Mark D. Stevenson

THE USE OF CYLINDRICAL GAUZE AND COTTON DRAINS IN DISCHARGING EARS

Aural surgeons must have witnessed the efficiency of gauze drainage in the ear following mastoid operations. The pus is constantly carried by the moist gauze packing in the external auditory meatus to the preferably wet gauze protective dressing. The solution with which this dressing is moistened should not be strongly antiseptic or irritating. Normal saline is excellent, although to encourage osmosis I sometimes employ a heavy sterile solution of magnesium sulphate. The packing in the auditory canal should be carried down to the tympanic membrane. There should not be any space left to serve as a reservoir for pus. This obliteration of space may be readily accomplished by placing over the outer end of the auditory canal a few folds of the end of a narrow 1 inch or 2 inch strip of gauze packing which has no loose threads on its margin, and then with a rough or screw-ended

TREATMENT OF PURULENT OPHTHALMIA AND SIMPLE MEANS FOR ITS PREVENTION IN INFANTS

Any Pusproducing organism or combination of such organisms may cause purulent ophthalmia, although the gonococcus of Neisser is responsible for a very large percentage, especially of the worst cases. Contrary to generally expressed opinion, I do not believe that the gonococcus or other pathogenic germs, unless extremely virulent, can quickly and successfully attack or destroy normal corneal epithelium. Intact healthy epithelium everywhere in the body, over skin or mucous membrane, presents the most effectual barrier against infection. A corneal ulcer, the chief danger in these cases, is due either to the extreme virulence of the infection; poor nourishment of the cornea resulting from pressure strangulation, produced by local pressure of the swollen surrounding parts interfering with blood, lymph and nerve function; to direct pressure, a form of traumatism, by the undrained retained and, therefore, more injurious discharges; or to ordinary injuries and abrasions of the corneal epithelium. The two

SOME IMPORTANT CONSIDERATIONS IN THE EXTRACTION OF CATARACT.

Established methods of cataract extraction will be discussed in this paper only sufficiently to draw attention to certain of their important points and to compare them with those which I advocate. Soft or membranous cataracts or such others as some traumatic varieties, which do not require extraction, but needling, removal by capsule punch, or other kind of operation, will not be considered. When the lens is found to be opaque, judgment should determine, after examination, if it is necessary or wise to operate, and if so by which method. The field of vision should be taken, and this is best done by the use of a candle, or preferably two, whereby the field may be mapped out with tolerable certainty. The tension should always be determined. An examination of the urine sometimes gives suggestive hints as to the cause of the cataract, the presence of retinitis, and probable length of

THE TREATMENT OF LACHRYMAL OBSTRUCTION.

Before this Section it is not necessary to discuss the treatment of all the various obstructive causes of epiphora. Those cases due to psychic or reflex causes, to refractive errors or in which hypersecretion is due to other non-obstructive causes will not be considered. The treatment of those portions of the tear drainage apparatus above the lachrymal sac, being well understood, will receive but little attention. However, further consideration of the treatment of pathologic conditions of the lachrymal sac and nasal duct, especially if it leads to free discussion, seems timely, since the diverse methods now employed indicate that it is not well understood. The necessity of treating abnormal conditions in the nose will be emphasized, since they are very important in the etiology of these affections. For purposes of treatment, I divide the tear drainage apparatus into three parts. The upper portion includes the puncta and canaliculi. The treatment

HOW TO PLACE LENSES BEFORE THE EYES SO THAT DISTANCE OF THEIR RESPECTIVE ANTERIOR FOCI SHALL BE THE SAME.

Not every ophthalmologist seems to realize the extreme importance of having the anterior focus of each eye at exactly the same distance, and many who try to obtain this fail because of the improper methods used. If the anterior focal points are not exactly at the same place the ciliary muscles in their ceaseless efforts to find a position of rest will be under a constant seesaw. Every ophthalmologist finds cases in which comfort and good vision can be obtained for each eye separately, yet when the patient looks with both eyes, he complains of discomfort and dizziness and of not being able to see clearly. The problem is how to remedy this. Many patients with glasses have the same visual acuity in each eye. After refracting such cases, and while they view distant test-types with both eyes, I take a plus and minus sphere of .25 diopter strength and place