wherever practicable. We frequently find that the full error as revealed by atropin cannot be corrected, and, personally, the neces sity for its use occurs less and less often in my practice. Formerly, I used it as a rule in myopia and astigmatism, and very rarely corrected a myopic astigmatism without it.

The test with glasses is still, and always must be, the crucial one, and I would not depend upon either an ophthalmoscopic diagnosis, upon retinoscopy, or the ophthalmometer of Javal, or upon all of them, if the patient rejected the glasses indicated. I regard all three methods as very valuable control tests, and when by the use of one or more of them, we arrive at the same results as with trial lenses, and when the glasses so selected are comfortable and satisfactory to the patient, I believe we are warranted in prescribing them, and that we will attain satisfactory results, and relieve asthenopic and reflex nervous disturbances. The muscular condition is an important factor to be remembered in the prescription of glasses, and influences me in use or non-use of a mydriatic. It is evident that esophoria is often associated with ciliary spasm, and that the presence of exophoria in a given case makes atropin less desirable.

My rule then is to avoid paralyzing the accommodation as far as I can consistently with accurate prescribing. But however expert or skillful one may become with the ophthalmoscope and the more recent methods of examination, there will always remain cases where the accommodation must be put at rest.

Some years ago I had the honor of reading a paper before the New York State Society upon the "Determination and Correction of Astigmatism," and at the same meeting the late Dr. George S. Norton discussed the merits and demerits of atropin in all the various errors of refraction. His conclusions, based upon the examination of upwards of one thousand eyes, were substantially the same as my own, and although my views of the frequent necessity of its use have been modified, as I have learned to rely less exclusively upon the trial with glasses, Dr. Norton so well expressed the indications calling for it, that I would like the privilege of quoting from his address. He says, "In ordinary cases of refractive anomalies of all kinds where glasses can be given and worn at once with perfect comfort, no necessity arises for further examination. But if the glass the patient apparently requires cannot be worn at once with perfect ease, or if the test seems to vary from one moment to

another while making the examination, or if there is Em. or a low degree of M. or As. myopic or hyperopic, with asthenopic symptoms, headache or nervous disturbances, especially combined with esophoria, then I always advise an examination to determine the full error of refraction."-Trans., New York State Society, 1890.

To the above I would add, where marked spasm of accommodation seems to exist, where a decided discrepancy is manifested between the other tests referred to and the trial with glasses, or when the indicated lenses are not accepted, though the result is the same by all methods.

These conditions warrant us in paralyzing the accommodation, but Dr. Norton further stated, significantly, that he did so less and less frequently as he made more use of retinoscopy and the ophthal

mometer.

If we have decided that a mydriatic is necessary, how shall we select the one most desirable in a given case? Atropin is undoubtedly the most reliable and thorough, and in young persons is usually preferable. In adults, or where for any reason it is undesirable to employ it, Homatropin, alone (a 2 per cent. sol.), or in combination with Cocaine, will usually be satisfactory. It is open to the objection that it does not in all cases thoroughly paralyze the accommodation, but this has little weight with me, for in such cases the whole error, as revealed by atropin, could hardly be corrected. I have had only a very limited experience with Hyoscyamine, but in several instances have had unpleasant poisonous effects, and therefore consider it less desirable.

CHALAZION—ITS PATHOLOGY AND A QUERY.

BY H. W. WESTOVER, M.D., ST. JOSEPH, Mo.

CHALAZION is of not infrequent occurrence, and at times annoys the practitioner by its tendency to recur after removal.

Its pathology is often dismissed by the statement that it is a retention-cyst of the eyelid, or it may be a small fibroma. It is well known that in its removal by surgical means particular care must be exercised to remove all the cyst-wall, lest the growth speedily

return.

my

If it is simply a retention-cyst, it would seem this should not be the case. Therefore the last three cases that came under observation were subjected to a careful microscopical examination. One was found to be a small fibroma, but the other two were found to consist largely of a mass of mycelium fungus.

This being quite a surprise, care was used to guard against error in observation, lest fibrous bands be mistaken for mycelium. Accordingly, teased and stained portions were treated with a solution of potassa fusa, when, the detritus being dissolved out, the unmistakable fungus was disclosed not taking the stain as would fibrous bands and tissue.

The question naturally arises: Is this pathological condition frequent occurrence in these cases?

If chalazion is frequently due to the invasion of a mycelium fungus, we can readily understand why it is so prone to recur if not absolutely and completely removed, because a small fragment or mycelium being left, the growth is promptly and readily renewed. In the literature at my disposal no mention is made of this condition, and therefore the query is propounded to this meeting, asking if such a state of affairs has ever been observed by those present or reported by others.

The only explanation occurring to me is that the spores of the fungus might have found lodgment at the mouth of a meibomian gland, more especially if it was in an abnormal condition and the secretions of the gland retained. The spores, finding there a favor

able nidus for development, and the mycelium ramifying and developing in the lumen and contents of the glandular tissue, might eventually produce the tumor.

This would be somewhat analogous to the development of otomycosis, where the external auditory canal is the seat of aspergillus, which is a mycelium fungus.

DISCUSSION.

DR. WILSON: Microscopy satisfies the desire for knowledge, but it doesn't help us any. It strikes me that I have seen cases of these things go along through a regular process of evolution, and yet terminate of their own accord. I believe that to be a natural state in one of those tumors. It is self-limited. The operation depends upon the subject in whom it is found. I have seen so many of these go away by the use of medicine, and I am certain that there are many that disappear on the application of Homoeopathic remedies, especially the antipsoric remedies. They disappear in from three to four weeks. Hepar sulphur and Silicea are the best remedies.

H. W. WESTOVER, M.D.: I think it is of practical value to have the microscopical diagnosis. It is quite true that many of these cysts, or these growths, are of an evanescent and temporary character, and frequently make a spontaneous recovery. But in some cases these conditions are prone to remain for many weary months, with annoyance to the patient from the stiffness of the lid and the size of the growth; and if it happens to be a lady, for cosmetic reasons they dislike to have these disfigurations upon the face or lid. In such cases it has been my fortune to see them persist, in spite of internal remedies. If we know that they are of a character which is prone to return, but will not return if they are thoroughly and completely extirpated, then we are justified, I am sure, in thoroughly extirpating them and not taking any chances on their return, and we can safely endeavor to secure union by first intention. Therefore, while this may be considered minor surgery, still the benefit of having it microscopically determined as to its character gives us much benefit in our work, because we then know exactly in what way to conduct our treatment and what prognosis to give the patient.

DR. SIMPSON: The question with me seems always to be to cure quickly as well as safely. Another thing I have noticed about these operations: If they are carelessly done, sometimes you will have a little fungous growth there. I never have had that happen in my own operations, but have seen it. I usually take a little carbolic acid on cotton on a probe, and, being careful not to touch the conjunctiva, go into the sac and touch the sac inside.

AN INSTRUMENT FOR THE RAPID AND COMPLETE EXAMINATION OF THE OCULAR MUSCLES.

BY HAROLD WILSON, M.D., DETROIT, MICH.

In the instrument herewith submitted for your consideration, a brief description of which has already appeared in the Journal of Oph., Otol. and Laryng., for April, 1894, it has been my intention to secure the greatest possible completeness, convenience and accuracy, at a moderate expense. The routine examination of the muscular apparatus of the eyes has become so universally a part of the regu lar examination of ophthalmic patients, that it is highly important to be able to make all the necessary tests rapidly. Moreover, these tests are sometimes necessary outside of the office, and the requisite apparatus for making them should be easily carried to the patient's bedside or elsewhere. These requisites together with others to be detailed, have I think, been secured in the instrument here shown. I have called this instrument a phorometer, but as you will observe, when it has been more fully described, it does much more than to measure simply the equilibrium of the ocular muscles. Were not the term rather too lengthy, it might be called an "ophthalmomyometer."

It consists as you see, of two rotary cells; a rotating disc carrying prisms of several sorts, and a strong convex cylinder; and a rotary or mobile prism; so combined and arranged as readily to afford the necessary adjustments with accuracy. These are mounted upon a rod sliding in a firm standard clamped to some proper support.

The instrument is capable of the following uses:

A. The determination of muscular equilibrium. 1. Of the recti muscles.

2. Of the oblique muscles.

The determination of the equilibrium of the recti muscles may be made for both near and remote vision by one of the following

methods: