cal intervention depends in many instances the life of the patient. A clear recognition of the nature of the lesion will prevent also the danger of an unnecessary, not to say a meddlesome, operation. From the cases already detailed it appears that, in my experience at least, an exact diagnosis is often impossible. It appears clear, however, that a lesion essentially fatal, if unrelieved, presents symptoms so suggestive as to form a conspicuous guide to the surgeon's hand; symptoms that lead him to the sure relief of the tumor with twisted pedicle or the hematoma of ectopic gestation, but which also call him to stay his hand in the sudden and painless tumors of the overdistended bladder. In most of the tumors under consideration pain is the first, the most important and enduring symptom. Pain alone demands careful examination of the pelvic viscera. Discomfort in the lower abdomen, if not amounting to real pain, may reveal on examination a pelvic tumor the nature of which will become clear only upon the appearance of other symptoms and signs. Even in the light of exploration it is difficult to see what the symptoms meant. In a second case precisely like the first I should feel quite as much in the dark. Those who were familiar with this case would probably suggest the possibility of a dilated stomach. They would use the stomach tube as a means of diagnosis. As the catheter will solve the question of the full bladder, so will the stomach tube that of a dilated stomach. Yet it would seem absurd to say that the stomach tube should be passed in all fluctuating tumors of the lower abdomen. Indeed it is absurd unless the stomach is in some way suggested as the possible cause of the tumor. The large bulging tumor of the dilated colon, with or without symptoms of intestinal obstruction, gives signs which I am sure will hereafter suggest to me the true lesion. If the tumor subsides under anesthesia, if it is tympanitic, resistant and tender, if it is rounded and symmetrical, if the obstruction is acute, and if there has been no gradual cachexia, the dilated colon is strongly indicated. The suddenness of the appearance of the tumor and of the symptoms The great emergencies of pelvic surgery attended rules out the dilated coils of a chronic obstruction, by the sudden appearance of tumors are ovarian tor- such, for instance, as are due to cancerous stricture. sion and extra-uterine pregnancy. In rare instances, The diagnosis of extra-uterine pregnancy is usually perhaps, the perforation of an appendix may give rise easy. Pain in the course of irregular menstruation, to a tumor of considerable dimension. Appendicitis with dribbling of blood from the uterus, always sugand salpingitis, too, might be included in the present consideration. Both these diseases, however, present such definite histories and such definite physical signs -physical signs so definitely follow the initial pain - that the tumor so invariably associated with them can hardly be called obscure or unsuspected. A consideration of these common lesions is therefore beyond the scope of this communication. The tumors of an ectopic gestation, on the other hand, may attain in a few hours a size that is extraordinary, so also may the tumor of an ovarian torsion, a dilated and obstructed sigmoid flexure, a suddenly distended ovarian cyst, an acute dilatation of the stomach, and a full bladder. gests it. With the sign of hemorrhage the diagnosis is almost sure. With any other confirmatory signs of pregnancy it is about certain. Most cases of extrauterine pregnancy are unaccompanied by any tumor of considerable size. The tumor, if any is found, is small. It is often buried up in the free blood of the pelvic cavity. Even if a tumor is felt it may not be that of the fetal sac. Recently a friend and gynecologist sent me at the Massachusetts General Hospital a patient with extra-uterine pregnancy, in whom under ether he found the fetal tumor on the right side, where under ether I also found it. The exploration showed a tubal pregnancy too small for bimanual palpation, on the left side. The mistake of opening a full bladder by laparot- There are, however, tumors connected with extraomy is so inexcusable that I may be pardoned for uterine pregnancy and hemorrhage, and of very consaying a few words upon the diagnosis of a full blad-siderable size, as I have already stated. Those found der. It cannot do harm to repeat that the full bladder in the case of an extra-uterine pregnancy are preoften causes grave mistakes, no matter how experi- ceded by pain, and accompanied by the usual signs of enced the diagnostician. Presenting, as it does, a pregnancy. They are collections of blood in the laysmooth, symmetrical, fluctuating tumor, who is to be ers of the broad ligament, or encapsulated in the pelblamed for thinking it a simple ovarian cyst, especially vis. if there have been no urinary symptoms whatever, no pain, no overflow, but on the contrary natural and easy micturition at the usual interval? He would be inexcusable perhaps who should open a bladder when urinary discomfort and dribbling of urine pointed clearly to the bladder in a state of overdistention, though I have been called to operate upon many such tumors, the nature of which was conspicuous. But should he be blamed for exploring such a tumor in the total absence of urinary symptoms? I think he should be, when by the use of the catheter a sure means of diagnosis is at hand. The catheter, therefore, should be used in all fluctuating tumors of the lower abdomen as a means of eliminative diagnosis. As a matter of routine the catheter should be used just before laparotomy. The diagnosis of an acute dilatation of the stomach may be said to be impossible; a correct one in the case mentioned would have been mere guess work. The diagnosis of ovarian tumor with twisted pedicle is easy when a tumor is known to exist. Where one has not been found previously it is very difficult. It depends upon sudden pain, with or without signs of hemorrhage. The tumor is elastic and tender. signs of strangulation, gangrene, peritonitis, are often obvious. The diagnosis of ovarian tumor with twisted pedicle must always be suggested by these symptoms. The It In spite of difficulties of diagnosis the signs point the right way towards surgical intervention. matters little whether the diagnosis of extra-uterine pregnancy is wrong if the surgeon is guided to the relief of an ovarian torsion, or if, expecting a torsion, he finds an extra-uterine hemorrhage; if, expecting an ovarian tumor, he finds a dilated stomach; or if, expecting an internal strangulation or an intestinal obstruction, he finds a dilated and twisted sigmoid flex ure. It does matter, however, if, expecting to find a serious lesion, he finds a full bladder, or if, ex pecting an ovarian torsion, he finds a normal preg nancy. Fortunately the call for relief is a loud one in the serious lesion; the surgeon makes few mistakes who quickly responds. It is not a loud cry in trivial cases; it is a suggestion for careful study, or even for prolonged observation, under which the true nature of the phenomena can be accurately determined. In summing up the matter of these acute abdominal emergencies which constitute the greater portion of obscure and suddenly appearing tumors, I am led to remark that here, as in all medical and surgical practice, the chief aim should be to view the whole with common sense; to consider carefully the history, to weigh carefully the symptoms, to apply all reasonable methods of examination, and finally if it is determined that intervention is necessary, to proceed to operation without unnecessary delay. the first week in January, the flow had ceased for several days, but the pain continued in both inguinal regions, in the back and extending down the backs of the thighs; she also complained of headache and great nervousness. She refused to let me make any examination, and insisted that all she needed was rest and a little medicine for "rheumatism in the back." I prescribed for her and directed her to go to bed. She did not go to bed, but rested a little more than usual and felt better. Four days later she saw me again, and reported that she was better except for frontal and occipital headache, that she was very weak and that her "malaria " was troubling her again, as the night before she had an attack of vertigo with palpitation, followed by prolonged chilliness and cold sweat. Upon my declining to assume further responsibility for her case without a thorough examination, she In all suddenly appearing tumors of the lower ab- finally consented to let me examine her, and I found domen, however obscure they may be, intervention is the following condition: Temperature 101.3°, pulse demanded if the symptoms are the least urgent. A 80, respiration 22. Heart, lungs, liver and spleen tumor that has attributes of sudden formation, of ten- negative. Urine contained large amount of albuderness, of hemorrhage, of profound constitutional dis- min. Vaginal examination showed that the uterus. turbance, demands immediate intervention. Tumors, was slightly enlarged, anteflexed, tender and rather however, which do not possess the attributes of ur- soft. The right broad ligament was resistant, swolgency may be watched, especially if the local symp-len, and contained irregular masses, but was too sentoms are subsiding, and if the patient's strength is re-sitive to permit the appendages to be distinctly outturning. From their very nature, however, they all lined. The left pelvis was filled with an elastic, tender require surgical intervention sooner or later. BY AGNES C. VIETOR, M.D., BOSTON, cystic tumor extending up into the abdomen, midway between the symphysis and umbilicus, and from near the median line to about midway to the anterior superior spine of the ilium. Behind and below this tumor, near the cul-de-sac, was a small, irregular, firm, exceedingly tender mass. A diagnosis of acute exacerbation of a chronic salpingitis, with possible presence of pus, and probable left ovarian cyst, was made. The patient was warned of the seriousness of her MRS. A., thirty-six years old; mother of two children, condition, but she still resisted going to bed. During youngest seven years old. Family history negative. the night she had a repetition of the chill and sweat. Personal history negative, except that menstruation has The next morning she had a chill lasting two and a not been perfectly regular as to time; occasionally the half hours; I saw her just as the chill was subsiding intervals between periods would be prolonged, vary- and found her face flushed, conjunctivæ injected and ing from five weeks to six or eight months. Patient, an icteric tinge of the skin. Temperature 103.3°, then, was subjectively a well woman till seven years pulse 92, respiration 20. Examination showed no ago, ten weeks after the birth of her last baby, when change in the findings of the day before, but the pashe had an attack of what was called peritonitis, tient looked much more ill. In the evening I was which attack was ascribed to mental anxiety and sent for in haste, and found intense abdominal pain catching cold. Ever since this illness she has been over the region of the tumor; the abdomen was tymcompelled to be careful not to get overtired, over- panitic and markedly sensitive, and there was some doing being always followed by discomfort in both rigidity of the walls. The patient had been delirious iliac regions, lasting from a few hours to several at times the past few hours, and was vomiting at indays, and relieved by rest. Four months after this tervals. Temperature 104.8°, pulse 96, respiration initial illness, she miscarried spontaneously at three 24. I made a diagnosis then of pyosalpinx with months, convalescing without complication. About probable twisted pedicle of the cyst (ovarian ?), and this time she is said to have contracted malaria. urged celiotomy. Three years later she had an attack, diagnosticated as appendicitis, from which she recovered, but which left her with an occasional feeling of discomfort in the right side of the abdomen. Patient came under my care in January of the present year. She gave a history of overexertion all the month of December, preparing for the holidays. The exertion brought on the usual pain, which increased in severity, as she did not rest. She menstruated the last week in December, the period being unusually painful. When I saw her, 1 Read before the Surgical Section of the Suffolk District Medical Society, March 7, 1900. The next morning I hastily curetted the uterus, hoping to leave that organ, and then performed celiotomy. On opening the abdomen and detaching the adherent omentum, there was escape of a small quantity of bloody serum. After walling back the intestines with gauze, the pelvis was seen as follows: Uterus in position, slightly enlarged, especially longitudinally, fundus forward. To the left of the uterus was a tumor which nearly filled the left pelvis and projected upward, into the abdominal cavity; its walls appeared roughened, dark red in color and had enlarged veins running over the surface. The left tube, slightly enlarged, was seen to be stretched out over the upper anterior surface of the tumor. This tumor ness, it was freely supplied with blood vessels, and seemed everywhere adherent, except on its upper sur-made the dissection of the tube and ovary very difface. In separating the adhesions at the bottom of ficult. The operation was so lengthened by these the pelvis, the tumor was ruptured, giving exit to a complications, and the patient's condition was so preserous fluid. It then became exceedingly difficult to carious, that, as the appendix appeared normal, it follow, but finally a pedicle was formed for the re- seemed the less of two evils to free it and leave it moval of the remains of it and the left tube. The rather than risk even the few minutes necessary to left ovary was found below and behind the tumor, as remove or invert it. palpated from the vagina, and was largely converted into a series of hematomata. It could not be entirely enucleated from its bed of adhesions without dangerous delay, and a small, apparently healthy portion was left in the stump. On the right side the appendages were completely hidden in a mass of dense exudate, to which the intestine and the tip of the appendix were closely adherent. The appendix was separated, and being found otherwise normal, the raw surface was closed in by peritoneum with a catgut suture. The intestine was then separated, but in one place the adhesions were so dense that in separating them the wall was damaged. This was repaired by a Lembert suture. At the point of this adhesion was a small cyst, 2 by 3 centimetres, filled with a serous fluid, that at first seemed to be the occluded and dilated extremity of the right tube. Further dissection, however, showed that it was a peritoneal cyst. With great difficulty, the right tube was found buried in the dense exudate, was enucleated and removed. It contained about 2 drachms of pus. The right ovary was buried still deeper in the pelvis and could not be entirely brought up. It was almost impossible to make a pedicle for these appendages, but eventually we succeeded in making rather a broad one. Except for the exudate burying it, the right ovary was apparently healthy and a small portion of it was left in the right stump. The peritoneal cavity was washed out with normal salt solution, a portion of which was allowed to remain, and the abdomen was closed. While all the acute local symptoms were referred to the region of the tumor on the left side, you will see by the temperature chart that the constitutional reaction was due in large part to the condition on the right side, as the temperature and pulse subsided only graduallly, though steadily, seemingly with the absorption of the exudate. The vomiting, delirium, chills, sweats and all abdominal symptoms ceased with the operation. Except for the nephritis which continued for over six weeks to give albumin in the urine, the convalescence was uninterrupted. ing. During convalescence she had several nervous paroxysms NOTE. The post-operative history of this patient is interestof an emotional type, the most marked being during the week when menstruation was due, though it did not appear. After returning to her home she improved for a few weeks and felt at last she was a well woman. Naturally, she was tempted to overdo, and one day after a five-mile walk she began to feel not so well; she had occasional discomfort in the region of the right stump, she grew nervous," mentally depressed and "tired,' suffered from insomnia and began to lose flesh and strength. She did not improve greatly under treatment and I advised the picture of acute melancholia with suicidal tendencies. I change of scene. She returned home in a fortnight much worse, then had her remain in town and gave her positive suggestion every other day, inducing a light hypnosis. She improved the first séance. After ten days I again sent her out of town, steadily under this treatment, the insomnia disappearing after giving her the suggestion in writing, to use as needed. Her improvement was steady and at the present writing she is perfectly well and the picture of health. SERUM THERAPY IN PNEUMONIA.1 BY WILLIAM H. SMITH, M.D., BOSTON. IN 1892 Friedländer discovered in a case of croupous pneumonia a capsule bacillus, which he considered to be the etiological factor in the production of this disease. In 1883 Talamon found in a consolidated lung a diplococcus, which he called the pneumococcus; but it was not until 1886 that Fraenkel isolated the pneumococcus from a sufficient number of cases of acute croupous pneumonia to show that it had an etiological bearing in the production of this disease. He was able to cultivate the organism and to study its methods of growth and its characteristics. Since this time numerous investigators have confirmed the observation of Fraenkel - Netter, Weichselbaum, and more recently, Pearce at the Boston City Hospital, and Wright at the Massachusetts General Hospital, and from the data gathered it may be said that the etiological factor in the production of acute lobar pneumonia, in from 90 to 95% of the cases, is the pneumococcus. The organisms which take part in the production of broncho and lobular pneumonia are more varied, and today it is well recognized that any of the following organisms may produce a lobular or broncho pneumonia: the tubercle bacillus, the diphtheria bacillus, the bacillus mucosa capsulatus, the bacillus of bubonic plague, and the influenza bacillus, or the various forms of cocci streptococcus pyogenes, staphylococcus pyogenes, and the pneumococcus. One case is recorded where sarcina seemed to be the original invaders. The specimens which I show do not convey an adequate impression of the pathological condition, except to one who has seen similar cases. The tumor, as you will see, is represented here only by those shreds of membrane, the greater part of it remaining firmly adherent to the tissues of the left pelvis. Dr. W. F. Whitney kindly examined the specimens for me, and pronounced the tumor a peri- If, however, we eliminate the lobular or broncho toneal cyst. It was the outcome, no doubt, of the pneumonias occurring in the course of the acute inrepeated attacks of peritonitis from which the patient fectious diseases, and those secondary to an inflammahad suffered during the past seven years. The rough-tory process elsewhere, in a majority of cases the ened and congested surface of the cyst where it rose organism found, either alone or in association with into the abdominal cavity showed an acute inflamma- other organisms, is the pneumococcus. tion of this portion of the cyst wall. I have mentioned a smaller, similar cyst on the right side, but the characteristic of the right side was the dense exudate which hid and blanketed the appendages. This exudate varied from 1 to 2 centimetres in thick Since, therefore, in 90% to 95% of all cases of acute croupous pneumonia, and in a large number of the uncomplicated broncho or lobular pneumonias, the 1 Read before the Massachusetts Medical Society, June 12, 1900, and recommended for publication by the society. etiological factor is the pneumococcus, we shall. in our cluded that better results in this class of cases were A cure resulted in Wiesbecker reported 5 cases treated by serum obtained from human subjects recovering from pneumonia. All 5 recovered, and there seemed to be a diminution of the subjective symptoms. The serum In pursuance of their investigations these observers from blisters from pneumonia patients has also been used practically everything containing pneumococci. used, but with little effect. Most recently Washbourne Attenuated cultures, glycerin extract of agar cult- has succeeded in producing immunity in a pony after ures heated to 60°, heated bouillon cultures, filtrates nine months' treatment with living and dead cultures, and precipitates from cultures, dried organs of ani- and has obtained a serum which seems to have powermals dying from pneumococcus infection, were used ful immunizing properties. The difficulty which all in these investigations, or infusions of the same in investigators had experienced up to this time was in sterile water. Sputum, collected at the time of the their inability to keep the pneumococcus culture which crisis in cases of pneumonia, either fresh or after they were using virulent. Washbourne applied the heating, was employed in these experiments; while method of Pfeiffer of streaking agar cultures with the pleural exudate following croupous pneumonia sterile blood of rabbits and by this means and keeping was also used. the blood at a temperature of 37.5° C. it was found The results obtained from this line of investigation possible to maintain the virulence of the pneumococcus seemed to show that certain animals could, by the in- at a given level for a period of sixty days. The minijection of pneumococcus cultures or exudates or se- mum fatal dose of the culture used by Washbourne cretions containing pneumococci, be rendered immune was .000001 of a loop which held 5 milligrammes. for a longer or a shorter time to an otherwise fatal The serum was mixed in varying amounts with a tendose of the pneumococcus. After this artificial im- fold fatal dose of the culture and the mixture injected munity had been discovered, the next line of investi- into the peritoneal cavity of rabbits, control experigation was to determine if the serum of the immune ments always being made with a minimum fatal dose. animals was protective when inoculated into another The smallest quantity of serum which would protect animal, and, according to Mennes, Foa and Carbone the animal under these conditions he considered equal were the first to establish the fact that a mouse re- to a unit. The strongest serum yet obtained from his mained alive after inoculation with 2 to 4 drops of blood from an immune rabbit when this was followed by a fatal dose of pneumococcus culture. This is the first experiment in serum therapy against the pneumo coccus. It remained for Emmerich and Fowitsky to show that the mouse remained alive if the immune serum was injected after the pneumococcus culture a fact also proved by the Klemperers. pony, equal to .03 cubic centimetres, protected against a tenfold fatal dose; a cubic centimetre, therefore, equals 33 units. Sera from normal rabbits and guinea pigs would protect against the minimum fatal dose, but not against a tenfold fatal dose. Washbourne treated 6 cases and had no deaths. He considered that the serum should be inoculated as early as possible and at least 600 units should be injected twice a day. Spurrel, Hartnett and Cook have reported cases Mennes has re The etiological factor in the production of pneu-treated by Washbourne's serum. monia having been found, the fact that animals could be rendered immune for a longer or shorter time having been shown, and the immunizing property of such sera demonstrated when further inoculated into animals, it remained to discover the practical application of these facts. At varying intervals there have been reported cases of pneumonia treated by the antipneumococcus serum. The Klemperers treated by subcutaneous injection a series of cases with apparent benefit, as shown by fall of temperature, slowing of pulse and respiration. Lara reported the results in 10 cases of pneumonia, the sera used being obtained from immunized dogs, rabbits, or glycerin extracts of organs of refractory animals. He considered the results encouraging. cently succeeded in obtaining a powerful immunizing serum from a horse. Neither Mennes nor Washbourne, however, wish to state positively that their serum is of value without further investigation. Certain subjective disturbances have been reported following these injections of the serum, such as excitement following the use of dog serum, agitation following the use of rabbit serum, and urticarial rash. As the question stands today, it may be stated that, experimentally, animals may be rendered immune, that their sera has protective property, and that continued investigation is doing away with some of the difficulties which previously harassed the early investigators. But the fact still remains that in dealing with the pneumococcus we are dealing with an organism capable of many variations and degrees of virulence, and that the sera obtained under such conditions must of necessity vary both in strength and character. Washbourne's method of cultivation seems to be a distinct advance, inasmuch as he maintains In 1898, before the Italian Medical Congress in life and virulence in the culture over a longer period Turin, Massalongo and Francheni reported upon than have other observers. His investigations are Pane's antipneumococcus serum. They had used his recent, and it is too early to state what the result will serum in 10 cases of the most severe type on alcoholic be. Experimentally, antipneumococcus serum seems subjects with weak hearts and nephritis. They con- to be of value. Practically, that it is of any great In Naples in 1897, Professor Pane reported that he had obtained antipneumococcus serum from a donkey and a cow that he had successfully used in treating a number of cases of pneumonia 23 cases in all, with 2 deaths. value does not at present seem to have been demon- War. This, as well as his advanced age, seemed of strated, as the reported number of cases are too few; interest in view of the condition of his heart. I acthe series of any one observer too small. What the cordingly made inquiry at the Pension Office in regard future of the serum therapy in pneumonia will be it is to his military and medical history, and also of his too early to say. mother, who is still living, as to his health in early life. His mother, in reply, denied that he had ever suffered from shortness of breath in childhood, and said he always had good health until he went into the army. A communication from the Pension Office states that "the records show that the soldier enlisted Clinical Department. CASE OF PATENT FORAMEN OVALE IN AD- February 28, 1865, and was discharged on surgeon's VANCED LIFE. BY WILLIAM L. WORCESTER, M.D., certificate of disability March 31, 1866. On muster rolls to August 31, 1865, he is reported present; September and October absent without leave; from ABRAHAM H., apparently a full-blooded negro, said October 31, 1865, to February 28, 1866, present. to be fifty-seven years of age, was admitted to the hos- The certificate of disability is not on file, but the pital, February 25, 1898, suffering from general par- records of the regiment show treatment in the regialysis. In the notes of the physical examination, mental hospital for valvular disease of the heart at made at the time of admission, the following state- various dates from November 3, 1865, to April 15, ment is made as to the condition of the heart: 1866. The first medical examination held in the "Apex beat in sixth interspace, under nipple; no case was made December 7, 1887, but the condition heart sounds heard; a long, loud murmur, systolic of the heart was not reported until his second examiin time, can be distinctly made out at apex." Dur- nation, August 6, 1890, when the board described a ing the patient's stay in the hospital, no indications of pronounced and remarkably distinct musical mitral embarrassed circulation were noticed. On account of systolic murmur heard over the entire left chest, the color of his skin it is perhaps likely that cyanosis, the location of the organ being normal." if it had existed, might have passed unobserved. He died May 13, 1900, of exhaustion from a series of a. Foramen ovale. b. Communication between ventricles. It is hardly probable that the examination at the time of enlistment was very rigorous, but it seems rather singular that such a disability should not have been discovered on the most superficial investigation, and still more so that the patient should have lived to be fifty-nine years of age without any striking cardiac symptoms, dying at last of a disease entirely independent of his malformation. Both of the abnormal openings can be seen in the above photograph. Medical Progress. RECENT PROGRESS IN OPHTHALMOLOGY. BY MYLES STANDISH, M D., AND WM. DUDLEY HALL, M.D., BOSTON. VIEUSSE,1 in these numbers, gives a very complete account of the subject. The first article contains a very good description of the anatomy of the ethmoidal labyrinth followed by a clinical history of 14 cases. In the second article the symptoms are taken up in detail. It is more than probable that the startAt the autopsy the heart was found to be moder- ing point lies in the os planum of the ethmoid rather ately hypertrophied, weighing 375 grammes; the than by infection through the agency of the veins. cavities, especially the right ventricle, were dilated. As the orbit becomes invaded by products of inflamThe valves were healthy. The foramen ovale was mation we notice swelling of the lids, exophthalmus present, measuring 2 by 2 centimetres in diameter. and a tumor at the inner angle of the eye. This latIt was divided into two unequal parts by a small ter varies in size from a small pea to even a hazel nut, tendinous cord. Immediately under the right aortic may be round or diffuse, firm or fluctuating and painsemilunar valve was an opening forming a communi- less. Pressure may cause a flow from the nostril and cation between the ventricles. On the side of the there may be a sense of crepitation. Proptosis may left ventricle it was about 1 centimetre in its long-be slight, the deviation down and out with but little est diameter; on the side of the right ventricle, not impairment of motion. The edema may be limited more than 2 millimetres in diameter. So far as or diffuse, and there may or may not be diplopia. could be judged from appearances, this was probably a congenital defect. The patient was a pensioner on account of disability alleged to have been contracted during the Civil The fundus changes suggest a mild neuritis and the vision may fall to .2 if there is pressure on the nerve. The third article discusses the etiology, and has spe 1 Rec. d'ophthal., March, April, May, 1899. |