eight additional, treated since, there were two having compound myopic astigmatism.

The action on the lids, from strain of the eyes, was so marked in one of these cases that I feel it necessary to relate it, as it explains the cause of his blepharitis.

Case of March 5, 1877. Mr. E. C. S. After wearing his distant glasses for a while, his eyelids became perfectly well; when one day he had considerable writing to do, and having forgotten to take his reading glasses with him to the office, he attended to all the business, writing until quite late with his distant glasses. The next day the blepharitis was as bad, if not worse, than ever. I have particularly cautioned him about doing this foolish act again. His eyes have again resumed their healthy appearance.

"Also in the case of date June 5, 1876, the hypermetropia was, without doubt, the cause of the blepharitis; as the lids of only one eye were affected, and this was the hypermetropic one, while the other was normal, and no defect of refraction could be found."

"The question would naturally arise, How can ametropia be a cause of blepharitis?" "

"That ametropia of any kind or form causes in all acts of vision a strain more or less upon the eye, which creates a hyperæmic condition of the neighboring parts, is a well-known fact, as may be seen in many such cases by red and congested conjunctiva and edges of the lids after use at close work or reading. In cases where the strain is so great as to create a continued hyperæmia of the edges of the lids, the extremely fine ducts and external openings of the small sebaceous glands (Zeiss's glands) that are to be found in the canals and follicles of the ciliæ, become closed by pressure, from the swelling of the tissue and vessels surrounding them, and having no outlet for the natural secretions, which are now increased by the hyperæmic condition, a choked status is formed, and inflammation and suppuration take place, as may be noticed in the little pus bead that is found encircling the cilia and extending down the canal to the gland."

"Rest of the eyes, with proper local treatment, removes in time this suppuration and inflammatory action, and apparently the whole disease is cured; but on resuming active use of the eyes, the same condition of hyperæmia returns, with eventually the whole former trouble. But, when the ametropia is corrected, and the strain on the eye removed, there will be no return of the condition of hyperæmia, and a perfect cure of the blepharitis can be made."

I would ask here, "Could the ametropia have been the cause of the styes in the two cases casually mentioned?" Since using their glasses, now over six months, there has been no return of the painful

malady. And would it not be well to examine the state of refraction of the eyes in cases of recurrent styes, as well as in all the affections of the lids and conjunctiva that present themselves?

I have looked over the following recent works on ophthalmology: Stellwag, Wecker, Galezowski, Schweigger, Wells, Graefe und Saemisch, Tetzer-Gruenfeld, von Graefe's Archiv, Zehender's Monatsblätter, Ophthalmic Hospital Reports, Annales d'Oculistique, Journal d'Ophthalmologie, Archives for Ophthalmology and Otology, Donders on Accommodation and Refraction, and Nagel's Jahresbericht, without finding any mention of this connection of ametropia to any of the above-mentioned forms of diseases of the eye.

Note. Since preparing and reading the above paper, a few cases have come to my notice, which I take the liberty of adding:

June 18, 1877. Mr. H. G., æt. 28. Eyes inflamed for two years.

June 19, 1877. Mary K., æt. 14. Papillary granulations all over the conjunctiva of the lids and bulb for the past three years.

June 20, 1877. J. M. J., æt. 16. Student. Has been having small styes on the lids for the past five or six years.

June 23, 1877. Sarah McN., æt. 27. Phlyctenular conjunctivitis. Reports that she has had such inflammation off and on for many years.

July 6, 1877. Miss F. S., æt. 18. Has always had weak eyes, and follicular conjunctivitis for the past year.

20

20

R. E. Vn. ; atropinized ; with+36=

XXX

20

L. E. Vn. ; atropinized

XXX

LXX

20

XX

July 18, 1877. Mr. S. G. L., æt. 38. A small pinguecula on the R. E. just back of the inner edge of the cornea, with quite a large vessel running along the conjunctiva to it. At times this becomes much inflamed. More particularly so after the use of the eyes at hard study for a time.

July 18, 1877. Mr. W. S.

20 XL

; with +60 +48, 90°

; with +60 +60, 90°:

20

XX

20

XX

H., æt. 22. For the past two years the eyelids have been inflamed. They are much worse after reading or writing for a time. When a boy, was frequently troubled with styes, but has had none for the past twelve months.

L. E. Vn. ; atropinized; with +20 ≈ +42, 75°

The following case is furnished me by Dr. Thos. H. Fenton : "J. H., æt. 20. Presented himself suffering from a large stye on the left upper lid; with the history of recurrent styes on this eye, as well as congestion and pain whenever he exercised his eyes steadily. The edges of the lids of the R. E. were slightly conjested, but gave no annoyance. After the stye was cured his vision was found to be:

After wearing the glasses for a month all traces of congestion

had disappeared. There is no more pain, and he says that he has never known so much comfort in seeing."

THE DIAGNOSIS OF PSOAS ABSCESS.

BY BENJAMIN LEE, M.A., M.D.,

OF PHILADELPHIA.

THE case which I am about to relate, while sufficiently important. in itself to merit rehearsal, as indicating the value of mechanical treatment in cases where a lesion of the spine is suspected, derives its importance, in the connection in which I introduce it, from the fact that up to the day on which I saw the patient, when I found him with a well-developed psoas abscess, none of the numerous physicians who had examined him had suspected its existence. As the diagnosis presented no difficulty to me, it occurred to me at the time that I should perhaps not be presuming if I should briefly place before the profession the modes by which I arrived at my conclusion.

HISTORY. I was called to the Girard House on Sunday, Feb. 28, 1875, to see the son of Mr. E. W. H., a resident of an interior town in this State. He was a well-developed, sturdy, thick-set boy of ten years; but pale, and with a countenance indicating past suffering and present anxiety. His parents were both living; the mother in good health, the father a sufferer from neuralgia and nocturnal pains in the tibia, probably periosteal in their seat. He had one brother and two sisters, all of whom were in fair health. When four years old he was attacked with whooping-cough, which he had very severely. From this time forward his parents noticed an alteration in his gait and carriage. He was awkward in his movements, and could not run like other children. At two different times he had attacks of severe pain lasting for several days, originating in the left side and shoulder and extending around to the spine. The three physicians who saw him during these illnesses were unable to assign any cause for the paroxysms. In August, 1874, nine months before I saw him, he had met with a very severe fall from a hay-mow. The distance was almost fourteen feet, but the fall was somewhat broken by striking some steps on the way. The brunt of the blow was

borne by the left ischium. The pain was severe at the time, and although he endeavored to make light of it, as boys will, he has since confessed to me that he was stiff for a considerable length of time from its effects. Within a month after, he was attacked with acute pain in the left side of the abdomen, in the region of the descending colon. The agony was so intense that he was held on the lap for a week, the only relief being from strong pressure with the hand over the seat of pain. This pressure was kept up day and night. His sufferings continued for nearly three weeks; and it was six weeks before he was able to walk. When he did so, his gait was more awkward and his movements more constrained than ever. The family physician was inclined, from the seat of the pain, to ascribe it to inflammation of the colon, and based his treatment on that supposition. "From time to time," writes his father, "he was seen by a great many physicians and many of them thought him incurable." Matters went on in this way until about a month before, when it was noticed that his spine was curved to one side. His father then determined to bring him to Philadelphia for advice. He had been seen the day previous to my visit by a highly respectable surgeon, who pronounced the boy to be suffering from a trifling muscular contraction, and advised his father to take him home and let him run in the fields, and use Indian clubs and dumb-bells, promising that the difficulty would wear off of itself with exercise and fresh air. Notwithstanding the entire absence of pain at this time, and the fact that the patient had a good appetite, and appeared well nourished, I was unable, even at the first glance, to take so favorable a view of the case. And just here I desire to "embrace the occasion," as our clerical friends say, to preach a short sermon on the danger of underrating the significance of muscular contraction. In my opinion, and it has been arrived at, not without extended observation and careful reflection, there is no such thing as a "trifling muscular contraction." Persistent contraction of a muscle is always a serious matter. It means mischief. Mischief, sometimes, it is true, simply in its own substance, in the shape of phlegmonous inflammation, when it will not be long in making its true nature apparent; but oftener in the vast majority of cases-mischief in an entirely different and often distant organ—of which it is merely the reflection, and to the thoughtful observer, the index.

It is the index, first, of obscure disease in the joints. Long before the attention of parents or physicians is called to the hip in the early stage of coxalgia, the watchful hamstrings and gastrocnemius begin to contract and, by slightly flexing the knee and elevating the heel, produce the peculiar limp which we have all of us learned to look