week or two, we may lessen the effort of convergence by trying prisms of 2° base inwards. These help the overtaxed recti interni in turning the eyes inward. The prisms may be combined with the convex lenses or used separately. Of course a mixed form of astigmatism is oftener met with where the refraction of the eye is not emmetropic. It may occur in anisometropiå, — that is, in unequal refractive power of the two eyes. Suppose one eye slightly myopic, the other slightly hypermetropic: there would be no binocular vision, in the strict sense of the term; and the frequent tension and relaxation of accommodation, and possibly of the convergence also, would be likely to overwork the apparatus of adjustment. The indication here would be, probably, to adjust a weak convex lens to the hypermetropic eye, so that in reading, this eye would be made slightly myopic like its fellow. When the difference in the refraction of the two eyes is very considerable, this course may not be advisable, and we must be content to put the one reading eye into the most favoring condition, approximating the other as nearly as practicable to the same refraction. Prisms may of course be used, if necessary, bases outward. Sometimes, but not often, in hypermetropia we find the recti externi weak. Prisms of 2° base outward would relieve the external, and put more work on the internal recti. The same result may be reached, though less in degree, by decentring the glasses; that is, if we wish the effect of prisms base outward in hypermetropia, we order a wider separation between the two glasses, so that the centre of each lens shall fall a little outside the centre of each pupil. These glasses relieve the overtaxed accommodation and the recti externi at the same time. By having them set nearer, that is, separated less widely, we may produce the effect of prisms base inward, and relieve to a certain extent the recti interni. In myopia, if we wish to slightly relieve the overworked muscles of convergence, we have the concave lenses separated so that their centres are just outside the two pupils.

Astigmatism uncorrected by glasses may, of course, give rise to accommodative or a mixed form of asthenopia.

Indeed, in connection with myopia it is, as is well known, a great factor in the production of pain and discomfort, and perhaps the same may be said of its influence in the asthenopia so common with hypermetropic refraction. Late investigations appear to show, further, that astigmatism, myopic and hypermetropic, uncorrected, threatens the integrity of the eye. Distinct lesions of the fundus of the globe are most frequent in myopic astigmatism. Next in frequency, a hypermetropic astigmatism is accredited with the production of a posterior choroiditis and atrophy around the disk of the optic nerve, such as is observed in myopia. Eyes of this class are, as before remarked, those that pass over and

become myopic, and usually progressively myopic. In view of these facts, it may be said that astigmatism is, in early life, a most dangerous optical defect, and that its subjects, like those that are myopic, should be most carefully guarded during the educational period. The later the earnest study from books begins, in the life of children with optical defects, the less probability of harm to the eyes. If school life, or protracted reading, writing, and drawing were never begun before the age of eight or ten, diseases of the eye or impaired vision would notably decrease.

A CASE OF PLACENTA PRÆVIA WITH TWINS. BY EDWARD M. CURRIER, M. D. (B. U. S. M., '81), PRAGUE, Austria.

ON the 12th of October, Marie Kozah, a Bohemian peasant woman, aged thirty-three, presented herself at the Lying-in Hospital, at Prague, Austria, desiring to be admitted. She stated that this was her fourth pregnancy, and that the former three were prefectly normal, going the full term, and living children being born in each case. She said that her last menstruation was on the 1st of March, so that she had nearly eight weeks to continue before the full expiration of pregnancy.

At the time she presented herself she was in a somewhat anæmic state, slightly pale, pulse 108. The abdomen was distended as far up as the ensiform appendix. She came to the hospital because about an hour before she had had a sudden hemorrhage, which frightened her, as it had never occurred in any of her former pregnancies. Palpation showed that the head was in the left iliac region, and the small parts could be felt in the right hypochondrium. The examination was hurriedly made and it was supposed that there was but one foetus. Internal examination showed that the vagina was much dilated and some blood clots were felt. The neck of the womb was still projecting into the vagina. It was very tender and the external os was sufficiently dilated to admit of the passage of two or three fingers. The cervix uteri was not yet effaced. Its channel was about five centimetres long, and the inner os was forming a contracting circle which would scarcely allow the passage of two fingers. The channel of the cervix was filled with blood clots and a globular portion of the placenta was slightly projecting. As far as the finger could reach, the inner os was covered by the placenta. The membranes were so thick that it was impossible to tear them with the fingers, so that the operator was obliged to use a uterine sound to rupture them. Then the right foot was seized with two fingers only and version easily effected by the bi-manual method

of Braxton Hicks. The extraction was made very slowly in order to dilate the inner os for the passage of the breech and head. The extraction being made, the uterus was less diminished than usual, and the presence of a second fœtus was easily diagnosticated. The hemorrhage recommencing, it was necessary to deliver the woman instantly. Two fingers were again introduced into the uterus, the membranes of the second child ruptured, a foot seized, and version and extraction made in the same manner as before. Then the placenta was detached from the inner walls of the uterus and a warm water injection was made to stop further hemorrhage. The uterus contracted and no further hemorrhage followed. The children were both male. The first one delivered weighed 1,885 grammes and was 44 centimetres in length. The second weighed 1,700 grammes and was 41.1 centimetres in length. The placenta weighed 800 grammes.

DIAGNOSIS OF HUMAN BLOOD-STAINS.

BY JOHN C. MORGAN, M. D., PHILADELPHIA.

DRS. J. G. RICHARDSON and J. J. Woodward, both eminent microscopists, have for several years been in (only) apparent antagonism on the question, Can human blood be positively distinguished from that of the various domestic animals? Our own microscopist, Prof. J. Edwards Smith, has taken part in this controversy in his usually interesting manner. The whole subject

is reviewed and set at rest, we may believe in an explanatory article which may be found in the "American Journal of Microscopy" for June, 1881. The sum of the matter is, that the blood of animals usually slaughtered, owing to smallness of globules, can be microscopically diagnosed with accuracy; that of certain others, not usually slaughtered, cannot be, owing to the superior size of the globules, approximating the human very nearly indeed. Per contra, small human globules are common in anæmia.

Again, corpuscles are changed in size, by yielding their contents to, or absorbing any fluid which may be used to suspend them, unless it be carefully adjusted to prevent this. For this purpose, Dr. Richardson uses a per cent solution of common salt.

Further, when micro-photographs, like those presented by Dr. Woodward in the Hayden murder trial, are used, it is important to exclude all but the central parts of the same from comparison, since the photographic lenses are not free from spherical aberration, which enlarges the periphery of the figure, or plate. — Dr. Piper.

Lastly, be it remembered that mosquitoes and other insects

may convey typical human blood to the person or clothing of an accused individual, misleading justice.

This important matter is complicated by a variety of circumstances, and on one of these I wish to make a point; viz., that in disease the size of the globules often varies from the standard of health. In acute exacerbation of goitre, and in pernicious anæmia, the globules, according to my observation, are often remarkably small, which would bring them into similarity with those of other mammalia. As it is truth and justice, not the prisoner's interests alone, which lead to expert labors, this fact should be considered when the small size of globules in a blood-stain promises acquittal.

MASSACHUSETTS HOMEOPATHIC MEDICAL SOCIETY.

REPORTED BY HERBERT A. CHASE, M. D., REC. SECRETARY.

THE semi-annual m eting was held in the Meionaon, Tremont Temple, Boston, Wednesday, Oct. 12, 1881. It was called to order at 10.30 A. M. by the president, J. T. Harris, M. D., of Boston.

The records of the last meeting and of the meetings of the Executive Committee were read by the secretary and approved.

The following were elected to membership: Frank J. Fesler, M. D., D. D. S., of Lowell, and Annie E. Fisher, M. D., of Boston.

The following amendment was offered by the treasurer, H. C. Clapp, M. D., of Boston: "To Art. XXV. add the following: Newly elected members shall not be liable to assessment during the year of their election."" Referred to Drs. Clapp, Smith, and Whittier, to report on at the next annual meeting.

The Committee on Surgery presented papers as follows: "Hydrocele," by J. H. Sherman, M. D., South Boston; "The Uses and Abuses of the Probe in Surgery," by I. T. Talbot, M. D., Boston; "Incised Wounds," by J. K. Warren, M. D., Palmer.

The Committee on a Homœopathic Insane Hospital reported* through J. Heber Smith, M. D., of Melrose. On motion of N. R. Morse, M. D., Salem, the following resolutions were adopted :

Resolved, That the Massachusetts Homœopathic Medical Society heartily indorses the report of its Committee on a Homœopathic Insane Hospital, and considers that the time has fully come when the State should furnish to its dependent insane the more efficient as well as more humane treatment of homoopathy.

* See Report on page 339 of our November number.

Resolved, That the Committee be requested to prepare and circulate petitions to the State Legislature, and that the members of this society, homoeopathic physicians generally, and the friends of homoeopathy in Massachusetts be earnestly requested to use their influence with the press, the people, and the Legislature, that this want be provided for at the earliest possible moment.

The Committee on Gynecology presented the subject of Uterine Displacements, embodied in papers as follows: Pathology, S. M. Cate, M. D., Salem; Ætiology and Symptomatology, Laura M. Porter, M. D., Boston; Treatment, H. K. Bennett, M. D., Fitchburg.

F. W. Bradbury, M. D., of Providence, R. I., was present as a delegate from the Rhode Island State Society, and made a brief address.

At I P. M. the society adjourned for lunch.

At 2 P. M. the members reassembled and listened to the annual oration, delivered by John L. Coffin, M. D., of West Medford. It was a very able effort and was heartily applauded. The Committee on Zymotic Diseases presented a paper on the 'Use of Water in Typhoid Fever," by W. B. Chamberlain, M. D., Worcester.

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The Committee of Arrangements reported that it was impossible to obtain any reduction in the price of the Meionaon, even if it were taken for a term of years. On motion of H. L. Chase, M. D., Cambridgeport, it was voted to hold the annual meeting in Wesleyan Hall, Bromfield Street, Boston.

A paper on "Obesity" was presented by J. H. Sherman, M. D., of South Boston.

Adjourned at 3.30 P. M.

BOSTON HOMEOPATHIC MEDICAL SOCIETY.

REPORTED BY FRED. B. PERCY, M. D., SECRETARY.

THE regular monthly meeting was held at the college building Thursday evening, Dec. 8, when thirty-two members were presThe censors reported favorably on the names of J. R. Boynton, M. D., East Boston, and J. F. Lindsay, M. D., Boston, and they were elected members.

ent.

The following were proposed for membership: James H. Utley, M. D., Newton; W. O. Ruggles, M. D., Neponset.

SCIENTIFIC SESSION.

The subject for discussion was Typhoid Fever. Dr. J. H. Payne read a very interesting paper on the history of this disease. Dr. F. D. Stackpole followed with an exhaustive paper on