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the lids to appear as if bordered by a red seam; they close only imperfectly upon the eyeball; and finally the combined effect of the shortening of the skin of the lids and of the ectropion is that the palpebral fissure can no longer be closed sufficiently. The eye is deprived of the greater part of its natural protection and, as a consequence, corneal ulcerations are apt to appear, especially upon the lower margin."

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Saenisch, also, in speaking of this vicious circle, says: "The members of this circle are: catarrh of the conjunctiva, blepharitis angularis, dermatitis angularis, eversion of the lower lachrymal puncta, epiphora, lodgment of fluids in the conjunctival From these follow blepharitis ulcerosa, ectropion, keratitis." What are the causes? Among the predisposing causes are the following: Scrofula, malformation of the lids, and the various forms of ametropia. The exciting causes are numerous. Among these may be mentioned exposure of the eyes to smoke, dust, and wind, over-use of the eyes at fine work, inflammation and obstruction of the tear passages, conjunctivitis, etc. A cause, when existing, which renders the disease peculiarly obstinate to cure, is the presence of fungous growths in the hair follicles.

Wells says ("Treatise on the Diseases of the Eye,” p. 735): "Blepharitis marginalis is frequently produced by the various forms of conjunctivitis and corneitis, more especially if the latter are accompanied by a great discharge of hot, scalding tears, which constantly moisten and excoriate the edge of the lids.”

Stellwag says: "When the predisposition to blepharitis exists, the process may be continued by the effect a conjunctivitis has upon the lid glands." He further says: "The acute exanthemata, particularly small-pox, eczema, and impetigo, have some influence in causing the disease. In case these exanthemata localize themselves on the lids in the form of numerous efflorescences, a blepharitis ciliaris often remains after the constitutional disease has run its course."

Blepharitis ciliaris is a decidedly chronic affection, which may exist for months or years or a lifetime. When occurring in children the supervention of puberty has sometimes a beneficial effect on the disease. In its primary form there is much less difficulty in effecting a cure if we recognize the cause and remove it. When, however, destruction of the glands of the lids has taken place and tylosis exists, treatment is of but little avail.

In the treatment of this disease the various causes which may have produced it, and which administer to its existence, must first, as far as possible, be removed. The patient should be placed under the most favorable hygienic conditions. Plenty of fresh air and sunlight, together with the most scrupulous cleanliness, is imperative. A careful and very gentle removal from the

tarsal border and roots of the cilia of all crusts or scales by first softening in warm water is another factor. Very great gentleness must be exercised in the removal of these crusts, lest the delicate structures beneath are injured, in which case new crusts will continually be formed by the exudation of lymph.

Constitutional and local treatment are now in order, the former implying the removal, as much as possible, of all dyscrasia which tend to impoverish the blood and diminish vitality; the latter consisting of washes and unguents carefully and judiciously applied. In many cases local and constitutional treatment combined with strict hygiene will suffice for a cure in the early stages of the disease. But there is a large proportion of cases which, though seemingly cured by these means, are soon again as bad as ever When such is the case a careful search for the cause will often reveal an obstruction situated somewhere in the lachrymal canal, causing stillicidium lachrymarum, which is one of the factors of this vicious circle.

Wells, in speaking of stillicidium lachrymarum and its results, says: "If the true nature of this irritability of the eye and of the lachrymation be overlooked, very obstinate and intractible inflammation of the edges of the lids and conjunctiva may ensue, which sets defiance to any form of collyrium or topical application, but readily yields if the impediment in the lachrymal apparatus is removed."

Dr. Prout, of Brooklyn, N. Y., has recommended removing a triangular portion of conjunctiva on the inner side of the puncta, thus enlarging the puncta, and subsequently, if necessary, dilating the canaliculus with probes. Slitting up the canaliculus and probing the duct have relieved many cases for me when I have found such obstruction to be present.

Ametropia, or faulty refraction, has, however, quite recently been discovered to be one of the leading causes of blepharitis ciliaris. I have so often found some error of refraction present in these cases, upon the correction of which by suitable glasses the blepharites has been cured, that I wish to dwell especially upon this method of treatment, and call your attention to the great importance of ascertaining the refractive condition of the eyes. in all such cases as afford no other visible cause for the lid trouble.

At the meeting of the Fifth International Ophthalmological Congress in New York, in September, 1876, Dr. D. B. St. John Roosa, New York, presented a paper on "The Relations of Blepharitis Cilaris to Ametropia," in which he announces the following conclusions:

"First. Ametropia seems to be the condition of most eyes affected with bleplaritis ciliaris.

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"Second. When the blepharitis is associated with errors of refraction, the cure of the edge of the lids is very much facilitated by, and sometimes depends upon, correction of the ametropia.

"Third. Paralysis of the accommodation by the use of atropia will usually, with no other treatmant, very much relieve the blepharitis that is associated with ametropia.

"Fourth. Patients suffering from blepharitis that is associated with ametropia will often ignore any other affection of the eyes than that of the edge of the lids, even when the error of refraction is so marked that we would naturally expect quite serious consequences from its non-correction.

"Fifth. The form of blepharitis to which my statistics refer is not a mere irritation of the edge of the lids such as often accompanies a catarrhal conjunctivitis, but a true hypersecretion of the tarsal glands and hair-follicles, with the formation of crusts and sometimes the development of ulceration.

"Sixth. Hypermetropia is the error of refraction most frequently associated with blepharitis ciliaris."

Dr. Roosa, in this report, presents the record of thirty-one cases of blepharitis, twenty-six of which had some refractive error, upon the correction of which very many of the cases were cured. In 1878, at the meeting of the American Ophthalmological Society, held in Newport, he still further substantiated his theory by producing a record of fifty-seven cases of recorded refraction in cases of blepharitis treated at the Manhattan Eye and Ear Hospital, and forty cases in his private practice. The analysis of these cases still more substantially proved the remarkable connection between these two conditions.

My experience in the treatment of blepharitis ciliaris has led me to investigate the refractive condition of all cases presenting themselves for the treatment of this disease. In a very large proportion of the cases I have found the necessity to prescribe some form of glasses the wearing of which would alone effect a cure in the milder cases.

As examples of the various refractive conditions which exist in some of these eyes, I will present a few cases which I have treated within a few months. In some cases, in little children, the diagnosis of the kind and degree of the ametropia has been determined by the ophthalmoscope alone; in older people with the ophthalmoscope and also with the test types. I have found it necessary in but few cases to paralyze the accommodation with atropia.

CASE I. Miss E-, of Bowdoinham, has had blepharitis and conjunctivitis, very troublesome, for three years past. Asthenopia very troublesome on using the eyes a little. Both eyes were found to be hypermetropic=1 D. Convex glasses of 1 dioptric

were prescribed, and worn by the patient with wonderful improvement.

CASE II

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Mrs. S, Auburn; blepharitis and asthenopia. O. D. v. . With +1.75 1o axis 60°, v. = 1. = 4. O. S. v. . With+1.25 1o axis 110°, v. . This combination of spherical and cylindrical glasses was ordered, and the patient relieved of further trouble.

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. CASE III. Miss H. G. Vision always very poor. Eyes always troubled her and could never get glasses to fit. and asthenopia.

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O. S. v. 1. With +11.5° axis 90°, v. =.

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It will be observed that in this case vision was not brought to the normal, owing, probably, to some irregular astigmatism which could not be corrected. The patient was made happy, however, in the great improvement to sight and the improved condition of the lids.

Lewiston. A bad case of blephara

CASE IV. Mrs. E, Lewiston. denitis.

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This case had previously been treated with ointments, but to no avail.

CASE V. Eva L, aged twelve. Bleph. ciliaris. This case had been treated by local and constitutional means. The edges of the lids were relieved for a time, yet, as soon as she began to go to school and use the eyes, the whole trouble returned. Testing for ametropia revealed the following:

O. D. v. —. With 1.5 +5o axis 70°, v. = .

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O. S. v. . With+1+.75° axis 110°, v. = 4. After using the glasses a few weeks the lids were all right. CASE VI. Master G, aged nine. Always had trouble with his eyes. Blepharitis ciliaris and asthenopia. Refraction: O D. v. = . With + 1o axis 90°, v.

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It was impossible to make an entire correction on account of other conditions; nevertheless, the glasses were worn with great comfort and relief to asthenopia and blepharitis.

CASE VII. Miss L. Y, aged fifteen. Blepharitis with asthenopia and much headache from using the eyes. Refraction

revealed:

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O. D. v. —. With +.25 O. D. v. . With+.25 These glasses were worn with wonderful relief to all the head troubles. It will be observed that astigmatism enters into the most of these cases, a slight degree of which even it is sometimes of the greatest importance to correct.

These are but a few of the cases which I might adduce wherein correction of the ametropia has cured the blepharitis. I have introduced them to show you a method of curing this trouble which you will often find indicated, and when indicated will find no substitute in therapeutics.

BOSTON HOMEOPATHIC MEDICAL SOCIETY.

OCTOBER MEETING.

THE first meeting subsequent to the summer vacation was held Oct. 9, at the usual place. Dr. F. B. Percy resigned the secretaryship of the society after a year of faithful service, and nominated in his place Dr. Horace Packard, who was elected. The quarterly election of president and vice-president resulted in the choice of Dr. F. B. Percy and Dr. J. P. Sutherland. Dr. David Thayer tendered a letter of resignation, which was accepted. Dr. C. H. Farnsworth presented a short paper setting forth the flattering results obtained by him from the use of Con. mac. in a case of scirrhus mammæ. When the case was first brought under his observation it presented all the characteristics of malignancy, but, under the long-continued use of the above-mentioned drug, the swelling and pain have entirely disappeared, and, at the present time, both mammæ are in an equally healthy condition.

Dr. Talbot has observed cases where the same remedy has seemed to remove pain and check the progress of the disease. A case was brought before the society which presented characteristics of epithelioma in the initiatory stage, but cicatrization had taken place, and ultimate recovery seemed assured. Hydrocotyl had been administered internally and a solution of Merc. cor. occasionally applied externally.

Other remarks in relation to the treatment of malignant diseases were made by Drs. Sherman and Cushing.

NOVEMBER MEETING.

The November meeting was fully attended, forty-one persons being present. The exercises of the evening were preceded by a social lunch.

Drs. W. H. White, M. F. McCrilles, Geo. R. Southwick, and A. M. Selee were elected to membership.

Dr. Talbot called attention to the effort being made to gain admission for homoeopathic practitioners into the United States army and navy, urged all members to use every personal effort possible, and closed by offering the following resolutions, which were unanimously adopted :

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