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Meets the last Monuay evening of each month at the Brown Pal. ace Hotel. Papers and clinical cases are solicited from the profession.

DR. S. S. KEHR, President

DR. E. J. CLARK, Secretary. All visiting physicians are cordially invited to attend these meetings.



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Descriptive pamphlets issued by Santa Fe Route Passenger Department contain complete information relative to these regions. The items of altitude, temperature, humidity hot springs, sanatoriums, cost of living, medical attendance, social advantages, etc., are concisely treated from an impartial standpoint.

Physicians are respectfully asked to place this literature in the hands of invalids who need a change of climate. Adress

J. P. HALL, Gen'l. Agent, Donver, Colo. In corresponding with advertisers please meution THE CRITIQUE.

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correspondence with physicians, the interviews of our representatives with medical men in every State and Territory, there seems to be nothing so valuable as


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No. 2.



Professor of Eye, Ear, Nose, Throat.
In the Homocopathic College of Medicine and Surgery, of the Kansas City

University. Heterophoria is unbalance (one muscle being stronger than it should be or than its opponent) of the extra ocular (the recti and oblique) muscles. It is not a disease, but a symptom, and combined with the condition that produces it, is the cause of many reflex symptoms and annoying conditions, with which the general practitioner is confronted.

The cause of Heterophoria is an Ametropic (not a normal) refraction of the eye. The optical apparatus is too short, too long, or is constructed so that one meridian of the eye is a little longer than the meridian at right angles to it. These conditions are known as Hyperopia (far-sight), Myopia, (near-sight), and Astigmatism, (oval-sight), the one most frequently met with is astigmatism, while Myopia is the least frequent of all, These cause the Heterophoria in the following manner: in trying to make the eye accommodate so that objects may be seen clearly there is a great amount of (nerve) force sent to the muscle of accommodation, which is supplied by the third (motor oculi) nerve, and as four of the muscles (three recti and the inferior oblique) are supplied by the same nerve it is impossible not to force the accommodation to its required duty without over exertion of the convergence, and vice versa, or if the eyes are used until they are very tired or the light is so poor that the accom modation is put upon a strain the external muscles will partici. pate in the strain to an equal extent: or if the general system has been weakened by disease and the patient is allowed to read too early or too long before complete recovery, this symptom, with its subsequent train of aggravating symptoms oft times makes its appearance. Therefore the causes may be summed up briefly as follows: errors of refraction, over-use of the eyes, use of the eyes in a poor light, use of the eyes too soon, or too much soon after an illness; grippe has given the largest number of these cases in recent years.

The symptoms are very numerous, and as different as the patient. Usually the most frequently present is "blurring of vision after reading a short time." Eyes feel weak and watery, letters run together, headache. Sick-headache, even to vomit. ting, nervousness, palpitation of the heart, frontal, and occipital headaches, double vision, hazy vision, redness of the eyes in the corners, ambliopia. These symptoms are sometimes so severe as to cause the patient to go to bed. In cases of periodical headaches or sick headaches where the patient is always relieved after a sound sleep or confinement in a darkened room or from closure of the eyes you are safe in suspecting this difficulty and insisting that the eyes should be examined and the difficulty corrected, insisting that the patient wear glasses if necessary.

The correction of the Heterophoria (which is called Hyperphoria if one visual line tends above the other, Exophoria if it tends to converge and esophoria if it tends to diverge.) lies chiefly in the correction of the errors in refraction (which nearly, if not always exist.) I have met many cases of heterophoria but have seen only one in which there was no error of refraction. The correction of the Heterophoria does not always consist in the correction of the refraction, for that may be corrected as far as the lenses are concerned, but if the lenses are not placed in the proper position before the eyes it is better, in many instances, that they should be left off entirely, for the attempted correction is often making things worse instead of better. To correct the errors of refraction does not mean to put the proper glass before the eyes in an improper position, but to have the lenses correct and have them carried in the proper

position before the eyes so that the eye, when the glass is worn, has no more work to do than a perfectly normal eye should have. In fact the glasses are worn to make the eyes emmetropic (normal) and not for the appearance. If then the proper glass is put before the eyes in the improper position there is a strain and it is for the removal of this strain that the glasses were fitted. This little fact is what I desire to impress upon you, that it is necessary that the frames should fit the nose and face so perfectly that when the center of the pupil is in the position for which the eyes are used most the center of the lens is directly in front of the pupillary center. In this manner, and in no other should the glasses be worn no matter wbether Heterophoria is present or absent. In this position only is each eye perfectly at rest, when looking at a distance or near by. By this method alone I have found that about eighty per cent. of the cases of heterophoria that have come under my care have gotten well, so that the patient would not continue treatment, and not have to return for treatment. Those cases that have become heterophoric after or during an illness, will recover much more rapidly if the heterophoria is corrected in this manner than they will without it. Of course judgment must be used in the use of the eyes at these times, and if the patient is properly instructed what to do, and what not to do, there is more opportunity for a rapid recovery. Not every case will get well by these means alone, but the great majority do, and those that do not yield to this treatment must have the proper exercise and treatment for the muscular difficulty. Prismatic ex. ercise every day, and then every otber day, with the use of the galvanic current positive pole over the weakened muscle, and the negative on the neck for five minutes after each treatment will often overcome the difficulty without the use of remedies. Where remedies are indicated I use them, but often there are no symptoms to prescribe for other than those that existed prior to the fitting of glasses, which had not yielded to remedies, and often these have disappeared and only the unbalanced condition exists. If the cause is removed the muscle will eventually become balanced by the ordinary methods of nature, but sometimes this result is so slow that we use the exercise and galvan. ic current, with the proper glasses and the indicated remedy

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