ble number of tumors of the lachrymal gland have been reported and their histology has been thoroughly studied and O. Becker's sweeping criticism is evidently not substantiated by facts. Almost every year has brought forth the report of one or more such cases in literature, and while it is true that the majority of the tumors had a partially epithelial character, as is natural from their origin, there are quite a large number of tumors on record in which the epithelial character was altogether wanting or played a very inferior role. However, we shall return to this point later on.

The symptoms of the affection usually begin with a slight swelling in the outer upper part of the orbit by which the eye is pressed out of its normal position. As the swelling increases, which is usually a very slow process, the exophthalmus increases also and the eye 'is pressed down, in and forward, while up and outward movements become restricted. This is usually accompanied by diplopia. Gradually the outer part of the upper eyelid is pressed more forward, its folds disappear and it appears elongated. At this time, if not before, it is possible to feel the tumor at the location mentioned, and, perhaps, to see parts of it protruding under the conjunctiva when turning the upper eyelid. It may appear solid or lobulated to the palpating finger and it may feel hard or semi soft and elastic, according to its consistency; yet it is probably impossible to make a diagnosis as to its nature from these symptoms.

As the growth goes on the lid can neither be lifted nor does it fully cover the protruding eyeball. The veins of the lid and of the temple appear engorged. If the tumor grows more rapidly backward into the orbit, it may form a shell, so to speak, behind the eyeball, and thus produce an exophthalmus in an almost straightforward direction as we are accustomed to see due to tumors of the optic

nerve.

If the tumor is allowed to grow further, the exposed cornea sloughs or dries out.

During this gradual development of the tumor the patients sometimes suffer from considerable pain, others complain only of the diplopia, and this latter symptom may disappear when the eyeball is so far pressed down that the lower lid covers the pupillary area.

The only etiological factor which in the reported cases is sometimes stated is a previous injury of some kind or other to the temple on the affected side.

Aside from the danger to the eyeball by destruction of the cornea, and of blindness by atrophy of the optic nerve due to the compression of the blood-vessels, the tumors of the lachrymal gland, by their malignity, endanger the patient's life, and should, there

fore, be removed as early as their presence is recognized.

In the earlier stages of their growth this may be done with the preservation of the eyeball and of vision, although ptosis may result and has in a number of instances resulted from this operation.

The removal is easiest accomplished by an incision through the upper eyelid along the orbital margin. As these tumors are usually very friable and soft, some even almost gelatinous, the removal must be done very carefully and with the avoidance of sharp-cutting instruments. It is often impossible, with the greatest care, even, to remove the tumor as a whole. Another method consists in removing the tumor from the conjunctiva after splitting the outer canthus.

Later on, when the tumor has filled the posterior parts of the orbit and the eye is lost, or when it has spread so far as to make a clean removal by the methods just mentioned impossible, it may become necessary to eviscerate the whole orbit. In such cases, however, the tumor has usually enterd the cranial cavity through the orbital fissures, and the effect of the operation can, at best, be only a palliative one.

The healing is usually very smooth and uneventful. When the eyeball has been saved, it returns to its normal position and the patient may even regain binocular vision.

As stated before, the histological character of these tumors varies greatly. It has been my good fortune to personally examine seven tumors of the lachrymal gland, three of which I have myself removed and reported in Knapp's Archives and the American Journal of Ophthalmology. I have of late again studied my specimens very carefully and with the following results: Five of the tumors may be considered as being to some extent of an epithelial character, two show no epithelial structure whatever.

Of the five tumors showing epithelial structures there is only one in which this character is throughout the tumor the prevailing one. In fact, so closely does this tumor follow the normal appearance of the lachrymal gland. that I described and published it as an adenoma. The connective tissue between the glandular structures is also increased, but not to any very large extent.

The four other tumors, which also show an epithelial character, and which in their structure seem to be very much like those described by O. Decker as adenoids, are but little different from each other. The more I have studied them the more have I become convinced that the epithelial tissue found in them must be looked upon as the remnants of the original glandular tissue, which are in places somewhat hypertrophied, but that there is hardly

any new formation of glandular tissue, and that in consequence the real character of these tumors is not that of an epithelioma or a glandular carcinoma. The bulk of the tumors is made up of myoxomatous and cartilaginous tissue, by which the glandular structures are widely pressed apart and probably have atrophied and totally disappeared in places. The epithelial tissue still found shows, as a rule, a glandular, tubular arrangement of the cells. around an open lumen. There are here and there cystic enlargements, which show that some secretion has been going on while the growth progressed. In some places small colloid bodies are found, probably metamorphosed cells.

The sixth tumor of the lachrymal gland which I examined was a spindle cell sarcoma of the purest type. It consists simply of smaller and larger spindle cells closely packed with no visible intercellular substance and some round cells in the younger portions. I may state that this tumor has grown back into the orbit and produced a straight forward exophthalmus with absolute abolishment of the motility of the eyeball. The patient died later on of multiple spindle-cell sarcomata in all important organs.

out as

The last tumor of the lachrymal gland I removed was so soft that when on incision the thin capsule was opened the contents oozed granular sticky mass. As the forceps could nowhere get a hold of it, I had to squeeze it out before I could thoroughly remove the capsule. It proved to be a chondrosarcoma. There is not a trace of glandular tissue to be found in this tumor. The only other tissue it contains is here and there a microscopical spicula of bone. There are also some colloid bodies in this tumor.

The number of tumors of the lachrymal gland here considered is, of course, not a large one in itself, although not so small when compared with the whole number of cases reported in literature. Yet, with the exception of the case, which I consider to be an adenoma, the remaining ones are chiefly characterized by connective tissue formations, not by an epithelial structure. I do not think, therefore, that I am wrong when concluding that the tumors of the lachrymal gland very frequently take their origin in the interstitial connective tissue and only in the rarer instances are truly epithelial in character.

Lymphoma, lymphadenoma, tubercular tumors and chloroma of the lachrymal gland, as have been described in a number of instances, I have not had an opportunity to see.

Dr. Nicholas Senn was unanimously elected president of the American Medical Association as the recent meeting at Atlanta.

The Location of Foreign Bodies in the Limbs by Means of the Roentgen Rays.

An instrument has been devised for this purpose by E. P. Hershey, C. E., M. D., of Denver, Colo., made from an ordinary T-square, the center being sawed through from above downward, and grooves made in the wood from the center to one side vertical to the center line. Within the portion sawed. out was placed a piece of copper wire accurately fitting the space, and fastened within the grooves, made vertical to this wire, were placed fine pieces of German silver wire, at a distance of one inch apart.

The skiagraph taken by Lacombe and Johnston, and developed by Williamson & Haffner, shows the result obtained. The dark object being a crushed bullet, and below is to be found a pin, both pressed into the flesh and placed under the arm farthest away from the source of light. The most striking point of interest is the fact that the bullet is clearly shown through the bone, as the radius lay between the bullet and the source of the rays. It would be useless to locate a bullet by means of the X-rays unless there was a positive means of locating the foreign object. With this device any object may be located with unerring accuracy.

From experiments tried upon the chest and abdomen, there is no doubt but that within a short time foreign bodies may be located within them, and with the same instrument located to a nicety.

Massage in the Treatment of Sprains and Bruises.

The Revue Internationale de Médecine et de Chirurgie for January 25 contains an abstract of a paper which was read by Dr. Krafft of Lausanne, before the Société Médicale de la Suisse Romande. Dr. Krafft, says the writer, reported a hundred and three cases in which he had employed this treatment with excellent results. He stated that a careful toilet should be made of the region to be treated, and that the hands should be rubbed with a one per cent solution of corrosive sublimate in glycerin, so that they may slip easily over the skin and thus prevent irritation. Before beginning massage a cold douche should be applied locally; afterward prolonged effleurage is begun and continued by simple friction, which is made more energetic when following the course of the blood. Other manipulations, he said, such as kneading, were completely useless in cases of recent accidents. After massage, active and passive movements may be made. By this simple procedure, said Dr. Krafft, very satisfactory results might be obtained. New York Medical Journal.

Microscopic lies are not always little lies. They are the gilded fiction of bacteriology coming from a universe of infinity of unimagined minuteness and an incomprehensible multiplicity of living factors. A microbe is like man. He is a connecting link between a material universe and an unknown infinity of life's immateriality.

The lunatic and the microscopist are expected to have an unlimited imagination. One see worlds through his mind's eye, while the other searches with imperfect aids for the boundary of an infinite space; there are worlds and worlds which dazzle the field of the microscope and are as unknown as are heavenly planets.

We have heard what the man thinks of the microbe, but the illumined field of the slide will not tell us what the microbe thinks of the man. We are inclined to believe that if man continues to make microbes possessing the idiotic function of what here follows, the microbe's opinion would be justly and germfully severe. Here is a part of an editorial upon the microbe of old age taken from a daily paper. It has been said that the next

thing to a very good joke is a very bad one, but this one carries out Milton's definition of the sublime that which is palpably obscure:

"Bacteriology is a great science, and during the past twenty years has developed with amazing rapidity. Of late, however, there seems to be a tendency on the part of the investigators to construct a 'microbe theory." In this they have been so successful that theory is now far outstripping our actual knowledge of cause and effect as applied to these socalled 'germs.'

"One school of European bacteriologists are willing to stake the reputation of every student of the science from Bastian and Pasteur down to Johnson of Kansas that bald-headedness in the human species is caused by the ravages of a microbe which they have called the 'bacillus carnivorax.' Its discoverer, a Frenchman by the name of Saymonne, also professes to believe that drunkenness is contagious, and that the 'microbe of alcoholism' will eventually be discovered. The microbe of insanity is even more than suspected of being an undiscovered reality.' The air surrounding angry mobs of men is also said to be filled with microbes that will, upon being inhaled, almost instantly convert an onlooker and make him believe that the object of the crowd's wrath should be exterminated.

"In short, there is no end to the fancies which imaginative microbe theorists can conjure up.

"Ridiculous as the majority of these theories are, there are dozens of investigators of international reputation who can expound such doctrine by the hour and bring excellent arguments in proof of what they say along their special lines."

Here is potted wisdom. Ignorance is the wet nurse to this germ theory. Here is progress; these are living moments, but it is an awful scale in progress between that baldheaded bacillus called the "bacillus carnivorax" and man. Ponder on that contagious bacillus. which produces drunkenness called the "microbe of alcoholism!" We thought that it was a barkeeper, not a microbe. Again, that “undiscovered reality," the "microbe of insanity." Then it is not oppression which makes wise. men mad but microbes. Last but not least, that hoodlum microbe causing mobs to act with effect on all men concerned.

Thank heaven the force, influence and the active consideration of self and other matters will debar these new germ theorists from discovering the microbe of a real actively engaged cyclone or a busy earthquake. The bacteriologist who tries to discover the mi

crobe of a bursting steam boiler will blessedly and fatefully leave his researches incomplete. We trust that close contact will be necessary for the discoverer of the microbe of exploding dynamite. Telescopes in this case would be efficient in discovering his remains.

THE EXTREMES OF SHOCK AS MANIFESTED IN RAILWAY INJURY.

A RETROSPECTION.

Nordau says: "Egotism is a lack of amiability, a defect in education; perhaps a fault of character, a proof of insufficiently developed morality, but is not a disease. The egotist is quite able to look after himself in life and hold his place in society; he is often, also, when the attainment of low ends only is in view, more capable than the superior and nobler man, who has inured himself to selfabnegation. The ego maniac, on the contrary, is an invalid, who does not see things as they are, does not understand the world, and cannot take up the right attitude toward it."

We have always viewed retrospection as a more or less harmless by-play of egotistical thought, with just enough of the "I" in it to give it individuality; besides, there should be permitted in the rehearsing of past experience a liberty of style not generally permitted in scientific communication. Basford may be correct, when he says: “One who uses many periods is a philosopher; many interrogations, a student; many exclamations, a fanatic." Again retrospection, to make it truly interesting, should be more or less altruistic; the "I" or ego should add to the true condition of others. The story of the suffering of man should always aim to interpret the virtues and defects of others, and while the writer may extol the virtues of others, he unconsciously shows his character in the detail. For Froude says: "The essence of true nobility is a neglect of self. Let the thought of self pass in and the beauty of great action is gone like the bloom from a soiled flower.'

Experience, after all, is but "retrospect knowledge," and gives us the truest ideas of life and man and more completely adds to the knowledge and wisdom of others than to ourselves.

Reviewing life, as a doctor, for the past thirty

years, and as a railway surgeon for twentytwo years, we find that memory, instead of being obtunded by a continuous repetition and monotony of occurrence, seems the more acute. Thinking of the many people attended, the harrowing scenes encountered, the great suffering, the multitudinous forms of pain, the dire and excessive mutilations of the human body, and the constant presence of sorrowful, pathetic and dramatic deaths, Prior's lines. have come to mind more than once:

"Who breathes must suffer, and who thinks must mourn,

And he alone is blest who ne'er was born."

Man's life at best is uncertain and particularly so the vocation of a railway employe. It is very brief at the longest and very troublesome in its most favored conditions. But particularly so with the employe, who is surrounded by ponderous moving power; by the by-play of uncertain footing and the paralyzing, forceful action of gravity. All of nature's forces are at times arrayed against him; darkness, fire, storm and deceitful surroundings; morbid mental conditions, the criminality of bad men, the abberrations of time, nature, place, and the uninterpretable actions of Providence. Hence, more keenly than many in other vocations, we naturally view life as the most uncertain of all things, and simply for the reason that in a long and active career we have seen death come so suddenly, so rapidly, so unexpectedly, and in such appallingly shocking forms as to debar the possibility of the exercise of anything like normal and unruffled thought and explanation. Within a few minutes we have seen men, full of bouyancy, hope and strength, changed into a mangled mass of inanimate, discolored bone and flesh, an absolutely appalling change from a condition of force, power and effect to a gross materiality. The railway hospital surgeon is under a constant tension; every element of humanity and feeling, every element which makes him turn to inner consciousness is almost continuously rife. To anyone having experience in the severer forms of railway accident, shock, profound shock, or, as it has been called by some, "traumatic delirium," that benumbing, unknown quantity is very familiar. For constantly, the most tragic and soul harrowing element of his life is depicted in the results of shock.

We believe that the derivation of delirium,

curious as it is, comes from de, which means from, and lira, which means a ridge between two furrows; a quaint, but suggestive derivation. These two furrows to us represent life and death and the ridge the mutilated man between, and certain it is that the separation between these metaphorical furrows is only too oft marked not only by hours, but by

minutes and seconds as well.

The history of railway accidents shows that they rarely come with a mild and placid aspect, there is eternally an element of shock to all concerned, which is constantly produced in consequence of the immense difference between the effect, intensity and result. While some competent authority has seen fit to describe the condition, as "traumatic delirium." We understand delirium to mean, "a state in which one's ideas are wild and irregular and unconnected -mental abberration-strong excitement, wild enthusiasm, insanity, frenzy, madness." Excitement there may be in these cases, but there is in the most pronounced cases, no mental abberration, and hence we would rather use the expression shock than to characterize this condition as one of delirium.

We desire to say that in spite of the caption of "traumatic delirium," the words of Dr. William Hunt, senior surgeon, to the Pennsylvania hospital, Philadelphia, contained in a contribution to Ashhursts' International Encyclopædia of Surgery, have given a most classical description of this condition, and we take pleasure in quoting from him. He says:

"There is a rather rare form of immediate traumatic delirium, which, nevertheless, must be more or less familiar to every surgeon of a great accident hospital, or to those who are in any position, as upon the battle field, where they become familiar with sudden and severe casualities. Delirium might appear to some to be a misnomer, for the characteristic is that every word and idea are perfectly coherent. There is great exaltation of mind, but an utter want of appreciation about the injuries. Trauma of the spine has been involved in the crush and the line of communication of the brain has been cut off, but this is not necessarily the case. There is no collapse at first; the skin has its normal temperature, the pulse is full and rather frequent, the face may be more flushed than natural, the eyes bright and the expression good. The surgeon enters a ward some morning after a terrible accident has occurred, and finds that a victim of this kind has just been brought in and laid upon a bed.

He is at once recognized by the patient as one in authority. 'How are you, Doctor,' he says in a high voice, 'what have they brought me here for. I am not hurt! No sir, look at that!' And out goes an arm with the force of a prize-fighter, delivering a crusher. 'Look here!' And he tries to lift a leg, which his sensorium falsely tells him he has done, although his expression may indicate a vague and passing doubt. 'Why, there is my wife! Molly, what are you doing here? Don't cry, what are you crying for? I'm not hurt, go home to the children and tell them I'll be there to supper, and at the mills to-morrow! Won't I, Doctor? Go home!' Soon this great tension gives way, collapse comes on and by night the patient is in another home than that in which he promised to be. I have never known such a case to recover. With all its coherence, with every intellectual and perceptive process correct, as far as external matters are concerned, every word and thought as to other persons and objects right, everything as to himself wrong, how are we to classify this state, except as one of delirium? Important questions might arise as to the testamentary capacity of such persons; from what I have seen and described there is nothing in their condition inconsistent with full ability to direct the management of their estate and effects."

Yes, we fully agree that every element of perfect mentality is present. For many years we have seen this, and can bear testimony to the fullest detail of the truthfulness of this description as far as it goes. Let us carry out the description a little further. After the crushed and mangled patient lies there a while, and still viewing everything with a quick and alert eye, he suddenly says: "Give me a drink, raise me up, give me a little air! Oh! but that water was good, give me another drink!" As we notice him we find that his face is becoming blanched, his pulse quick and weaker, big drops of perspiration hang upon his brow; the alæ of his nose begin to move and vibrate with every breath. His face now turns more brilliantly pale, almost phosphorescent. His voice has now a slight husky tone, he suddenly and without any seeming effort spews out of his mouth the clean, uncolored water he has just taken, and with each attack of emesis his pulse becomes more feeble and intermittent. "Give me more water," he calls, "that's good, thank you." Memory is now slightly touched. "Did you give me that drink? Please give me another." Again emesis stops his utterance. "Oh, for God's sake turn me on my side, my back is killing me, give me some