against these favorable features of myopia, however, must be set the consideration that, while hyperopia is generally a sheer congenital error or refraction, not involving any physical disorder of the eye itself, myopia is almost always a pathological condition, in many cases acquired, and unless properly corrected by lenses and subjected to intelligent hygiene, tends to grow progressively worse, with ultimate danger to the eyeball.

PRESBYOPIA.

The presence or absence of presbyopia, says the Optical Journal Review, is usually easily discovered. When the correction for distance has been found and has been placed before the eye under test, then if there is presbyopia it will be impossible to read at the reading distance the type which should be read at that distance, and all type viewed at that point will be blurred more or less. Putting on plus spherical power will cause these appearances to disappear. However, if there is a condition of subnormal visual acuity present, there will be a lack of reading power, but the balance of the tests made will make clear the true state of affairs.

The Correction of Presbyopia. The correction of presbyopia would seem at first sight to be a very simple piece of business, and yet if the refractionist of many years' experience is asked which class of cases gives him the most trouble, he is apt to answer, "the presbyopes." There are a number of reasons for this; one is that the wearer of the glasses does not know just what glasses can do; he wants a pair with which he can see both far and near as well as he used to; or the glasses are rather high in power and he is bothered by the changes in prismatic action of the lenses as he looks at objects at different distances. As a rule it is most satisfactory to correct presbyopia for a point somewhat farther away than the wearer of the glasses says is his reading point.

A good way to get an idea in the matter is not to ask the patient to hold print at the point where he thinks he reads, but to hand him a card of printed matter to look at while you are attending to something else, and then to watch and see where he holds the card to read, but with nothing previously said about his reading it. He will naturally read the card, as he has nothing else to do, but nothing. having been said as to the distance, he will hold the card at that distance at which he usually reads and not at the point where he thinks he reads it. Then correct for a point a little farther out than this, and the best general result will be reached.

EFFECTS OF ULTRA-VIOLET RAYS.

The Optician calls attention to the fact that an inflammation, known as electric ophthalmia, is produced by even brief exposure of an unprotected eye to ultraviolet rays of very short wave-lengths. Fortunately, these rays are absorbed by glass, so that the eye can easily be protected against them. The question has recently been asked whether the ultraviolet waves of greater wave-length, which are not absorbed by ordinary glass, and which are much more abundant in the radiations emitted by electric lamps and incandescent gas mantles than in the light furnished by old-fashioned gas burners and kerosene lamps, may not also injure the eyes.

Dr. Schanz, of Dresden, attributes ocapity of the crystalline lens and senile cataract to the agency of these rays. As sunlight and diffuse daylight, to which the human eye has completely adapted itself, and which may, therefore, be regarded as the normal illumination, likewise contain the longer ultra-violet waves, the important question is whether the eye receives such waves more abundantly from the modern powerful artificial sources of light, arranged in the usual way, than from daylight of equal illuminating power.

Dr. Voege, of Hamburg, has proved by numerous comparative tests that ultra-violet rays are far more abundant in daylight than in light of equal intensity furnished by incandescent electric and gas lamps, and most electric arc lamps. An eye looking at an arc lamp receives fewer ultra-violet waves than it would receive from the rays of the sun reflected to it by a bit of polished metal at the same distance. Hence the modern powerful lamps are not injurious to the eye if certain precautions which are required for the visible as well as for the ultra-violet rays, are observed.

A powerful source of light should not be placed too near the eye, and an unnecessary intensity of illumination of the desk or work table should be avoided. The lamps should be so arranged and shaded that the dazzling incandescent source of light is not directly visible. The best method of illumination is the indirect system, in which the rays strike a white ceiling and are thence irregu larly reflected to the table, producing an illumination very similar to that of diffused daylight. Unshaded incandescent gas lamps should be inclosed in opal or ground glass globes. For work with arc lamps and other lights of great photographic intensity spectacles made of glass which possess an especially great power of absorbing ultra-violet rays should be employed.

ACQUIRED MYOPIA. Almost all cases of myopia are acquired. With very rare exceptions children, when born, have hyperopic eyes, which tend normally to change to emmetropia in a few years, this due to the growth of the eyeball. But this growth may be made excessive as the result of the use of the eyes for looking at near objects. The convergence of the eyes, the need of exerting the ciliary muscle, brings a blood supply to the eyeball, which increases the tension, with the result that the eye as a whole, or else the front or rear portion of it, stretches,

thus making the distance from front to rear greater, which means, of course, myopia. Where this action is excessive the resultant myopia is looked upon as malignant, and is believed by some specialists to be a sign of general disease, rather than a disease in itself.

BIFOCALS.

The presbyope who is also a hyperope, or if he has astigmatism of moderate or high degree, must wear double focus glasses if he is to have good vision for both far and near. A lens placed before an eye without accommodation can focus that eye for one distance and no other, so that if the glass is so arranged that in a certain portion of the lens there is attached another lens of different power, then this would be a double focus or bifocal lens, through a part of which the eye would be focused for one distance, and through the other for` another distance. The presbyope if he is also an ametrope must, if he is to get the best of vision, wear such a lens. There are many cases where ametropes do not wear bifocal lenses, neither do they make use of two different pairs of glasses, but this is because they are not called upon to make exact use of their for eyes but any close distances; therefore, they are satisfied with the one pair of glasses, though they may have to look over the top of them when they want to look across the room or farther away.

APHAKIA.

This is a name given to that condition of the eye where there is no crystalline lens present. It is a very great rarity for an eye to be found in this condition except as the result of an accident or the removal of the lens because of cataract. A cataract is a translucent lens. When fully developed it lets a little light through, just as does a sheet of ground. glass, but there is no vision, and to give vision the lens is removed. The eye is then said to be an aphakik eye, the diop

tric power being usually such that a plus 10 lens, or thereabouts, has to be worn to give a distinct retinal image. Aphakik eyes are tested in the same way as other eyes, but the visual acuity is seldom up to the normal and may be much below that point. The idea that the sight of the old person will be restored when the crystalline lens has been removed is a half truth. As a rule, sight is given to the person, but not the sight of his youth, for the scar left on the cornea by the operation, and the pulling of the tissues of the cornea as the result of this operation, produce a more or less imperfect corneal surface that continues.

REFRACTION IN BACKWARD CHIL.

DREN.

Dr. John Lewis Beard, in The Educator, says that most children who are considered backward-not to say mentally abnormal-by their teachers-are suffering from some asthenopic condition-some imbalance of the muscles of the eye, very often combined with an error of refraction-which if relieved would, in most instances, mark a very decided improvement in their mental status. And before a verdict of incorrigible is rendered a special investigation of the eyes should be made; not a simple test for visual acuity, but a thorough diagnosis by a competent optometrist. Indeed, every teacher should have special training which will enable him to determine whether or not a pupil's eyes are normal. Not that he should be qualified to differentiate in the variety of errors, but, for instance, when his pupil persists in calling erroneously from the blackboard, the teacher should have some simple method of determining the pupil's ability to see, and if his vision is found to be defective it should be his duty to report the condition to the parents or guardian of the child.

It is not always a case of poor vision, however, for frequently one's vision may

be normal, as in instances where the disturbing cause is hypermetropia, and the accommodative muscles are exercised to obtain good vision, from which nervous reflexes ensue, and the patient is incapacitated; or it may be the accommodation and convergence do not function harmoniously, or there exists a heterophoria--a tendency of the visual lines away from parallelism-caused by weakness of one or more of the motor muscles, while the focusing apparatus may be normal, the patient suffering nervous disturbances meanwhile, which are sometimes manifested in headaches, nervous stomach trouble, insomnia and even epilepsy and insanity, for, be it known, we do not see with the eye, nor with the optic nerve, but with the brain; and that portion of the brain which receives the visual impressions, the corpora quadrigemina and the thalamus (from which the optic nerve is supposed to originate) are greater in area than any lobe of the brain devoted to a special function.

And when we remember that all the motor muscles of the eye except the superior oblique, which rotates the eyeball downward and inward, and the external rectus, which rotates the eyeball outward, are supplied with nervous energy by the third cranial nerve, while the superior oblique is supplied by the fourth cranial, and the external rectus by the. sixth; and that the ciliary receives its supply from the ciliary ganglion, and the optic nerve originates in the cortical center in the great occipital lobe, and is the one nerve which transmits the majority of the impressions received by the brain --in fact, is the main line in the great telegraphic system-we realize how the short-circuiting of any of these wires (nerves) may produce disastrous effects; and how a boy or girl who suffers from any abnormality of vision may appear mentally defective and refractory, and how important the intelligent dealing with these cases becomes.

CONSERVATIVE

ELECTRO-THERAPY.

Electro-therapy frequently has been held at a low estimate by the profession because of the extravagant and apparently unreasonable claims made by many of its advocates, who proposed to cure everything with electricity to the exclusion of all other methods.

It was not unnatural, therefore, that those unfamiliar with the use of this measure, should go to the other extreme and believe electricity of absolutely no therapeutic value whatsoever.

Now comes the sane and conservative physician who is fair enough and broadminded enough to ascertain for himself the merits of the various electrical modalities and to fit them in with his other therapeutic aids. He finds them perfectly compatible with his drugs and with surgical procedures and most valuable. allies, enabling him to accomplish results hitherto impossible.

When we say conservative we mean careful and using discernment and judgment. It does not mean condemning everything that is new because one is unfamiliar with it, but it means investigating it carefully, but fairly, and resting one's judgment and use upon the result.

Each electrical modality meets certain therapeutic or clinical indications. When these are present the appropriate measure will give positive and reliable results. just as would be expected of a drug under like circumstances.

To practice medicine with but one drug would be obviously absurd, and to expect to use one form of electricity for all conditions is equally so.

A few years ago the X-ray was lauded as a cure for almost every disease that human flesh is heir to. Then came the reaction and it was claimed by many to possess no therapeutic properties.

This equally erroneous position could not be long maintained, and now we recognize its absolute value in certain diseases; its relative value in others, and finally, its utter uselessness in a considerable number.

What is true of the Roentgen ray is equally true of galvanism, high frequency, vibration, etc.

We must look upon each of these from the standpoint of its physiological action and make use of it accordingly.

Drugs, diet, hygiene, electricity, surgery, etc., all have their appropriate use, and in the hands of the skilful and broadminded physician work harmoniously with one another for the benefit of his patient.

GALVANISM IN POLIOMYELITIS. Tom A. Williams, in the Maryland Medical Journal, calls attention to the fact that little children are reluctant to essay movements of a partially disabled limb. When it is an arm they let it hang and use the other; if it is a leg they make no effort, and prefer to be nursed and waited upon. Suspension in water greatly facilitates movement when the muscles are feeble. He confirms the experience of the New York Committee, who found out how easily a child in a bath could accomplish little movements which he was unable even to attempt when his limb was not so supported, and it is very easy for the mother or nurse to invent little play-games to maintain the child's interest for an hour at a time while suspended in a warm bath. There is no danger in this so long as the water is maintained near blood heat. The skin does not macerate, and the effect upon nutrition is most favorable.

To stimulate the circulation in the limbs they should be gently massaged several times a day.

Galvanism.-But from the foregoing procedure one must not expect to procure regeneration of atrophied muscle or nerve. Surgeons know well that the muscles supplied by a cut nerve atrophy and will not regenerate, although they are massaged till doomsday. If, however, they are galvanized from the beginning, atrophy will not occur, for the exercise of their contractile functions maintains the integrity of the muscle elements, and it is only galvanism which can excite contractility when the motor nerve and its endings have degenerated. If treated by galvanism from the beginning, a living muscle cell will greet each regenerated nerve fiber which pushes to its destination. If galvanism is not used, the envelopes of only dead muscle-spindles will be met with. The time for these to regrow must be added to the duration of every case not treated by galvanism. It is necessary to restate these simple physiological facts on account of the vogue of the pernicious statement that no treatment of poliomyelitis should begin until four months have elapsed. This doctrine is another instance of unthinking orthodoxy. But if the elementary physiological considerations just presented make no appeal, the author cites the high authority of Erb, Bergonic, Zimmern and Zappert, the distinguished Viennese peditatrician (added to that of Duchenne's final experience), who make a practice of galvanizing the paralyzed muscles just as soon as the acute symptoms subside.

Mode of Application. The current should be applied only to those muscles which are paralyzed, and the negative pole should be placed over the muscle itself near its tendon of insertion, while the positive pole should be attached to a large electrode applied over the abdomen or other indifferent point. It is useless to stimulate the motor point except during the first two weeks, i. e., before nerve endings have ceased to be stimulated on account of degeneration.

X-RAY IN CANCER.

Pusey, in a comprehensive article in the Journal of the A. M. A., says: No one who is not blind to facts can doubt, if he will take the trouble to investigate, that carcinomatous tissue in the skin can be destroyed with X-rays. On the basis of a large experience in primary and secondary carcinomas of the skin, he states he is willing to maintain that carcinoma tissue in the skin can be destroyed by exposure to X-rays as by any mechanical or chemical method; that the method, therefore, can be used with assurance, and that the results as regards permanency are fully as good as those obtained by any other methods. There are certain theoretical advantages which the use of the X-ray offers over other destructive methods.

First. It is painless and avoids the or deal of operation. This is an advantage not only of humane consideration, but of practical importance, because it enables one to treat early lesions in cases in which the patient will not at any time accept the gravity of the situation and submit to operation or any other method of gross destruction.

Second. The method may be so used as to destroy carcinoma cells, but leave in large part the connective tissue stroma intact and in condition to repair itself. Third. Accordingly it leaves sma!!

scars.

Fourth. It can be used in cases in which the surrounding healthy tissue cannot be sacrificed. This means that:

Fifth. It is valuable in certain cases in which ordinary methods are objectionable, because they involve extensive operations and serious subsequent disfigurements, as, for example, about the eye and nose. This means further that:

Sixth. It has a field of usefulness in some cases in which ordinary methods are impossible, because of the amount of destruction of tissues which complete removal would require; in other words, it may be used to produce a radical result in some inoperable cases and to in