it was in the same condition, but less markedly so at its point of departure from the ganglion; until at its peripheral distribution at the skin, there were few, if any signs of disease. In this case it would seem pretty clear that the disease had been set up in a certain part of the ganglion of Gasser, which corresponds perfectly to the ganglion upon the porterior roots of the spinal nerves; and then through the ganglion an influence had been radiated downward along the course of the sensory nerve fibres that pass through it, which resulted in the congestion and inflammation of the skin of the forehead and eye.

Very similar cases are on record to the one I have just related. I have collected a large number of them from the periodical literature, especially, of Europe. But this is a fair sample of them all. In respect to cases of this kind, one difficulty arises; a difficulty that has been especially insisted upon by Friederich, of Heidelberg, who declares, that, in all such cases, there has been a descending neuritis, which has traveled along the nerve, from the point of lesion out to its peripheral distribution; and, in this way, invades the tissues to which the nerve goes. There can be but little doubt but that this may occur. But that it suffices to explain all the phenomena of certain cases may well be doubted.

However, the impossibility, hitherto, of pointing out the cases known to be absolutely free from objection of Friederich, makes it necessary to resort to some other method of establishing the point in question. Up to this period, such proof has been wanting. But, though this is the case, there are many strong analogies in favor of this view for which I am contending.

In the first place, the action of the motor nerves upon the muscles is certainly very marked and pronounced. Very extraordinary phenomena occur in the action of the muscles, through the agency of the nerves distributed to them. Moreover, the occurrence of changes in the secretions and excretions of the body under the nervous influence, are now well known. The saliva may be greatly increased or diminished; the secretion of the milk may be greatly increased or diminished; and the secretions from the skin, the secretions from the liver and the kidneys are kuown to be largely under the control of the nervous system. Not to go further in this direction, I may be

permitted to say that the changes which take place in the secreting and excreting organs of the body, as they perform their functions, are very closely allied to, if not identical with, nutritive action. The actions that take place in the liver, the salivary glands and kidneys, are accomplished through the agency of cells, and those cells of the secreting structures appear to be very closely under the control of the nervous system.

From such considerations, we may gain a strong presumption in favor of the view that the nervous system exerts an influence over the nutrition of the body. But it will not be possible for me to enter fully into the discussion of this question. My object at the present time, has been to lay before you a few facts touching this important subject, and to make certain suggestions better calculated to stimulate thought than to set forth any doctrine of trophic action, which, indeed, cannot be fully done on the basis of our present knowledge. I will, however, before ceasing to speak, state to you what I consider at least probable in regard to the mechanism through which the trophic action of the nervous system occurs. It is my belief that the ganglia upon the posterior roots of the spinal nerves constitute members of a true trophic nervous system. But I do not believe these ganglia, connected, as they are with the fibers of the sensory nerves that pass through them, constitutute only a small portion of the trophic nervous system. They bear possibly the same relation to it, that the ganglia of the fundamental chain of the sympathetic may possibly do to the vasomotor nervous system. It is my belief that there is a central trophic nervous mechanism in the gray matter of the spinal cord. And connected with the trophic tract are the nerve fibers motor as well as sensory, that enter and leave the spinal cord. That from this tract in the spinal cord an influence is exerted upon the nutrtion of the body to be compared with the influence exerted by the spinal cord over the muscular system; or to be compared to the influence exerted by the spinal cord over the vascular system. It is my belief that this tract in the spinal cord is summed up in the medulla oblongata, and is probably identical with the "heat regulating" center, to which reference has been made by various observers, as by Riegel, by Tschichichin, Wood and others. That from this center of nutrition,

nutrition of the entire body is controlled or influenced. Disease of this particular tract in the spinal cord, and in the medulla leads to changes in nutrition, the rate and character of nutrition, and to various other phenomena, to which these nutritive changes give rise, such as changes in the temperature of the part, and so on.

It is by involving this tract in the spinal cord that those rapid sloughings, or changes in the nutrition of the extremities, and other parts of the body occur, such as have been described by Brown-Sequard, and others, as following lesions in the spinal cord. Without giving you the reasons for this belief, it is my opinion that it is through disturbance of this tract of the spinal cord, or in the course of various nerves, whether sensory or motor that the so-called idiopathic inflammations occur; as, for example, inflammations of the lungs, or limited inflammations of the liver, or in some single muscle or group of muscles, or of the skin, as in various non-parasitic disorders of the skin. These inflammatory disorders that have no demonstrable physical or chemical local causes, in my opinion, are to be attributed to irritation of the part in which the inflammation has its seat, through the medium of its nerves, and especially through the medium of that part of the nervous system that I have called the trophic, and has been called so since the researches of Samuel. Irritation once set up in the part; in other words disturbance of its nutrition, sooner or later is followed by congestion in the same part, in accordance with the maxim known since the time of Haller," where there is irritation there is congestion," the congestion following in the wake of the irritation. As to the mode of occurrence of the congestion following in the wake of irritation, it is another question, and one that, it seems to me me, we are now in condition to explain. I may say in passing, however, that the congestion arises largely in the part which is the seat of irritation, on account of the irritative action itself embracing the working of the local vaso-motor mechanisms which are involved in the seat of irritation. Their action, it is reasonable to suppose, becomes so far impeded, that they fail to exert over the vessels of the part that degree of tonic action necessary to enable them to maintain their proper size under the expansive pressure of the blood, and the side of the vessel naturally dis

tends in proportion, as the local vaso-motor nerves lose their tonic effect over them. In some such way, we may explain the occurence of the congestion of a part after the irritation, the nutrition of which has been disturbed through the channel of its nerves.

If this doctrine that I have outlined can be established upon good grounds, it seems to me destined to throw exceedingly important light on many, hitherto, unsolved questions in pathology. It will afford us a reason, at least a better reason than we have ever yet had for the occurrence, apparently without cause, of local irritation, congestions and inflammations; and may lead, sooner or later, also in a practical way, to improved means for relieving the same.

These suggestions, however, are offered, as I said before, more for the purpose of stimulating thought, and of indicating the direction that I have felt myself warranted in carrying my inferences, in construing phenomena that may be properly gathered under the head of Nervous Trophic Action.

I am still carrying forward my researches upon this subject, and hope in the future to be able to offer a well arranged, thoroughly established doctrine, which will leave the question no longer in doubt, as to whether the nervous system really exerts such influence, as it appears to me it does, over the nutrition of the body; and also, able to point out the practical applications of the doctrine in such a way, I should hope, as to commend it to the profession.

On motion of Dr. Davis, the thanks of the Society were tendered to Dr. Jewell for his report.

The assistant Secretary, Dr. Earle, read the name of Dr. F. L. Wadsworth, proposed for membership. Referred to the Board of Censors:

Dr. S. J. Jones read the following report:

CANTHOTOMY AND SOME OF ITS ADVANTAGES.

BY S. J. JONES, M. D., CHICAGO.

Under the designation of Canthoplasty there has been introduced to the profession a procedure that has been found very beneficial in certain affections of the eye. The term seems to

imply a plastic operation, and in that respect does not appear to be a happy selection. Canthotomy describes more accurately the operation, which consists in dividing the external canthus, for either temporary or permanent enlargement of it.

It is done on the same principle that incision is performed, through the sphincter ani in fistula in ano when the continued contraction prevents union in the fistulous cavity. A similar but less marked improvement is obtained by vigorous stretching of the sphincter for fissure of the anus.

If only a temporary enlargement of the canthus be desired, a simple incision, either by a knife or scissors, through the skin, orbicularis, and conjunctiva will divide a sufficient number of the fibres of the muscles to diminish its power.

Reunion of the cut surfaces may be indefinitely delayed by separating them daily by a blunt probe. This enlargement may be still further increased by a small incision in the upper lid, at right angles to the horizontal one thus made and about its middle. This will enable the upper lid to be raised with greater ease and to a greater extent, which is of marked advantage in certain cases.

If it be desired to make permanent the advantage thus gained, it can be done by putting in a few stitches bringing into apposition the cut edges of the skin and conjunctiva, when they will unite, leaving the fissure between the eyelids enlarged to the extent of the horizontal incision.

The pain from the operation is not so severe as to require the administration of an anesthetic. Relief from pain which preceded the operation is sometimes almost instantaneous, especially when the lids are swollen and tense. But little, if any, deformity results.

Among the more marked cases in which this advantage is gained, and which interest the physician in general practice quite as much as the oculist, are those severe cases of conjunctivitis of new-born children, when the lids are tense and livid, and so swollen that they can with difficulty be raised sufficiently to remove the pus that is being secreted in large amount. In most of the cases, the cleansing of the eyes from