seventeen pounds (the same as it was when the child was ten months old). There was a very marked change in the size and strength of the limbs, as well as in the decrease of the size of the abdomen.

This abnormal growth presented a soft, doughy, inelastic feel, lobulated in form, destitute of resonance, and painless when handled, except, when pressure was made to the abdomen, it would increase the dyspnoea. As to the exact nature of this abnormal development, I must confess it is beyond my province to determine with positive certainty, although I am convinced it belongs to a class of tumors called lipomata, or fatty tumors. This tumor has not as yet entirely disappeared, although it is not one-eighth the size it was, and every indication points to entire recovery. The development of the child had been so much retarded, that it did not cut its first tooth until it was nineteen months old. The chief remedies

employed in this case, outside of those given to relieve the immediate suffering, were sulphur, calcarea, and silicea, although I employed a preparation of the hypophosphites of lime, soda, and potassa, combined with hydrastis, which I believe was of much service in toning up the appetite, strengthening digestion, promoting assimilation, and supplying elements that were indispensable to the complete recovery of the child.

X.

THE SURGERY OF STRABISMUS.

BY JOHN H. PAYNE, M.D., BOSTON, MASS.

I WISH to call your attention to a subject of much importance in ophthalmology, the correction of strabismus by operative measures.

Its importance arises from the fact of the extreme annoyance to the possessor of the presence of this defect, its influence on the integrity of the tissues of the eye, its tendency to the production of a complete atony of the nerve fibres at the fundus oculi from disuse, its frequent dependence on a diseased condition of the fundus that might have been arrested by proper and timely surgical measures, its disfigurement, and, last but not least, its difficulty of correction.

Many measures have been proposed, aside from the simple tenotomy, which, as you know, can correct only a deviation of two lines, whereby the correction might be made more complete, and at one operation; but nothing has as yet proved entirely satisfactory. The principal difficulties have been, inability to estimate the exact amount of contraction of the muscle following an operation, which varies in different individuals; also the limit of correction possible by a simple tenotomy.

The two following methods are meeting with the most favor at present among specialists: the first, a combination of tenotomy of the contracted muscle with an advancement of the tendinous insertion of the opposing lengthened muscle; the second, a rotation of the eyeball within the capsule of Tenon,

- a method recently devised by Dr. de Wecker of Paris, and by him called the "Capsular Method." This latter has not, to my knowledge, been given to the profession as yet, but is still being experimented with by the originator. I had the privilege of personally witnessing the results in many cases, and they seemed so satisfactory that I am induced to explain his method in detail here. After separating the lids by the stop-speculum, catch up a fold of the conjunctiva and subconjunctiva over the tendon of the lengthened muscle, on the side opposite to the direction of the deviation, and one line from the edge of the cornea, and excise a triangular flap threeeighths of an inch in length, and as wide as necessary to produce the desired result, leaving the whole breadth of the tendon of the rectus exposed. Loosen the sub-conjunctiva from the upper surface of the muscle for a considerable distance by passing the blunt scissors around between them. Then, with the sharp-toothed dressing-forceps, nip up a small fold of the capsule of Tenon just at the upper edge of the muscle, and close to the outer edge of the cut conjunctiva, and make a small incision with the scissors through this. Proceed likewise at a corresponding point at the lower edge of the muscle. Introduce the blunt hook into these incisions, and loosen the capsule under the muscle from its attachments to the sclerotic. Draw the cut edges together by sutures, the outer ones including the capsule and the conjunctiva, so as to draw the capsule forward on the eye, and thus advance its attachments. This draws the eye over to that side, and produces a double thickness of capsule along the line of the cut edges, which holds the eye in that position.

This alone will answer in slight cases of strabismus. In excessive cases, combine this advancement of the capsule over the laxed muscle with a severing of the attachment of the tendon of the opposing muscle, as by the old procedure. The amount of conjunctiva excised, and the distance apart of the points of entrance and of exit of the sutures, regulate the result. By this process we have the advantage of being able to correct the slight shades of deviation, and the most exces