decided. Cheney thinks if an epileptic is found to have a refractive error, and if correction of this error results in a cessation of the attacks, the treatment cannot be regarded as valueless because the trouble ultimately returns. It should rather be regarded as a proof that reflex irritation is capable of precipitating the attack, and should lead to careful search for other possible exciting causes.

The experience of T. W. Mitchell and M. A. Starr are in strong contrast to these observations. The eyes of over 100 choreic children of Mitchell's clinic have been examined with the utmost care, but, although many of them have been given the most careful attention, not any notable good was obtained by correction of refraction or other errors. In the disorder which M. first described as "habit-chorea" glasses have now and then been found useful, but not always. As to epileptics Mitchell met with no better fortune. Starr does not believe that true epilepsy or chorea can be produced by eye-strain or cured by its relief, and states that he is constantly seeing cases in which such treatment has been faithfully pursued and has failed.

Apparently asthenopia in such cases has no other effect than other peripheral irritations and requires as much attention as the latter. The examination of the eyes in any nervous disease forms an essential factor of the whole examination and should never be neglected.

Ametropia undoubtedly has a certain influence on the mental development of a child, who forms his conceptions from sensory impressions, of which those acquired by the visual organs play a most important part. It is easy to understand that these are curtailed by defects of the eyes and that we must strive to correct such deficiencies. Thus a kind of aprosexia, i. e. a lack of perception, has been observed in errors of refraction from undue strain of accommodation, with rapid improvement after correction. Some authors even assert that the exertion hypermetropes

have to make in reading, renders the finding of words difficult and interferes with the development of speech. Myopic children who receive only a very limited amount of impression of the outer world through their eyes often show a limited mental habitus. Correction of the errors of refraction in these cases does not only improve vision but has a favorable educational effect.

DISCUSSION.

Dr. J. Steele Barnes: Dr. Zimmermann has covered the ground pretty thoroughly and very tersely. The fact that so many general neurasthenic conditions are caused by errors of refraction, we cannot controvert. I am not one of those who be lieve every ill is going to be cured by correcting errors of refrac tion, but it is a common experience that a great many nervous troubles, when no other treatment seems to be of value, are cured by correcting errors of refraction. A short time A short time ago I read an article by an oculist in California who, perhaps in a sarcastic manner, wrote upon this subject. Although he was receiving a great deal of pecuniary benefit from it, he was laughing at the profession in the east for sending patients to California to be cured of all sorts of nervous disorders and even for tuberculosis, since when they would come into his office he would find some error of refraction, correct it, and send the patients home well. There are a great many others who do not find that to be the case; but it simply shows us that there are some cases in which, if you will, before sending your patients away or advising them to go to a different climate, have their eyes looked over, you may hit upon something that will help them.

CLINICAL REPORT OF CANCER OF BREAST UNDER TREATMENT BY THE X-RAY.

BY SAMUEL H. FRIEND. M. D., OF MILWAUKEE.

This patient has cancer of the breast and is under the Roentgen X-ray treatment. The history briefly is as follows: The patient was referred to me by Dr. William Mackie. She is 42 years of age. The cancer appeared one year ago in March and grew rapidly. I saw the patient on May 10. Her condition at that time was as follows: The right breast presented a hard, firmly-fixed mass of cancerous tissue. On the right side of the breast, extending into the axilla, there was an ulcerating surface 7 inches in width by 6 inches in length. From this ulcerating surface a venous hemorrhage occurred at every motion of the arm. The discharge of serum was constant and copious, wetting 6 or 7 dressings each day. The odor coming from the ulcerated mass was nauseating.

This is the protective covering which I used at the first treatment and shows the blood-stains from the hemorrhages which occurred. (Dr. Friend here exhibited a protective covering used in treating the cancer.) Pain was a constant symptom and prevented rest and sleep. The physical condition of the patient, as you may imagine, was very bad. She could not walk without shortness of breath. Blood count 2,560,000 erythrocytes; 680, 000 leucocytes. The treatments at first were exceedingly fatiguing on account of her general weakness. Her weight was 113 pounds. This is a drawing-a rough sketch-showing the tumor as it appeared before treatment, and also some photographs showing the progress of the case.

(Dr. Friend here exhibited several drawings and photographs illustrating the condition of cancer at various times since treat ment was begun.)

The first treatment was given on May 10; she was exposed to the X-ray for ten minutes. The pain and hemorrhages ceased immediately, and she has been free from pain up to the present time and has not lost one drop of blood. She has had up to today altogether 19 exposures. The odor from the suppurating surface has disappeared. The discharge of serum has decreased to such an extent that she requires but one dressing a day. She sleeps eight hours every night and has increased in weight one pound each week. On May 23 the leucocyte count was 4,000. The red blood-corpuscle count was above normal on Monday, June 2-7,200,000.

The following measurements of the ulcerating surface show the progress of the case: On May 26 the measurement of the ulcerated part of the tumor had decreased two inches; the breast likewise had shown a decrease in size. On this Monday, June 2, the ulcerated part of the tumor is 33 inches in width and 24 inches in length.

TREATMENT OF THE FIRST STAGE OF OPHTHAL MIA NEONATORUM.

BY D. BALDWIN WYLIE, M. D., OF MILWAUKEE.

I believe it is pretty generally conceded that the opthalmologist, as such, has little to offer that is of more than passing interest to the general practitioner; and that most of us who follow this special line of practice are aware of the fact that the greater number of papers which we read before societies composed largely of practitioners of general medicine are listened to more out of courtesy and good natured indulgence than on account of interest in what we are reading. There are, however, some topics which interest us all; one of these is ophthalmia neonatorum. This, certainly, is of great interest to every physician who is ever called upon to act as accoucheur, not only because of the great responsibility it thrusts upon him, but also because of the splendid opportunity it affords him to do good; and, as a matter of course, the great majority of physicians in general practice are called upon in this capacity with greater or less frequency. In fact, the subject is of interest to every one, whether of the specialty, general profession, or laity; for the reason that at least 25 per cent. of all blindness is due to this disease. There fore, with the hope that you will acquit me of any charge of egotism and grant me such indulgence as my motive shall seem to earn, I shall do myself the honor of presenting to you a few ideas that have come to my mind, partly through practical experience, partly through personal intercourse with those of my fellow workers who are near at hand, and partly through mental contact with those who are more remote through the agency their contributions to the literature of scientific medicine, upor the management of the first stage of blenorrhea neonatorum.

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