nutritious diet from the commencement, being of a feeble habit.

On the 16th a marked improvement was visible, and from this time a steady amendment took place. The tonic treatment was continued, and on the 25th the eye was sufficiently recovered for him to leave town. On the 17th July I saw him again, and the corneal cicatrix was the only trace of injury. The capsule of the lens was not ruptured, nor was there traumatic cataract. The sight was perfect.

CHAPTER V.

THE opposite condition to atrophy of the globe may result from a punctured wound, especially when there has been detachment of the iris. I have seen many instances of staphylomatous enlargement originating in this accident. In such cases opacity of the lens and capsule will usually be seen if the cornea be clear, and around the seat of injury the sclerotic will be thin, irregular, and discoloured, partaking of the tint of the choroid.

Joseph Lovell, aged 23, was admitted into St. Mary's Hospital, March, 1858, as a patient of Dr. Sibson, from whom he was transferred to me. Eleven years previously, whilst behind a boy who was spinning a top, he was accidentally struck in the right eye with the sharp peg of the top. Acute inflammation followed, and both eyes were closed three weeks, when the symptoms gradually subsided. Twelve months prior to his admission the eye again became irritable and gradually increased in size, there being much pain, especially in the evening. The other eye was so weak and the sight so affected that he was unable to read large type.

The eye presented the characteristics of marked staphyloma. The upper half of the sclerotica was thinned and irregular from dark bulging projections. The cornea was enlarged, and near its centre was a cicatrix to which the iris and capsule of the lens were adherent. The whole globe was

enlarged and projected, giving an unsightly aspect to an otherwise good-looking face.

I removed the eyeball on the 31st March, and the patient made so rapid a recovery that the orbit appeared healed on the third day. An artificial eye was inserted on the seventh day.

I am indebted to Dr. Bader for the following accurate description of the extirpated eye, which had been unfortunately burst in placing it in a bottle for examination: "On separating it in lateral halves I found the retina detached, probably on account of the vitreous humour having escaped (detaching it in doing so). The portion from the ora serrata to the entrance of the optic nerve appears natural, the sclerotica of proportionate thickness, the choroid and hexagonal layers normal; the elements of the retina, rods, bulbs, and capillaries perceptible; not so the nerve-cells or optic nerve-fibres. The hyaloid is thickly sprinkled with pigment, and what remained of vitreous humour contained many transparent shreds and a great quantity of transparent globules (oil?)

"From the ora serrata forwards the globe is staphylomatous; the ciliary processes and iris flattened out on the staphyloma; portions of the iris adhere to a corneal cicatrix; the suspensory ligament was torn through, especially at the lower periphery of the lens, and the staphyloma appears to have been under pressure of the vitreous humour. A ring of hard transparent lens-substance and some phosphate of lime, enclosed by transparent capsule, was in contact with the corneal portion of the staphyloma, and fixed by firm adhesions. of the anterior and posterior capsule to a transverse corneal cicatrix."

The retina is said not to suffer from small punctures, as those made with a cataract-needle. Majendic pushed the

opaque lens against the optic nerve in the operation of depression, and repeatedly touched and even punctured it with the cataract-needle, without producing either pain or even sensation to the patient; nor is it said these injuries were followed by inflammation or any amaurotic symp

toms,

Nevertheless, amaurosis does follow the small puncture made with the cataract-needle; I have seen cases where the operation of solution was performed by puncture through the sclerotic, made rather far back to avoid the ciliary processes, in which no inflammation followed, absorption progressed, and the pupil became clear; but about six months after the first operation, and one month after the disappearance of the cataract, muscæ volitantes and scintillations appeared, the sight began to deteriorate, and despite of every treatment, permanent amaurosis from chronic retinal inflammation resulted.

A similar effect follows depression of the lens when it is made to rest on the retina, and that is one reason why extraction is so generally preferred by London operators. A case of immediate extinction of sight by depression of the lens, has been recorded by Bonavita, a pupil of Vacca.1

A lens in an eye presenting a favorable cataract, and having, as usual, perception of shadows of objects, at the moment that the cataract was pressed down to the bottom of the eye the pupil widely dilated, there was at once extinction of sight, and the eye remained amaurotic.

It is important therefore not to think lightly of retinal wounds, however trifling, and if operating for cataract by reclination or depression, to take the utmost care to prevent the lens pressing on the retina.

When the system is in a bad state, a trifling wound of the eye will bring on violent general inflammation and suppuration of the globe; I have principally observed this in persons who had led irregular lives and whose powers were low; soon after the injury violent pain attacks the eye, shooting back to the brain; the lids rapidly swell and assume a crimson hue; the eyeball itself enlarges, tightly girded by the lids; and in a short time all natural appearance of the organ is lost, the cornea becoming first yellowish, then brown, the conjunctiva enormously chemosed and more or less dry. This constitutes an important point of distinction between ophthalmitis from injury, and gonorrheal ophthalmia, with which I have known it confounded. To a superficial observer there is a general resemblance in the swelled and crimson lids, the chemosed conjunctiva projecting like a fleshy mass between them and burying the cornea; but in the specific inflammation the conjunctiva secretes pus which agglutinates the lids, or passes over the cheek; whilst in the traumatic ophthalmitis, there is little or no pus till the eye gives way, and then the pus flows from a small aperture, which gradually enlarges as the slough separates.

The relief from pain is marked when the eye has given

way.

John Pierce, an Irishman, aged 37, whilst engaged in shaking carpets on March 20th, 1857, was struck on the left eye by a nail which flew up from the carpet with considerable force; the eye became painful and swelled, and on the 22d he was admitted into the accident ward of St. Mary's Hospital under Mr. Coulson; eight leeches were immediately applied; five grains of calomel administered, and saline mixture ordered thrice daily.

23d.-Eye worse; lids enormously swollen, and eyeball projecting between them in a state of intense inflammation.