In about seven weeks he returned almost blind in the other eye from a severe irido-choroiditis. The patient based his reason for this delay on the fact that his friends had mentioned a case, in which a piece of steel had remained eleven years in an eye without serious consequences to the other eye. The globe was extirpated nearly eight weeks after the accident, too late, however, to modify the inflammatory action in the other eye. The piece of steel was found in the ciliary muscle. In this case you observe a glaucomatous process in the remaining eye, the great tension (hardness) of the globe being readily felt by gentle palpation with the tips of the two fore fingers. The disease has not yielded to iridectomy nor the use of pot. iod. and mercurials. The prognosis is certainly most grave.

In the other case before you, we have the following history The young man, 20 years of age, received a piece of steel in the right eye a year ago last December. It was removed from the eye by his family physician, at the end of about seven weeks, the walls of the globe being left. Unfortunately the other eye became inflamed and gradually almost blind. At present we find the injured eye atrophied, without inflammation. The other is also without inflammation, but is partially atrophied, the tension being much less than normal. There is a cataractous lens with iris very extensively attached, and still the patient can see to go alone in the street, although with difficulty. As there is scarcely a hope that iridectomy would improve vision, and as the sight is slightly improving under the use of iodide of potash and atropine, we will, for the present, follow no other treatment.*

I cannot close these remarks without urging you to make this chapter of ophthalmology a subject of special study.

* I would insist upon the operation of iridectomy, if the iris was even slightly raised above the surface of the lens. It is, however, atrophied, and undoubtedly attached to the lens throughout its whole posterior surface.

You will at times be called upon to exercise your utmost prudence. Just as the question whether you should amputate a limb or attempt to save it, may be a very difficult one to solve at the proper time, so will be the question whether you should extirpate an eye or attempt to save it.

RUSH MEDICAL COLLEGE.

Clinic by PROF. GUNN. December 31, 1874.

(Reported by HENRY L. HARRINGTON.)

CASE Fracture of the Os Innominatum at the bottom of the

Acetabulum.

Son of R. J. Fowler; aged 11. The patient, a well developed, robust lad, comes from Storm Lake, Iowa, for advice, giving the following history :

Thirteen days ago he was thrown from a horse in a frozen ploughed field; when picked up he was found. lying with his right hip upon a large frozen clod.

A physician was called, who pronounced it a case of fracture of the ala of the right ilium and treated accordingly. Eight days afterwards, the father, suspecting that all was not right, called in consultation other physicians, who decided that the head of the femur was dislocated into the thyroid foramen: accordingly strenuous efforts were made at reduction, but without avail. The patient was able at all times to move the injured limb, and walked about the house the fifth day after the injury. He did not at any time suffer from fever, nor from any other symptoms of constitutional disturbance.

On examination, we notice when the patient is walking, a decided halt in his gait. When standing, we observe marked flattening of the right trochanteric region; great apparent lengthening of the right leg; slight eversion of the right foot; and also that his body is strongly inclined towards the right side, and slightly bowed forwards. At this stage of the examination I suspect that we have downward and forward dislocation of the femur. Upon

placing the patient in the supine position and searching carefully in the groin for the head of the bone we fail to find it; we also find that the body and legs are straight, and that although the foot is everted, it can be rotated inwards voluntarily co-extensive with the sound side. Upon careful measurement we find that the elongation is only apparent, and due to the inclination of the pelvis. Again, upon putting the leg through its motions, we notice, that with the exception of extreme flexion and extension, they are as perfect and as devoid of pain as those of the left limb. We will now be obliged to give up entirely the idea of dislocation.

There is only one positive sign left upon which to base a diagnosis, i. e., the flattening of the trochanteric region. This is so great, that a straight edge placed along the outer side of the injured side, rests upon the external malleolus, the great trochanter and the crest of the ilium, while upon the sound side it rests upon the malleolus and great trochanter only, being separated from the crest of the ilium at least one and one-fourth inches. Can it be an impacted fracture of the neck? I think not, from the fact that it would not account for the degree of flattening present; for the reason that in that injury we usually have some shortening, and also because the efforts at reduction would probably have separated the fragments. We must, therefore, look to the inner extremity for the injury. I do not think it can be impaction of the neck within the head, because that would not account for the flattening. I am now of the opinion that we have a fracture at the bottom of the acetabulum, with bulging inwards of the fragments, which allows the head of the femur to occupy a plane nearer the mesian line of the body. To confirm or to refute this diagnosis, the patient was placed under the influence of ether, and an examination made per rectum, which revealed a prominent tumor projecting into the pelvic cavity, corresponding in position to the right acetabulum.

It is a remarkable case, from the fact that we have had

no symptoms of inflammation of the pelvic organs or tissues. No treatment is required; the lad will undoubtedly regain very good use of the leg.

Editors' Book Table.

[NOTE. - All works reviewed in the pages of the CHICAGO MEDICAL JOURNAL may be found in the extensive stock of W. B. KEEN, COOKE & Co., whose catalogue of Medical Books will be sent to any address upon request.]

THERAPEUTICS AND MATERIA MEDICA. A Systematic Treatise on the Action and Uses of Medical Agents, including their Description and History. By Alfred Stille, M.D., Professor of the Theory and Practice of Medicine and of Clinical Medicine in the University of Pennsylvania, etc., etc. Fourth edition, thoroughly revised and enlarged; in two volumes. Philadelphia: Henry C. Lea. 1874.

From the publication of the first edition "Stille's Therapeutics" has been one of the classics; its absence from our libraries would create a vacuum which could be filled by no other work in the language, and its presence supplies, in the two volumes of the present edition, a whole cyclopædia of therapeutics.

The present is simply an improvement upon the former edition, not in plan and scope of its matter, nor in the style of its presentation, for the breadth of the one and the elegance of the other scarcely admitted improvement, but in the additional matter, whose introduction has been necessitated by the advances in science, and also in the evidences of careful revision to which the whole has been subjected.

The new matter added constitutes about two hundred and fifty pages, of which the article upon Electricity covers a considerable portion. The author is a most uncompromising champion of the exclusive value of clinical experience as the basis for the determination of the thera

peutic application of medicine, and considers the deduction of the "therapeutical uses of medicines from their physiological action" as a "mischievous error," which opinion we beg leave to deprecate as altogether too exclusive, as clinical medicine without physiological experiment would lack one of its most efficient guides, one of its sources of enlightenment, without whose aid it would grope doubtfully in the darkness of empiricism; and physiological experiment without the endorsement of clinical observation, would lack its only reliable certificate of therapeutic usefulness.

The language and style of the work evinces the professional erudition and scholastic accomplishment of the author, and, aside from its scientific and practical value, will serve as a model for professional authors who have yet to learn that the medical man is not the worse physician for being the accomplished scholar.

PAMPHLETS RECEIVED.

H.

A BRASS RING LODGED IN THE LARYNX FOR FOUR YEARS REMOVED BY SUB HYOIDEAN LARYNGOTOMY. Cure, by Geo. M. Lefferts, M.D., Surgeon to the New York Eye and Ear Infirmary. 1875.

TRANSACTIONS OF THE AMERICAN OTOLOGICAL SOCIETY. Seventh Annual Meeting. Newport, R. I., July 15, 1874.

HOW DO SPERMATOZOA ENTER THE UTERUS? By Joseph R. Beck, M.D., Fort Wayne, Indiana. Reprinted from the American Journal of Obstetrics for November, 1874. New York: Wm. Wood & Co. 1874.

ON REFLEX IRRITATIONS THROUGHOUT THE GENITO-URINARY TRACT, Resulting from Contraction of the Urethra at or near the Meatus Urinarius, Congenital or Acquired. By Fessenden N. Otis, M.D. 1875.

LETTER TO THE COMMITTEE OF CITIZENS of the proposed Schuylkill Drove Yard and Abattoir. By Jno. II. Rauch, M.D., Treasurer of the American Health Association, late Sanitary Superintendent of Chicago, Ill. Philadelphia. 1874. CONTRIBUTIONS TO THE ANNALS OF MEDICAL PROGRESS AND MEDICAL EDUCATION IN THE UNITED STATES, before and during the War of Independence. By Joseph Toner, M.D., Washington: Government Printing Office. 1874.