CASE OF EPITHELIOMA REMOVED FROM PREPUCE OF CLITORIS.* BY THOS. C. SMITH, M. D., Washington, D. C. Dr. Smith presented a tumor which he had removed on January 7, from a woman sixty years of age. At first glance the growth appeared to be a hypertrophied clitoris. The clitoris was completely hidden by the mass, which was so sensitive that the patient was thrown into convulsions by the gentlest manipulation. The growth first made its appearance last March, and gradually increased in size, until at his examination it was about two inches in length. It involved the nymphae. As it appeared to be very vascular, and he apprehended hemorrhage, he transfixed the mass and cut it away, exposing the clitoris intact. The point of origin was found to be the prepuce of the clitoris, but the tumor extended as high as the symphysis. [Dr. J. B. Nichols examined this tumor microscopically, and found it to be an epithelioma.] *Reported, with specimen, to the Medical Society, January 10, 1906. CASE OF ALCOHOLIC HYPERTROPHIC OF LIVER AND KIDNEYS.* By D. S. LAMB, A. M., M. D., CIRRHOSIS The liver weighed 6 pounds 14 ounces; about twice the normal weight; was very markedly hobnailed; microscopically [Mr. Neate] showed increase of connective tissue, but no atrophy of liver cells was found. The kidneys were large, weighing over eight ounces each and microscopically showed marked cirrhosis, and thickening of Bowman's capsules. The spleen showed passive congestion. From a man age 40, laborer, who was admitted to hospital after a "spree." He talked incoherently, and had to be tied to the bed; became delirious, was unable to take food; defecation and urination became involuntary, and he died on the fifth day after admission, apparently from exhaustion. His temperature *Reported, with specimen, to the Medical Society, January 10, 1906. on admission was 97.8, rose to 101 the next day, and 102.2 the following day, fell to 101 the next day, and to 100.5 the next. Pulse was 84 to 88 till the day before death, when it rose to 100. Respirations 20 when admitted, rose to 36, and to 72 the day before death. The post mortem examination showed the brain normal in its naked-eye appearance; the heart slightly enlarged and stuffed with white clots. Some tuberculosis in each lung, the lower lobe of the right and upper lobe of the left. The liver, spleen and kidneys as described; and the other organs appeared to be normal. The stomach was opened, and to the naked eye showed no lesion. CASE OF FIBRO-MYOMA OF ROUND LIGAMENT; OPERATION.* By D. G. LEWIS, M. D., Washington, D. C. Mrs. H., a white woman, married, 44 years of age, residence Kensington, Md. She had one child, seven months old, the result of her only pregnancy. She was referred to Dr. Lewis by Dr. Wm. Lewis, of Kensington. She had been taken ill with a profuse metrorrhagia while walking on the street. Dr. Wm. Lewis sent her to the Garfield Hospital and the hemorrhage was checked by the use of tampons. Examination revealed an ulcerating neoplasm of the cervix, with a mass in the region of the right appendages. As the bleeding had been so exhausting, the patient was allowed to rest in hospital a week to recuperate. At the end of that time, the cervix was amputated and a specimen of the cervical tissue was taken for microscopic examination. Laparotomy was also performed and a firm mass, the size of a cocoanut, was found, whose point of origin was the right round. ligament. This mass was removed, together with the tubes, which showed chronic salpingitis. The mass was found to be a fibro-myoma. On receiving the pathologist's report that the cervix was undergoing epitheliomatous degeneration, he performed vaginal hysterectomy. The patient made an uneventful recovery from the operation. Dr. Lewis reported the case because of the infrequency with which neoplasms take origin from the round ligaments. *Reported, with specimen, to the Medical Society, December 6, 1905. REMARKS PERTAINING TO AND A BRIEF DESSCRIPTION OF A MODEL FOR A NEW OPHTHALMOTROPE. * BY D. KERFOOT SHUTE, A. B., M. D., Washington D. C. There are two types of Ophthalmotrope, one of them being exemplified by Knapp's instrument and the other by Landolt's. The former is constructed upon the principle that the eye moves about its center of rotation as if it were a universal joint or balland-socket (enarthrodial) joint, while the latter is based upon the principle of a hinge (ginglymus) joint. The former type is misleading from almost every point of view. Helmholtz taught that as far as the musculature of the eyeball is concerned, and from a mechanical point of view, the eye is capable of revolving about any conceivable one of an infinite number of diameters passing in any direction through the center of rotation. And yet he taught, as did Listing, that every possible Physiological movement of the eye occurs around an axis restricted to one plane (Listing's plane). This plane is a coronal one, a vertical transverse plane fixed in the head and passing through the center of rotation of each eye. Rotations about the vertical and transverse axes in Listing's plane can be compounded into rotations about any intermediate axis. Since the eye, mechanically, is capable of rotating about any one of an infinite number of diameters passing through the center of rotation, and yet is restricted physiologically to axes in only one plane, what is the restraining agency? It is a matter of encephalic co-ordination, a matter of innervation. This encephalic co-ordination creates axes for an eye, which are just as imperious in their sway over the movements of the eye as if they were fixed and rigid steel rods. It is true that under the dominating influence of the brain one physiological axis can instantly be replaced by another, so that movements can be secured in an infinite variety of directions. But the principle is the same as if one steel rod were withdrawn and another inserted in a different direction. Physiologically the eye revolves upon a given axis just as a rubber ball may be made to rotate upon a steel hat-pin thrust through it. It is upon this principle that Landolt's Ophthalmotrope is con*Read before the Medical Society, January 17, 1906. structed; it is upon this principle also that my own is based. My own device differs from that of Landolt in its simplicity, in the ease with which it can be constructed by any one out of very simple materials, such as an india-rubber ball, a hat-pin and a tobacco box; it also differs from his in the fact that the rubber ball can be so easily painted or marked with ink and made to serve as a model of an eyeball, instead of looking like a mere framework, as does Landolt's; it also has the great merit of concentrating the attention of the student upon a single axis at a time instead of distracting his attention by the presence of a number of very different axes; it can be made to show the rotation of the eye about axes in Listing's plane, thus giving lessons on physiology; or it can represent movements of the eyeball about axes perpendicular to individual muscle-planes and thus out of Listings' plane, so that the pathology of ocular motility can be investigated with the greatest accuracy. It readily permits also a study of ocular rotations under the influence of the internal and external recti when attached to the eyeball, either too high or too low. Lastly it differs from Landolt's instrument in that it was primarily constructed for the purpose of demonstrating the necessity of diversity instead of community of axes for the obliques on the one hand, and the superior and inferior recti on the other hand. In short the instrument differs from all others with which I am familiar in its extreme simplicity, flexiblity and adaptability for demonstrating all the known ocular rotations upon sound physiological principles. Maddox, in his extremely interesting and instructive work on "The Ocular Muscles', discusses the deductions to be drawn from a study of the india-rubber ball of Landolt and from a study of his own modification of this rubber ball in reference to "tilted axes". The question of tilted axes was originally suggested by Meissner, and although it has an exceedingly important bearing on the symptomatology of ocular palsies, no current works on physiology or ophthalmology, except that of Maddox, even mention the hypothesis. They all either fail to treat of the subject of axes of rotation altogether or adopt the commonaxis theory. Through study of Landolt's india-rubber ball, Maddox very justly observed that paralysis of say the right Superior Rectus (the left eye remaining in the straightforward primary position) produces the same effect as slight spasm of the right Inferior Rectus, if the hypothesis be true that the Superior and Inferior Recti have a common axis. Maddox goes on further to say that either previous clinical observations in the primary area of the motor field are incorrect or the single-axis view is no longer tenable. He makes the further strange statement that he will not attempt to say which is the case. During fifteen years' experience in the dissecting room I have often had the occasion to demonstrate to the students that the muscle lines of the Superior and Inferior Recti, and those of the obliques, pass to their insertions considerably on the nasal side of a pin passed approximately in a vertical direction through the geometrical center of the eyeball when apparently in the straightforward primary position. Since three points not in the same straight line determine the location of a plane, and since the center of origin (actual or virtual) of each muscle concerned is very considerably on the mesial or nasal side of the center of rotation, and since, further, each muscle line passes as a tangent to its point of contact with the eyeball on the nasal side of the center of rotation, the muscle planes are of necessity tilted from the vertical in the straightforward primary position of the eyeball; and a tilted muscle-plane demands an axis of rotation at right angles to the plane through the center of rotation. The muscle-planes of the superior and inferior obliques form a decided diedral angle at the center of rotation, and as each plane is oblique, their muscle-axes of rotation must be different. The same is true of the superior and inferior recti. It thus appears to me that even on anatomical grounds alone we must accept the view of a different axis for each of these muscles. Further, the facts of clinical experience demand the hypothesis of tilted axes (diversity of axes). Lastly the simple ophthalmotrope I have devised, like Maddox's modification of Landolt's india-rubber ball, beautifully demonstrates the conformity of the tilted axis hypothesis with clinical observations in ocular palsies. My model consists of a somewhat narrow rectangular box open at the top and at either extremity (20 centimeters long, 10 centimeters wide, and 5 centimeters high). The sides of the box support movable clamp-arms carrying perpendicular adjustable supporting rods which are for the purpose of receiving |