a primary object, considering the disease of the eyes as but a local manifestation of a general disorder, which is to be relieved by constitutional treatment. Astringent applications to the eyes are not to be neglected, when they can be made, without causing undue irritation; amongst the best of these, are the solutions of nitrate of silver, and of sulph. zinc. in the proportion of from two to four grs. to the ounce of fluid.

Injury of the eyes from the explosion of Gunpowder.-The exposed situation of the eyes renders them peculiarly liable to suffer in this class of accidents; and the cases which are the result, are certainly amongst the most deplorable which can be presented to the surgeon. In addition to the ravages of inflammation, foreign particles become deeply imbedded in the transparent tissues of the organ, prolonging irritation, and increasing the risks of irremediable opacity, or of disorganization.

Several cases of this description were under treatment in the hospital, in two of which no benefit resulted, and they were discharged as incurable.

In two others, a condition of the eyes was apparent, to which I shall briefly advert, in connection with a question of much practical interest. The eyes in these cases were not disorganized, but so far injured as greatly to impair vision. In one patient the left eye presented a large deep opacity covering the lower half of the cornea, and increasing in density towards the centre and in front of the axis of vision; the other portion of the cornea was clear, and through it the iris could be seen adhering to the capsule of the crystalline lens behind, which was opaque; the pupil was larger than natural, and of course irregular; but so general was the opacity of the capsule, that no vision could be enjoyed. The right eye presented a more favourable appearance. A deep opacity extended through the substance of the upper portion of the cornea, to the inner surface of which the iris was attached, giving to the pupil an angular form, and causing a considerable diminution in its size, from the large portion of the iris which was adherent. The effect of this adhesion is, that the fibres of the free portion of the iris are so restrained in their movements as to prevent vision under particular circumstances. Thus in a strong light they are drawn up so near to the adherent portion as almost to obliterate the opening, and the patient is prevented from seeing objects in a bright sunlight, while in a feeble light, and when the pupil is dilated by belladonna, his sight is tolerably good. In another case, an opacity of an oblong shape occupied the lower half of the cornea of the left eye, the capsule of the crystalline lens was opaque, and the iris was adherent to it around its whole margin. A view of objects through this eye was of course entirely obstructed, but a perception of light remained. In the right eye the iris was also adherent to the capsule of the lens behind, but the central portion of the capsule retained its transparency, leaving a small opening through which light was admitted, and a good degree of vision enjoyed.

The treatment in these cases, during my attendance, consisted chiefly in

efforts to diminish the opacity of the cornea, and to promote the absorption of the lymph which formed the bond of union between the iris and the surrounding parts. Various astringent applications were used to meet the first indication, and an ointment composed of the ung. hydrarg. fort. and ext. belladonna, in equal proportions, applied to the lids, was chiefly relied on, to promote absorption and loosen the adhesions. In slight or recent cases these remedies may prove highly useful, but when these structural lesions have existed for several months, as in the present case, we cannot expect much improvement from their use. When all hope of farther amendment from these applications is at an end, the propriety of interference by an operation becomes a question of serious importance, requiring for its correct decision much deliberation and judgment. If, as in the case first cited, a certain amount of vision remains, subject to variations dependent on the degree of light to which the eye is exposed, and preventing an individual from pursuing avocations which will expose him to these changes, ought we to attempt to enlarge the pupil by cutting loose the adhesions of the iris? Is it justifiable to risk the danger of inflammation which may follow the operation, and the effect of which would be to throw out a fresh supply of lymph into the pupil, for the prospect of benefit which the operation, unattended with any such result, might reasonably afford? When we consider the immense value of even a moderate degree of vision, contrasted with total blindness, we may well pause before we put this in jeopardy, in the hope of securing for our patient still greater advantages. Should we not, under these circumstances, rather exhort him to submission to his lot, than hold out the prospect of relief by such a doubtful and hazardous procedure? If, however, the sight is entirely destroyed by an opacity of the lens or its capsule, with adhesions of the iris, no doubt could exist as to the propriety of separating the adhesions, and of breaking up the lens by one or more operations. In one eye, in the case referred to, this operation has been twice performed by my collegaue, Dr. Fox, with every prospect of ultimate success. The iris has been loosened, and a portion of the opaque lens has been absorbed, thus giving a free passage to the rays of light within. The central opacity of the cornea is the only obstacle in this case to the complete restoration of vision.

Wound of the cornea-Hernia of the iris-Cure.-William Pentridge, aged about 4 years, was admitted 1st mo. (Jan.) 20, 1841, for a wound of the eye, received on the day previous. While at play he was struck upon the eye by a fragment of glass, which divided the cornea transversely from its outer margin, to near its centre.

The consequence was an immediate discharge of the aqueous humour, and a prolapsus of the iris through the wound. When admitted the conjunctiva was slightly injected, but the patient experienced no pain, and but slight intolerance of light. He was placed in a moderate light, and treated with cooling lotions to the eye; an occasional purge and light diet. In about ten

days the wound had united; but a small portion of the iris still projected and was adherent to its edges, causing the pupil to be lengthened in its transverse diameter.

The prolapsed portion of iris was touched several times with solid nitrate of silver, and soon disappeared, leaving the vision as perfect as before the accident.

The method of treating these cases generally recommended by authors, is to return the prolapsed iris; to pursue a antiphilogistic course to prevent inflammation, and to act upon the pupil by means of belladonna applied to the lids with a view of preserving the shape of the pupil. In several cases of hernia of the iris from wounds of the cornea, which have fallen under my notice, I have found it impossible to return the projecting portion, and to preserve the form of the pupil. Indeed it is difficult to conceive how this is to be accomplished by the methods recommended. Every attempt made to push back the protruded iris through the wound must necessarily be attended with the discharge of the aqueous humour; this being absent the iris is deprived of the support by which it is retained in situ, it again falls forward, and reappears at the opening, from which we are attempting to thrust it. If the wound be very small, or if the layers of the cornea be cut, so as to form a flap, the operation might possibly succeed; but I presume, in the large proportion of cases, any attempt to preserve the form of the pupil will be found abortive. Long continued efforts to effect this object are indeed injudicious, from the risk of inflammation of the iris, and the effusion of lymph into the anterior chamber, and between the transparent tissues, which they produce.

The indiscriminate application of belladonna or stramonium to the lids, which is generally practised in these cases would also seem to be objectionable. Where the wound of the cornea is extensive, and the protruding portion of iris is large, the relaxation of that portion which remains within the anterior chamber, could have no other effect than to prevent its tonic contraction, and consequently to promote, rather than to prevent farther protrusion. This remark applies to the early period of the case, before inflammation has been established, and the iris has contracted adhesions to the edges of the wound; but even after this necessary process has been instituted, there would seem to be no indication for thus acting upon the iris, unless the inflammation exceeds its natural limits, and threatens the closure of the pupil. As a general rule, if the constitution of the patient be good, simple wounds of the cornea, with hernia of the iris will, I think, pursue the course of incised wounds in other parts of the body; with the exception of the difficulty occasioned by the presence of the iris, between the edges, which causes delay in the cure. The inflammation is restorative, and not destructive, and the only duty of the surgeon is to guard the patient against all those causes which counteract the efforts of nature. Nor is the injury to vision so serious as might be imagined; simple irregularity of the pupil, unconnected with any other structural alteration of the eye, is not necessarily attended with a de

fect in the visual function. The organ has the power of accomodating itself to the altered form of the pupil, and the sight may continue as perfect as before the change.

Hence we should avoid active interference with the efforts of nature in this class of cases, unless the symptoms should actually demand it; and should be careful how we increase the risk of internal inflammation and adhesions by unavailing efforts to preserve the natural form of the pupil.

Effect of belladonna upon an irritable eye. A female of highly nervous temperament, who had been blind from cataract, and had been the subject of several operations for its cure, applied for advice for a diseased condition of the left eye, which followed the removal of cataract, and formed a serious obstacle to vision. The operation, which was performed upon this eye more than a year since by myself, had been followed by a severe and protracted attack of rheumatic ophthalmia, which resulted in a thickening of a portion of the capsule of the lens which had not been absorbed, and an adhesion to it of the pupillary margin of the iris, forming an enlarged and irregular pupil. The lens was probably entirely absorbed, and the thickened capsule was perforated by two orifices, one toward the inner and the other toward the outer canthus, through which the patient could see by directing the eye outward or inward, although she was unable to distinguish objects directly in front of her. In the right eye the iris was movable, the pupil clear with the exception of a minute portion of the lens which appeared in front, and the sight good, the patient being able to read large print without difficulty. Previous to a critical examination of the eyes, I directed (as is usual) the application of ext. of belladonna to the lids at bed-time, intending to inspect them in the morning of the following day. At this time I found the pupil of the right eye (which was the better of the two) largely dilated, but the patient was complaining that her sight was much worse since the applica tion. She was troubled with muscæ volitantes, and other illusive appearances indicative of partial amaurosis; I trusted that these symptoms would disappear, as the effect of the belladonna went off, but they have continued more or less to the present time, a period of several months, much to the annoyance of the patient, who complains bitterly of the change effected in her sight since this application.

The danger of the free application of belladonna or stramonium in cases where there is the least tendency to amaurosis, has been suggested by some authors; while by others, amongst whom is Lawrence, such fears have been considered groundless. The case cited is the only one in which I have remarked any strikingly injurious effects from it, after having seen it used freely and extensively prior to the operation for cataract. That the powerful atonic effect which this article is capable of producing should, however, promote the tendency to amaurosis, where it exists, appears reasonable, and should induce caution in its use where we have doubts as to the soundness of the retina.

Aneurism of the orbit.-An interesting case of this disease occured in the person of Bernard Callahan, a lad of sixteen years of age, who was employed in a factory on the Brandywine, near Wilmington.

Dr. F. G. Smith, of that place, kindly furnished us with the following history of the case. About six years ago, the boy, in diving from the height of eight or ten feet, struck upon a stone at the bottom of the stream, without, however, being sensible of having received any injury until one of his companions remarked that his eye was bleeding. There was no external wound, and the hemorrhage was inconsiderable; the stone upon which he struck was probably large and smooth. On that day, or the day following, he perceived a small elastic swelling about the size of a pea, under the conjunctiva of the lower eyelid, immediately below the external canthus. This continued slowly to increase for about four years, without, however, causing him much uneasiness, until the latter part of that time, when he applied to Dr. Smith; this was in the summer of 1839. A consultation was held upon the case, when it was determined to attempt the removal of the tumour by a ligature. Three ligatures were applied successively to portions of the tumour. After the third operation the boy was taken sick, and farther proceedings were suspended; the effect of these operations was to diminish the size of the tumour, and to afford temporary relief. No hemorrhage ensued after the ligatures came away, nor was any pulsation discovered in the tumour. Since this period the swelling has been gradually increasing, and has recently become painful.

The wood cut conveys a tolerable idea of the appearance of the disease at the time of the patient's admission. The diseased vessels are here represented as distended with blood, the upper eyelid is everted, and the eyeball

is thrown down towards the internal canthus. A morbid vascular structure occupies the external angle of the orbit, from which a set of enlarged and varicose vessels issue, running nearly parallel to each other, and extending laterally. The rounded prominence below is connected with this diseased mass on the ocular conjunctiva, and indicates a bloody sac situated under the skin of the lower lid, and deriving its blood from the deep-seated vessels of the orbit.

When the eye is in a passive state, these varicose vessels are covered by the palpebræ, and the sac below is empty, so that the morbid structure is scarcely visible; but on everting the lids, and making pressure upon the large blood-vessels of the neck, its true character becomes manifest. The circulation through the diseased mass being obstructed, its vessels are distended, and the sac fills. No thrill or pulsation could be discovered after the most careful examination; attempts were made to test the effect of pres