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tating a nature as to practically exclude them from ophthalmic surgery. So that ophthalmic surgeons have a valid excuse for being somewhat slow to adopt the measures which proved of such signal advantage in general surgery. The investigations which concern us to-night have during the past twenty years been going on along three lines, which overlap each viagra commercials canadian other but are in the main separate : First, along the line of laboratory work. Second, along the line of practical surgical work, not ophthalmic. Third, along the line of practical surgical work upon the eye. The viagra commercials canadian rise and growth of the bacteriological labora- tory is, without any doubt, the most potent and far- reaching influence which modern medicine and sur- g< rv have felt, and though" micro-organisms and their place in nature" viagra side price is a field of which the extent even is unknown, yet so much has been done that the record is one of almost uninterrupted progress. No recent year has passed without definite, positive additions to' our knowledge viagra side price of bacteria and their habits, due directly to laboratoi y work. One little corner of this field belongs to ophthalmol- ogy, and though it was not one of the earliest to be 1 Read before the section on ophthalmology of the New- York Academy of Medicine, October 21, 1S95. cultivated, the work has been varied and extensive. Gonorrhceal conjunctivitis, acute catarrhal conjuncti- vitis, trachoma, phlyctenular conjunctivitis, phlyctenu- lar keratitis, serpentine ulcer, many forms of superfi- cial keratitis (unclassified), destructive ulceration of a cornea, hypopvon pus, foreign bodies in the globe, sympathetic inflammations, have all been the subjects of laboratory experiments with reference to bacteria; and while we may not agree with all the theories which have been evolved, viagra side price the large number of recorded facts cannot but have a permanent influence upon fu- ture opinion. It is, however, the quiet and not the inflamed eye with which we are principally concerned in operative work. This also has been studied with reference to bacteria. The skin of the lid is found to be about like skin elsewhere, i.e., the staphylococcus epidermidis albus of Welch is constantly present, viagra commercials canadian with other cocci and bacilli in greater or less abundance, especially in the folds. The eyebrows and eyelashes are '"catch alls," as hair always is. Dr. Foote has gone a step further to-night, viagra commercials canadian and demonstrated the al- most constant presence of this albus in the normal conjunctival sac a fact in direct line with the ex- periments of Welch upon the skin. There is, then, no dearth of bacteria. The albus we have always with us, and the citreus and aureus are present in a respec- table minority of cases. Bacilli in considerable vari- ety are not infrequent. There is a notable absence of streptococci. Inoculations of pure cultures of these bacteria into the eyes of animals are among the most important viagra side price of the laboratory experiments. The aureus has been more frequently used than any other species, and the production of suppuration is uniform by all observers; so far as I know there is not a dissenting voice, though Leber and others have also proved that suppu- ration can be produced without bacteria. Intensely interesting also are the laboratory experiments upon the eyes of animals illustrating chemotaxis. From the laboratory evidence, then, we have to ac- cept as facts in ophthalmology: 1 st. That the bacteria are present in great numbers and considerable variety. 2d. That the aureus at least can produce suppura- tion of the globe. 3d. That suppuration can be produced viagra side price without bac- teria, notably by the metals mercury and copper. Turning now to the second line of work, and prnci- pally that of general surgery, no one who did not see with his own eyes what for want of a better name may be called the "old surgery," can ever appreciate to its fullest extent the change which has taken place. To call it " revolutionary" is to use a word we have heard so often that it has lost some of its force; to attempt even a meagre description of it viagra side price would take us too far afield. But that bacterial theories have borne the most varied, ample, and practical fruit in general surgery is beyond the shadow viagra side price of a doubt; also that, notwithstanding the many and contradictory changes in methods of dealing with bacteria, the evidence that bacteria cause most of the suppuration in the world has been steadily increasing since the first day that Lister broached the viagra side price theory. Turning now to our own viagra commercials canadian special field of work, let us frankly ask this question : What have bacterial the- ories and what have methods of dealing with bacteria done for ophthalmic surgery? Let us see. Plastic operations about the eye involving the use of large flaps, either with or without a pedicle, are un- doubtedly much more successful now than formerly, and I think no one will deny that this increased suc- cess is due in large measure to the more vigorous ex- clusion of bacteria from the field of operation. Plas- viagra commercials canadian tic operations of less extent, like those for some of the milder forms of ectropion and entropion, usually heal May 30, 1896] MEDICAL RECORD. 767